An Unusual Doctor's Emergency Shift - She came back from the dead

Prior, everything went on as usual.

Returning home after the afternoon shift, I had a quick Linner (Lunch+dinner) then went to ‘collapse’, as my wife would call it.

It would be 9.30pm when I peeled my eyelids open, a few hours of tossy-turny restless sleep, the only kind my biological clock would allow.

Its internal rhythms gone haywire from the odd and erratic working hours of a casualty house officer .

Punching in at 9.55pm, I soon took charge of Yellow Zone/Asthma bay, and received passovers from the previous shift.

Around 1030pm, the Triage Officer came through the Yellow Zone doors holding the phone, a puzzled expression on her face

I was helping out the red zone at the time,

and overheard the case.

“Dr Fateha, There's a call from Fook-Lu-Siew requesting confirmation of death"

I glanced at my Medical Officer, she, at me;

both amused by the request, one none of us had heard before.

Fook Lu Siew is a Funeral parlour, dealing with the recently departed of Taoist and Christian Faith.

It is a most unusual request.

Only those certified dead are brought there for embalming and last rites.

“Yong, you want to take this call?

I nodded in affirmation,

my adventurous spirit kicking back in.

This came right after a Helicopter Medical Evac from Kota Marudu a week before;

This time, I think I’m ready to bust some zombie-myth.

As the Ambulance rounded the bend at the Major Flyover

I pondered the possible scenarios

what made them feel the patient came back ?

- I asked my Medical Attendants

“what time patient passed?”

“I asked the parlour, reportedly-6.30pm”

“It's 11pm now. death more than 4 hours ?”

~Were the family so distraught they couldn’t let the deceased go they started having visions?

“where was the patient's Last Office? ”

“The Palliative Ward”

Now. Palliative ward.

Palliation = Comfort/ End of Life Care.

This means the patient’s family should have been prepared mentally for the eventual departure.

There must be signs of life convincing enough to shake them to call the hospital.

I had to consider the possibility of misdiagnosis of death then.

“Do you know who is the doctor who certified death at the palliative ward? ?”

“Doctor XXXX”

“But that guy just completed a neurosurgery posting, he probably certified multiple brain deaths, I don't he can be wrong!”

“……………….”

The ambulance doors opened.

I wasn’t all that ready greet 20 pairs of eyes looking at me.

Some held grief, some held frustration,

the ones that I avert eyes from were the ones that held, hope.

I was afraid I might dash them.

The leader of the pack approached. His eyes held hope. But I had to make it clear.

"Sir, I understand you think that the patient has returned. Even if that is true, her condition is less than stellar, coming from a palliative ward.

If there is a chance, will you expect me to perform CPR?

Looking left and right at his family, he nodded.

“Yes Doctor Sir, we want her back”

This meant they had expectations of her springing back to life.

This is going to be a difficult counseling session.

As thoughts raced through my head,

I was brought into a middle sized room, housing a wardrobe, a bathing tabletop for cleansing the body, and a wide rear area housing other ceremonial items.

I placed myself at the Right corner of the table.

There she was, a young lady maybe mid twenties… maybe that’s why they couldn’t let her go..

Her peripheries were blue, her eyelids tightly shut, no apparent rhythmic rise and fall of the chest.

Most likely a goner, I thought, as relatives streamed into the room, closing the door behind them

My Assistant prepared the AED (automatic External Defibrillator) machine for heart rhythm analysis, while I whipped out the pen torch and the stets.

No Pupil reflex.

Negative Doll’s Eye reflex.

No …Breath sounds.

I could sense that their gaze are all upon me, my breath grew quicker....

No heart sounds.

The AED machine was very silent. No beeps. It showed a very flat X-axis line.

"She shows no signs of life, her pupils, heart and lungs have stopped functioning"

Someone Piped up:

“Doctor. I did not see what you did just now.

Can you repeat it again?"

That came from a middle age male in a collared Tee. The one I thought was the head of the family.

Fatigue evident in his eyes. He was almost pleading.

Against my better judgement

I, Agreed.

This time I explained each and every step as I went through the motions, in Malay.

‘If the Brain and Cranial nerves were intact- the pupils would dilate’

those that stood by the sidelines crept and inched nearer to the table, to see her eyes better.

‘This Corneal reflex is what protects our eyes, when a foreign object threatens our vision. It is absent in her.’

‘If the brainstem was still intact, her eyes would stay fixed on me when I turn her head, evidently this is not happening’

‘She has no carotid pulse, the brain would be severely hypoxic without blood supply’

‘I can hear no breath sounds’

‘There is no heart beat. As you can see, her fingers and toes are all deep blue, that means they have been without oxygen for too long’

A voice came from behind the crowd.

“It wasn't like that just now”

then there was a murmur of voices.

The Man, said: “she had a pulse when we held her.”

His words carefully measured. No more. No less.

The Strain in his voice can be appreciated.

"I doubt so. I'm not trying to say that you are wrong, but there is a possibility that you are feeling your own pulse when try to feel for someone's pulse with your own thumb, it is more accurate to use your index finger"

Secretly, I wanted to tell them they will feel and see whatever their minds wanted them to see.

They would be imagining a pulse in her, when it is their own.

I glanced around the room.

