Yes, many times.
I work in a place where death becomes a part and parcel of life.
But recently, I saw someone dying, SLOWLY. Peacefully, but slowly.
A few days ago, a 41 yr old man was discharged from the ICU after he recieved a Stent in one of his arteries of the heart.
Now, generally, blood thinners like aspirin or clopidogrel or their combination are given to the patients after discharge, so that they take these medicines at home, till their next follow up.
He was given that too.
And very smartly, he didn't take it, neither his family members told him to.
They were like “ Uhm he is okay now, he don't need any of those costly meds. The doctor is just getting money from the pharma company “.
Within 4 days, he visited to our emergency with severe shortness of breath and chest pain.
The cardiologist was immediately called and when he asked, did he take the meds that was given at the time of discharge, they said “No”.
Sir immediately knew what it was. It was a case of Stent Thrombus..
In layman's term, Stent thrombosis is a condition where blood components get accumulated in the Stent causing obstruction of the artery and thus, causing all the symptoms like chest pain and shortness of breath. To prevent this Stent thrombus, blood thinners are given at discharge.
If it is not treated urgently, then the patient may die within hours.
Anyways, he was immediately taken to the OT. He was given blood thinners 20 times of the normal dose just to break the thrombus.
But all in haste. The thrombus was very thick and firmly attached to the Stent, and thus, was unbreakable.
The artery collapsed. The only thing that could be done now is remove the Artery, and put in a new one, that is CORONARY ARTERY BYPASS GRAFTING SURGERY.
He was immediately transferred to our department.
Thankfully, the anesthesist and the senior surgeon were there, and the patient was inside the OT again within 10 min ( generally it takes half a day)
Our senior surgeon didn't look anywhere and jumped on the case, opened the man's chest in a single incision and started pumping heart with her own hands (EXTERNAL CARDIAC MASSAGE). And on another side, I was removing the replacement artery from her legs ( saphenous vein).
It was done within 20 mins. And in the meantime, his heart starter beating again.
After 6 hrs, the surgery was successful. But still, he was having severe bleed because of all the blood thinners he got, which was necessary to save him.
So we were fixed in a dillema.
On one hand, if he was not provided with blood thinners immediately, then he's gonna die for sure within minutes. Death is 100%
On another hand, if he is going to get blood thinners, he will go into HEPARIN INDUCED THROMBOCYTOPENIA and will bleed to death within 12 hrs. Death is nearly 70%.
Hippocratic oath dictates us to save the patient as long as possible, no matter how small the chances are. So we decided to go for the later.
He was given a huge dose of blood thinness ( 10 lakh miliunits). As a result, he was bleeding severely.
He bled a total of 3 Liters (human body consists of 5 L blood).
To compensate, he was given 8 bottles of blood and 8 bottled of platelets too. Each bag consist of 250 ml. So he was given a total of 4 L. His family were asked to get it from the blood bank.
The blood bags are costly, and we saw that his death was inevitable, as bleeding was not stopping at all.
We counselled the family members, that he couldn't be saved, no matter how much blood he gets. So please don't waste your money behind getting blood anymore. Let him go peacefully. The family broke down, but eventually agreed, as this was the only sensible thing to do then.
We sat down, in front of the patient.
The last bag of blood was over.
His Blood pressure started to fall.
The ionotropes ( meds required during low BP), was not working, as there was no blood left to pump.
100/50..
70/40..
50/30…
40/20…
25/12..
19/7…
10/0..
5/0..
4/0…
3/0..
2/0…
1/0…
Death paved it's way with every tick of the clock.
“Blood pressure not recordable”, beeped the machine.
According to standard protocols, we gave all the life saving medicines as required Adrenaline, dobutamine, atropine.. But we knew, it was futile.
After 20 mins, the Ecg was flatline.
He was declared dead at 5:30 Am.
All this could have been prevented, only if he took his medicines at home.
He was just 41. Left behind his wife and 8 yrs old daughter.
