Death and Dying

 

October 10, 2013 · 20:30 McCormick Hospital Chiang Mai, Thailand

A relatively slow evening in the emergency room, eight hours of my shift done and five more to go, I was hoping for some incomparable and exhilarating traumas. It was day six of my medical placement in the ED, but nothing up to that point could have prepared me for what was about to happen.

The ED at McCormick Hospital was a small, narrow room that barely had space for six beds. The double sliding doors to the ED were wide open to let a cool draft in, as it was a humid evening. At 20:30, all of those beds were empty as the staff and I entertained ourselves with old x-ray films. That moment of tranquility changed in an instant as a deep walling cry bellowed out from the parking lot. Everyone in the room stopped what they were doing and locked eyes on the doors in anticipation for the trauma that was about to come in.

The next hour of my life was the scariest yet most satisfying experience I have ever had.

The moaning grew louder as a young woman, age 19, limped into the room. She was covered in blood and black char. Looking confused and horrified, she dropped to her knees, gasped for air, and threw her head back, attempting to scream but nothing came out. The ED nurses raced to her side and quickly escorted her to one of the beds. Just a moment later a young man, age 21, tranquilly shuffled in with nothing on but a pair of charred shorts. His entire body was seared black, as if he had just fallen through a chimney. A smell wafted through the air that was sickly sweet and deeply unpleasant. It hit the back of my throat, eliciting a visceral response in me to move faster, smarter and reach deep for a sense of compassion I had not yet discovered within myself.

This man emoted no sounds and no words but his eyes were filled with terror and anguish. I locked eyes with him and in that moment we shared a similar fear that bonded us forever. I committed my whole self to him right then. No matter how daunting or grim things got, I would be by his side for any physical or emotional support he may need.

Two nurses and I placed him on a bed and drew the curtains around us to better assess his condition. At a closer glance, I noticed his eyelashes, eyebrows and hair were all singed off. The smell of burning flesh was now concentrated, thick and pungent, stinging my eyes and coating
my mouth. I collected his vitals – BP: 182/114, PR:82, RR: 8, SPO2: 81. The head nurse handed me towels and bottles of sterile water and told me to put the towels on every inch of his body and pour the water without reservation. A chaotic dialogue took place between the nurse and the patient as the story of what had happened began to unfold:

This young man and his wife were cooking dinner together in their shack 30 minutes out of town. Their gas can, which was hooked up to their burner, exploded with the young man standing directly next to it. Because their kitchen was a very small room, the explosion ricocheted off all the walls, charring his entire body. His wife, who had been on the outskirts of the room, was able to drive them to the hospital.

The nurse did a rapid triage assessment and declared that this man had 85% TBSA burns with both 2nd degree deep full thickness burns as well as 3rd degree burns. I had limited knowledge on how burns affected the body at this point, but it was clear to me that he was in shock and edema was setting in very quickly. Only several minutes had passed and his skin became swollen, tight, and shiny. I stood next to him as his nurses were yelling orders across the room. He turned his head and looked at me with a tear rolling down his cheek. I returned his gaze with my undivided attention and a calming smile. He gazed back at the ceiling, closed his eyes and began coughing feebly. His nurses ran back over and shouted for an NG tube. I stepped back from him as he started to code and the entire team swarmed around him. As they intubated him, a stretcher was brought into the room and I was told that they were transferring him to Maharaj Hospital, a nearby public hospital with a specialized burn unit. I was instructed to bring sterile water bottles and his chart into the ambulance and wait for them in there. I moved with haste and precision without contemplation. I was unsure of the plan but I was honored and relieved to be asked to stay with this patient.

The 10-minute ambulance ride to Maharaj Hospital was completely silent except for the pumping of oxygen. It was the calm before the storm. My eyes were unwavering from this patient as I watched teardrops stream down the side of his cheek and drip onto the side railing of the stretcher. Each teardrop was like a knife to my heart. Every fiber of my being was screaming to hold him and let him know he’s not alone. It was clear his condition was rapidly deteriorating as the nurse told me his trachea was severely burned, his organs were beginning to fail and systemic edema was setting in.

As we pulled up to the ED of Maharaj, a team of at least 20, including doctors, nurses, burn specialists, plastic surgeon, cardiologists, and medical students, were all eagerly anticipating our arrival. We unloaded and went into a large area of the department dedicated to triage cases. It felt like I was walking into a slow motion circus from a nightmare. There was an audience that ‘oohed and awed’ at the severity of his condition, staff swarming around him poking and prodding him with every device available. His blankets were thrown off of him and he shivered uncontrollably for what seemed like an eternity. Someone drew blood while another took more vitals and set up for x-rays. Teaching doctors addressed their students, pointing out findings
and quizzing them on their medical knowledge. And all the while, a living, breathing, thinking human had been lying there alone. No one said a word to him. No one asked him a question, updated or consoled him. Not a single person stopped to address any of his needs as a patient who was clearly dying. Surrounded by people but completely alone.

People started to clear out as they realized that they couldn’t do much to save him. The adrenaline was gone and the masses disappeared with it; it was as if he was no longer interesting or important. I was lost in translation and didn’t have a clear understanding of what had transpired but I knew from looking at him that he was not going to survive the night. I asked my team what had happened and they confirmed that he was not going to live much longer. I asked permission to stand with him and address some of his basic needs. After getting their consent, I picked up the blanket at his feet and draped it back over his body. His once tiny, fragile, charred body had transformed into a rubicund swollen sac of fluid. I couldn’t distinguish basic anatomical markers on any part of his body. His burns were raw, oozing and the smell was almost unbearable. I continued to move up his body slowly, gazing at every inch of him and finally got to his face. Although his eyes were swollen shut, tears were still slowly streaming down his cheek. In that moment, a commanding and life altering sensation took over. Regardless of what this young man was capable of feeling or comprehending, I was not going to let him die scared or alone. I bent down, placed one hand on his chest and whispered a quieting sentiment to him. I wiped the tear from his cheek and stood there holding him until he took his last breath.