Pink -> Blue -> White & Cold

I felt so nauseated yesterday.

It was my second day in the respiratory ward. I was not late this time. In fact, I thought the day started just fine....I began my rounds at 9 am sharp.

One patient after another, I finally arrived at a lady patient who has been having recurrent infective exacerbations of COPD. When I saw her yesterday, she was short of breath even at rest, but maintaining her sats above 90% with oxygen. She appeared anxious as well. I have been giving her some oramoph yesterday in order to reduce her anxiety and make her comfortable. Looking through her notes, I noted that her condition deteriorated yesterday. She dropped her saturations. However, she managed to improve overnight.

When I met her yesterday morning, she remained breathless but in fact, I felt she looked abit brighter and less anxious. I asked her how she was doing. She replied, "Oh much better doctor. I was abit unwell last night. But I feel so much better now." I noticed that she did not have her vital signs checked since 6 am this morning, so I asked if the nurse could repeat it. Unfortunately, her saturations were only 81%!!

I sent off her arterial blood gas and gave her some more nebulisers and oramorph. Her saturations improved. I went on to review other patients, while waiting for the results of her ABGs to come back. However, a nurse came up to me and said, "Ling, come now."

I ran over to see the same lady...and there she was, staring straight into the curtains in front of her. I caller her name many times, but she did not respond. Her breathing was laboured. I was like, "Oh no!"

I got the arrest trolley and was about to send out an arrest call...when the nurse told me that she was not for resuscitation. I knew that she was not for ITU or invasive ventilation, but I did not know she was not for CPR. I was glad, in a way, that the nurse pointed this out to me, otherwise, I would be conducting a CPR on her unnecessarily.

In a split second, I noticed her colour changed... from pink, to blue...and then, she was as white as a sheet. A second later, her tongue protruded out of her mouth. I knew her spirit had left her. I gave her high flow oxygen in a final attempt to keep her comfortable. She had an extremely slow pulse of only 1 beat every 5 seconds....and not too long after, her heart just stopped beating. Her hands suddenly felt cold to me....

I felt really sick after the whole event. I felt a lump building inside my throat and oesophagus. It was not because I was going to burst into tears...hmm, I don't know how to describe my feelings then. It was just horrible, to witness a cardiac arrest. I have seen many arrests...but this is different.... I literally watched her die. The only comfort I got was the fact that I gave her more oramorph to keep her comfy. So hopefully, she did not die painfully. I lost my appetite completely after that event.

I could not ask for a better afternoon. The rest of my day was not as bad as the day before. I went home, still thinking about this lady....may you rest in peace, my dear.