Time out

'But I can't wait until Monday', he said.

'I'm sorry, but they don't do elective ultrasounds here over the weekend. Marking for an ascitic drain is not considered as an emergency', I replied.

His skin was a colour of grey, deathlike colour.

I attempted the drain in vain after explaining the complications. He was more than happy to proceed. His last scan showed disease progression from his pancreatic cancer. He was still on chemotherapy, palliative chemo.

I failed to do the drain. His omental disease was so thick and on percussing his abdomen I knew that his bowels were grossly distended and any further try would risk perforating his bowels.

I handed it over. My colleague then managed to insert the drain. He was obviously more of a risk taker than I was.

The following night I went to see him again. He had drained 5 litres and still draining. But he was contiunously vomitting bilious fluid. Despite have drained that 5 litres of fluid his abdomen remained grossly distended, in fact more than it had been before.

He was uncomplaining, smiling a feeble smile to me greeting me in a cheerful manner and asking me how I was. I tried to stay cheerful too, a hollow feeling in my heart knew he was nearing the end. His colour, his mood, his state overall was not right.

I examined him. He was as dry as a bone. Took some bloods to check his renal function and stuck him on some IV fluids, knowing that some of that would just increase the amount of his ascites. His abdo X-ray showed dilated loops of bowel with ascites in the background. From clinical examination and X-ray it did not seem that he had perforated.

His lab results came back. He was in acute renal failure and hyperkalaemia.

An hour after I finished my on-call, he was found slumped on his chair with vomitus near him. In view of his disease, he was not for resus. He was only 50 when he died. He was right. He couldn't wait until Monday.

This job includes dealing with at least one patient dying every week. The more I see, the harder it gets, not any easier. The term practice makes perfect applies to all except this. I see these patients deteriorating in front of me. I could still feel my eyes water as I tell the family that their loved ones is dying, not for ITU, have died etc.

Then my mind lingers on to thoughts of how they are in the grave. What is happening to them now. Have I made a mistake of not conveying to them the message of Islam?

Allah swt will give hidayah to those who ask for it, and to those He wants them to have it. Even though you think your iman is strong, never forget to ask for hidayah from Him.