last straw....

I had been a non-30minutes ACLS provider in the past. The practice of at least 30 minutes of CPR before certifying had been an

a non-written understanding among providers well before my days of internship. Well, as my grew in seniority and becoming an Attending, I had always stick to the rules and had not met any problem, but I had kicked over a iron plate 1+ weeks….

A busy Sunday night and I was attending a small wave of OPD grade patients when a bunch of family rushed in a young male. Prior to the arrival, the local rescue ambulance had responded to the scene and failed to secure the patient as the family had ferried the patient over with their own transport during the wait. The patient was a case of alleged self poisoning with chemical use to poison fish. I initially thought the victim had ingested some poison vine. I was wrong when the family came in with the patient. They had brought in a packet of light brownish color powder and one of the them told me it is potassium cyanide.

My initial thought was darn -> I had no cyanide antidote kit and there is no automated photo taking booth in our hospital. (I still recalled the episode of Macguyver saving the life of Pete with fluid(Na thiosulfate) from automated photo taking machine… Macguyver’s swiss army knife had inspired me and I have 4 swiss army knife(3 victorinox

and 1 wegner)). I had proceeded with resuscitation and the patient had ROSC (return of spontaneous circulation) noted after 10 minutes. A referral was planned to my ex-employer but unfortunately our ambulance had been out for ambulance call. I had asked one of the family about the cause of suicide and the family had told me that it was family issue. The wife came later and I overheard her conversation over the phone

The ROSC did not last long and the patient had gone into arrest again. After 50 mins of effort, I gathered the family and told them that nothing much could be done and I would give a trial of 10 more minutes. With the help of CPR machine, prolonged CPR had not been a stress for us and for case that is still hope I would push to the limit, but yet 1+ hrs is my limit. The wife had knelt in front of me begging and I told her that I would do my best…

At 1+ hrs. I decided to quit and walk out to tell the family that I had certified. Well, the family members had gone into a hysterical state and I continued to see the pool of patients which piled up over the past 1 hours.

While I saw the other patients, the family had kept bugging me for the next 10+ minutes; one had come out telling me that he felt pulse, the other had come to me saying that the patient is still breathing(Ventilator effort of coz..)…

Finally I talked to the folks and told them that I felt that it would be harming the patient’s “big body”(means cadaver in Chinese) if I continue to do chest compression. A bunch of family had begged again and the final straw which crushed my heart was the daughter of the victim, who knelt down before me and asked me to save her father…

Well, I called my team back to the resus room and start the CPR again for another 10+ minutes…

It was truly a heart breaking moment for me….the daughter was at Yun age…and I just can’t bare to turn down her begging….I had crossed the red line after all these years…

Well, case of the months for me….