In the face of death and dying

An 85 year old man with a ruptured abdominal aortic aneurysm was blue-lighted to the hospital for emergency surgery on Friday. This man was previously known to the vascular surgeons, but due to his poor cardiorespiratory reserve, he was deemed unfit for an elective AAA repair (he was unfit even for an EVAR) and had thus been discharged from routine vascular surveillance. Unfortunately for him, his aneurysm had ruptured that day.

Without surgery, this man was certainly doomed to die. However, given his pre-morbid status, his chances of surviving an emergency AAA repair were also close to nought. The vascular surgeons discussed this with him frankly, but the elderly gentleman still chose to hang on to the faintest glimmer of hope that he might possibly survive this operation.

Despite his horrific diagnosis, the patient showed surprising haemodynamic stability. His pulse rate was normal, he was maintaining a good blood pressure, and he was obviously perfusing his brain sufficiently for him to be joking around with the medical staff. As we were wheeling him from the A&E department to theatres, I remember him saying that he wanted to get to age 91, and he was banking on us to help him get there!

When we arrived in theatres, he was wheeled directly into the operating room and quickly transferred over onto the operating table. The staff all quickly got to work, because with each ticking moment wasted, this man’s chance of survival was being simultaneously reduced. My boss instructed me to start pre-oxygenating the patient as everybody else prepared him for surgery. As I held the mask onto his face, I took a step back to observe everything that the man was experiencing. He was placed in a “crucifix” position. A healthcare assistant was cutting up his hospital gown so that it did not get in the way of our monitoring equipment or the surgeons’ access. The ODP was quickly attaching him onto the monitors. Another anaesthetist was busy placing an arterial line in his wrist. One of the surgeons started to place a urinary catheter in the man. There were at least 10 people crowded around our poor patient, all wearing theatre blues, all looking very professional, yet all speaking in urgent, hushed tones. Our previously jovial patient closed his eyes- I don’t know if he was feeling a little drowsy from the effects of the strong painkillers he had been given, or whether he had closed them in order to shut out the terrifying sight of everything I have just described. I looked at him, and wondered if I could ever fully understand the fear terror that he must be experiencing.

Our patient had a friend who is a vicar. Miraculously, this vicar managed to arrive in the hospital just before we anaesthetised him. By the sure grace of God, the consultants in theatre permitted the vicar to come into theatre to see this man before starting the surgery that he may never wake up from. I vividly remember the old man walking into theatre with a surgical gown draped onto him and plastic covers over his shoes. He staggered in slowly with the aid of his wooden walking stick, then came to put a hand on my patient and pray for him. There was silence in the operating room as this man cried out for the Lord to pour out His mercies onto his dear friend. He prayed for all the team who will be attempting to save his friend’s life. He prayed so many words of truth and hope. I believed everything that he prayed, and I prayed along with them. His prayer was so powerful that it nearly brought me to tears. I am thankful to God that this patient could face death with such a prayer. I also thank God that all the staff in theatre were able to hear it.

When the vicar was finally ushered out of theatre, our staff immediately swung back into action. The surgeons were fully scrubbed by then, and were starting to apply skin prep and drapes onto our man. As the surgeons did the necessary, and as the theatre staff ran through the WHO checklist, I tried my best to explain everything that was happening to my patient. It dawned on me then that mine may very well be the last face this man would ever see before he dies, and that whatever I say to him may very well be the last words he will ever hear in this lifetime. I wanted to comfort him, but what could I physically do? I remember looking at my patient in the moments just before we anaesthetised him. He looked resolute, and I did not detect any fear in his eyes. Yet, I wonder what was going through his mind at that time? Was his life flashing before his eyes? Was he thinking about his wife or children? Was his mind a blank and panic-stricken? I mean, what does one think about before going into a sleep that you know you may never wake up from?

We finally began the induction of anaesthesia. I remember my colleague saying to him as she put him off to sleep “we’ll see you when you wake up.” Really? Will he? The man had now handed his life over to us. He was trusting us with everything he had and was. He was trusting us to deliver him through to the other end of the surgery- waking up alive.

However, the surgery was much more complicated than originally expected. The surgeons really struggled to get the clamp onto his aorta. He bled, and very quickly exsanguinated. He lost his blood pressure rapidly, and he failed to respond to rapid infusions of blood and boluses of adrenaline. We attempted to resuscitate him on the table, but our efforts were in vain. Our patient had died.

I know that there was really nothing much more we could have done to help him, but I still feel like we have let him down. This man was alive and laughing 15 minutes ago. Now, he is dead. He had entrusted us with his very being, but we had failed to preserve it. As I replay the events of that fateful afternoon in my head, I cannot help but wonder out loud “What do I put my faith in? Who do I entrust my life to? Who will never let me down?” My answer is not medicine, not politicians, not a husband, or family, or friends, and certainly not luck. My answer is Jesus. Jesus is trustworthy. He is powerful. He promises life-eternal and he will deliver it! Jesus takes away all fear, and in its place gives joy and hope and peace.

Perhaps it is this joy, hope and peace that I saw in my patient’s eyes before he died.

Perhaps that was why he looked so resolved and fearless in the face of such terrifying circumstances.

Perhaps he was thinking of the Lord before he went to sleep forever.

May he rest in peace.

“God is our strength and refuge, our present help in trouble, and we therefore will not fear, though the earth should change! Though mountains shake and tremble, though swirling floods are raging, God the Lord of hosts is with us evermore!”