my first successful intubation....a lesson well learnt.

"Dont be afraid Doctor Archana ... endotracheal intubation is not difficult. its not the muscle strength but the technique that matters. once you master the technique...you'll be an intubation expert!!"  thats what came from my senior doctor after i had struggled through my 15th unsuccessful intubation. he had to intubate the patient instead of me coz i was 'taking too much time' as described by the frustrated nursing staff .

          intubating a gasping patient just followed by effective CPR is an art i have always wanted to master from the first day i started medical school. How many ever other procedures you may have performed on a patient, i always new that  performing this procedure will leave you completly satisfied that you have actually saved a patients life that day. you have brought him back from the doorway of death. thats what completes a doctor... and thats what would complete my purpose...

          but somehow i never seemed to get a hang of this timely act. an arresting patient when brought inside the icu, almost always can be saved if intubated at the right moment.....and then there are the 'DNR' patients of course..
          the word DNR means 'do not resuscitate', which in certain institutions, is a desicion made either by the patient themself ,if in sane mind , or by the patients relatives. but in certain instituions where there is almost always a shortage of beds due to the heavy influx of patients everyday ,this term is an unspoken code used for those patients who, if put on ' the machine' to be kept pumping would only cause a lot of physical, mental and emotional stress to the relatives and the doctors themselves. such patients can be kept alive only mechanically. the machines breathes in and out for them and and thus the heart is forced to pump blood. this only goes on until the heart tires out. this is what is called brain death, as the patients brain must have stopped working a long time ago.
       and as the saying goes;  ' a doctor should be able to tell the patients relatives that they did everything they could to save him or her' and so thats what they do ; ..everything. but sometimes trying to save someone who can definitely not be saved is a waste of hands when some one in some other part of the hospital who can be saved needs to be resucitated right away.
      it is these DNR patients that we young doctors are allowed to intubate at first, as this art needs to be mastered when required at the right moment.
      i am one of those young doctors , who has tried intubating many gasping patients desperate to get it right each time but has never been able to take it till the end as i lacked the stamina as i thought it to be. my senior doctor would always have to finish it for me.
 ' Not again!!!'  i thought, as i was walking away from my 15th attempt.
" You have one more intubation you can try ' said my senior with a ray of hope. "Its the patient on bed number 2. She has been pulling on for a long time but she looks a bit bad today. Unfortunately there is no point in bringing her back as she will not be able to survive the night anyway." she said apologetically. "so there is no urgency. but it is important that you learn soon as you have many more lives to save."
           i moved towards bed number 2. a woman in her late 60s, her hands and legs tied up to the sides of the bed so that she doesnt disturb the infinite array of tubes attached to her body.
not a pleasant site to see. i flinched as i looked onto her face. she probably would have been a pretty face during her healthy days but now all i could see were the remains of a worn out face battered by disease and misfortune. i gazed into her charts ; chronic kidney disease stage 5 , ischemic heart disease, hypertension, diabetes.
      her heart rate  was decreasing by the minute.i was instructed to try intubating after her loved ones had a chance to say good bye. i quietly walked outside the ICU rehearsing in my mind what i would say to her relatives. ' i believe you have already been explained about the seriousness of her illness. i am sorry to say her condition is getting worse .........' i have done this a number of times , passing of bad news to loved ones. i have seen different reactions; sudden outbursts of grief, some fall at your feet begging you to save their life somehow, some silently listen and take in the information you have just given them.
            this time , her son listened to what i had to say, his eyes gettingg wet and quietly walked of. he came back with his family. a young lady similar to the son probably her daughter, an old man himself in his 60s and an old lady around the same age as well. i noticed that each one silently walked to her, one at a time. after whispering a soft prayer into her ears they stroked her hair slowly,and then her feet. as each walked out i saw the glistening of tears down their cheeks.
           it was my turn. i had requested the nurse to place the intubation tray next to the bed so i could start my little lesson. i saw her heart rate drop down to a minimum. i saw her taking slow, shallow but peaceful breaths. i put on my gloves and touched her forehead. she moved a little. but this time i saw her face for the beauty she really was. i saw the hearts she had touched. the love she would be leaving behind. 'please be at ease' i whispered into her ear. i didnt want to cause her anymore discomfort than she already was in.
         i slid the scope into her mouth and into her throat when she slowly flinched. her eyebrows drew closer to show her discomfort. as i held the scope a little higher i visualized the epiglottis and vocal cords.i pushed the tube in with comfort and checked the entry of air after connecting it to the ambu bag. i was in. i had done it at last... i had intubated a patient. i kept pushing the ambu bag to keep her chest moving in and out as i saw the reading on the ecg monitor reduce into a straight line.
         as i walked out of the ICU that day i felt myself fighting back tears. as she left this world ,she made me feel like a complete doctor. she helped me learn so that i could help save many more lives. as i walked past soft weeping sounds at a distance, i heard the shreaks of a relieved mother falling at her doctors feet because his timely action saved her sons life...