Gut Feeling

A Personal Reflective Narrative by Dr. Rodney Dcunha, an Intern at St. John’s Medical College, Bangalore

Death disturbs me. It never fails to. And what disturbs me more are the decisions we make in a critical situation when time is not on our side. The grey area between right and wrong. That's when intuition kicks in and does something that reason cannot explain.

I realised this first in my paediatric posting when I was an intern doing my rotation in Pediatric ICU. A critical child (I have forgotten his name) crashed at 12 am in the morning. We resuscitated the child and started him on adrenaline. The ventilator and the adrenaline were keeping him alive. Unfortunately he had a bad prognosis, the parents were counselled about it and they decided to take him home. As the night was busy, a nurse and I had to accompany the child and extubate the child at the hospital door before transportation in an ambulance.
As I walked out of the PICU at 2 am in the morning, contrary to what I had expected, the surroundings were silent. The mother was solemnly walking next to me, in absolute silence and tired eyes. I was busy pressing a bag, which made the child breathe. We were at the entrance waiting for the father to come in an ambulance when suddenly the monitor did not record the pulse. I checked the pulse, there was no pulse. At the hospital entrance at 3 am in the morning I started CPR. 5 cycles and 1000 compressions later I felt a feeble pulse. Five minutes later, the father arrived in an auto-rickshaw after which  I extubated the child while the nurse disconnected the monitors. The limp body was handed to the parents and they carried their dead child on the lap and left. The nurse tapped me and asked: ' Why did you do CPR? The child was going to die anyway?' I didn't have an answer. Two days later, I took time off and  thought about what I did. 

Did I do it for the child or myself?
Did I do it to keep him alive? What's the point of that? I killed him anyway by extubating him later. I just prolonged his suffering. Did I do it to because I had a choice? To watch him die or to keep him alive, and I chose the latter because I felt like I could do something to bring him back? To this day I cannot justify what I did. But to save his life was my first instinct.