Some were fidgeting, some looked at the Man.

Others looked at me.

The Man looked at the ground.

There was a eerie silence that I hope I could pierce.

It lasted far too long.

"Why not we do this.

Bring round her immediate family members.

The rest can leave the room.

I will go in detail each step of my examination, again. Thereafter, you can explain to any family members who have doubts"

At a loss for words,

I could sense the Man was glad he could detach himself from the gaze of his family as he ushered them out of the room, save five.

Apparently, he is reluctant to make the call to end the examination.

To do so, would mean he is giving up hope, on their behalf.

"Before I start, do you have any questions?"

"Doctor, Is it common for the dead to return to life? I've seen news of such"

I almost shook my head in disbelief.

“It only happens in news published by Metro.”

-I took the opportunity to have a pot-shot at one of the papers I hate the most for the low quality journalism it carries, with a tendency to sensationalize whatever little bit of inconsequential news it can get-

"To be honest, this has never occured in my line of work. The certified deceased, do not return. only in the movies"

”Doctor, why can I feel her pulse?"

“As I explained earlier, the likelihood is that you felt your own pulse”

A Male relative chipped in

"when she died, why didn't you doctors do chest compressions?"

"Sir, I am not privy what exactly transpired in the ward, but the decision whether to resuscitate must have been discussed with the family"

- I looked at the Man. He Nodded

The Man’s turn to speak.

“But you could have gave her a cardiac shock"

I couldn’t help but sigh as I replied, silently cursing all the drama series who showed every heart patient needs to be shocked using a defibrillator-

"It doesn't work that way, not all patients require Defibrillation. It's only for certain heart rhythms"

I Knew I had no one to back me up on everything I have said.

There I was, a young man of 27 trying to convince a family where all its members are considered my elders in age.

To make matters worse, I couldn’t speak their native language, Dusun.

I knew any waver in confidence or demeanour would mean an immediate failure of the counselling session,

followed by an immediate embarrassment at having my superior called here to tell them the exact same thing that I said.

The Man Spoke again

“ Could it be that she is in a coma?

"Sir, Coma can mean different things,

What I think you mean is that although her brain is no longer functioning, her other organs can still be?

But Sir as I demonstrated, all major organs are not fuctional.

Moreover, in a comatose patient, her other organs will needs artifical support, she will not make it unaided"

This time, a pregnany lady quipped

“ But her body is still warm"

I really don’t know how long this is going to drag on. It is very very apparent they just couldn’t let go. And yet I can’t show my frustration.

"Where did you feel it madam?

On her back?

In this air conditioned funeral parlour, where she received an embalming bath, the only warmth she can retain is over her back"

After that, I went through all the steps to certify patient’s departure, for the third time.

Then I told them, maybe you can call the other family members and we can open the floor for questions.

They came in once again.

This time an elderly lady came to the fore.

I think she just arrived from the interior regions of Sabah.

She Spoke first

“The veins on her face are soft. She is still alive."

I was at a loss.

At this rate, nothing I say is gonna change anything. What am I to do?

To me relief, a family member gently held her hand and brought her to the side, whispering to her along the way.

"Maybe I look young and Indeed I am in the profession for a mere 2 years. Doubt me, but you can trust my medical assistant Ronney.

He is very experienced, and can help translate all I've said in your language"

At my cue, my assistant went over to the distraught mother and started explaining to her in Dusun what transpired.

The other relatives listened intently.

I could sense the tension in the room lift a little.

I walked over to the Man, which I came to learn was the patient’s husband.

He squatted next to the wardrobe beside the embalming table, holding a cream coloured wedding dress while absent-mindedly smoothing out the edges. I placed my hand over his shoulder.

"Sir, I feel your pain. It is not easy to let your wife go.

If you insist that I perform CPR now, I can but I can assure you it will bring her no benefit. I might even crack her ribs."

He stood up

He nodded but did not reply.

It is almost 12 midnight.

An Hour has passed.

Just a moment ago,

I felt as if I was in the defendant’s box defending the diagnosis of death while the judge jury and executioner were all in disbelief.

"Dear all, we have to return to the hospital.

It is my hope you can accept her departure with a willing heart.

You can ask me if there are lingering questions"

Silence.

“we will take our leave”

As I left the room,

I held on to my MA for emotional support.

I felt extreme relief, and I knew I couldn’t have done it without my supporting staff.

When I was a medical student,

there was a component of our studies called Personal and Professional development, focusing on self improvement, communication skills and group dynamics.

I can really feel its impact sinking in.

Without that training, I wouldn’t have been able to keep my cool throughout the gruelling session.

Thank you UKM. (my alma mater)

I turned to my MA, Ronney

“Bro, how long you've been on this job?”

“9...almost 10 years”

“came across anything like this?”

“Never boss. I'm so grateful you came along.

I could have been sent here alone by the ED,

and I would have been at a loss ,dealing with the family”

“I am also equally grateful Ronney, for your presence. They probably found me a tad too young to be convined"

“But boss, I too felt her body was lukewarm.

it felt, unusual”

“……..”

The Story of Lazarus, 2013

Queen Elizabeth Hospital, Borneo

Dr Yong Kuan Yew

Currently, It's the 7th lunar month, the hungry ghost festival, in Asia