So, big surprise, the world didn't go up in a puff of smoke on 21 December. But with so much talk about the end of an era and the year drawing to a close, I too find myself mulling over events of the past twelve months.
For me personally, 2012 features as the toughest year in recent times. In some limited ways, my world has ended more than once this year. Luckily I can also say that I've gained invaluable wisdom and strength. Incredible people have enriched my life. I'd say that because of 2012, I'll be better equipped to live 2013.
As far as hospital experiences go, this must surely also have been the year in which the fallibility of modern medicine, the endurance of the human spirit and the incredible comfort of faith in God have come to the fore most poignantly.
The single most valuable lesson I've learned this year is probably to count my blessings, to appreciate my situation no matter how negative I might feel about it. There are always people who have a harder time of it. This may come across as a cliche and is difficult to stomach when you are struggling through hard times. I have the dubious priviledge, however, to see the best and the worst of the human condition daily. To differing extents, I witness, counsel and share in tragedies so I can truelly say that I'm better off than many, many people.
I tried to comfort a mom when her barely adult son sustained 90% flame burns, a condition incompatible with life. She had lost two other sons that very same week in different accidents.
My housekeeper's niece found herself in ICU after ingesting a pesticide. Her entire family were besides themselves with grief when informed that medical tests conducted to determine brainstem viability all failed and the next step was to switch off the ventilator. They gathered around her bed and prayed with total and childlike faith. The next morning, the girl's corneal reflexes had returned. Soon therafter, she was extubated, moved to the general ward and discharged home with a slight limp the only remaining neurological damage. In the neighbouring ICU bed, a little baby, incredibly ill from pneumonia, also appeared to make a recovery so complete and speedy that her doctors were taken by complete surprise.
Possibly the most remarkable case to cross my path this year is that of a young mother of two. She is exactly my age, which somehow makes her story more real to me. Perhaps I can imagine myself in her position. She developed vague abdominal pain and presented to casualties a couple of days later when it was clear that the pain wasn't subsiding. When she finally got to theater, the rattling discovery was made that her entire small intestine had infarcted.
She had basically had a heart attack or a stroke but instead of her heart or brain being cut off from its blood supply and with that essential oxygen and nutrients this had happened to all 8 metres of her small intestine. One cannot survive without your small intestine because that is where you absorb the food you eat. This lady's intestines were black and necrotic.
We basically closed her up again and sent her to ICU on a T- tube with the very realistic expectation that she would not survive the weekend. And that is the expectation with which I had to counsel the family. I cannot imagine how one could possibly absorb such information. Their young mom, daughter, wife, previously healthy had come to hospital with a bit ofa tummy ache and now this doctor was telling them that medical science expected her to be dead by the end of the weekend and not even to wake up post surgery to say good bye to them.
The weekend came and went, the next week passed and our patient remained haemodynamically stable, non-septic. We started debating whether it would be ethically acceptable to stop the sedation and allow her to wake up and see her family. The ethical questions centred around whether one should inform her about her medical condition and that she has no chance of survival. Her family were well counselled but refused to give up hope of a recovery.
We didn't have long to debate as to what our next step should be because she soon extubated herself.
It is now more that a month later, she looks beter every day and has even gone outside to sit in the sun.
I'd rather not debate on her chance of long term survival but surely, just the fact that she could see her kids again and chat to her husband and her mom is a miracle.
So the world didn't end for my patient at the end of that first weekend. She has had four more weekends and many hours to ponder on her life and its inevitable termination.
Our last day will most probably come when we least expect it. I can but wonder what I would do with borrowed time and whether I could use it in such a way as to improve my stakes in the hereafter. So, perhaps in 2013, I shall aim to live as if my world may end on any given day.
