One year and a half of Covid, and it's not getting any better

 

"Kita tak cukup ventilator kat sini, ICU bed penuh. Lagipun patient 50-50 je, we dont think he'll make it long. Sorry kita tak boleh terima patient ni." 

"Sorry, he has a very low chance of surviving. Might as well you explain to family members and issue for DIL NAR (death in line, not for active resuscitation." 

73 years old atuk datang sesak nafas, sampai ED memang nampak nafas laju, cungap2 cari nafas. Oksigen dalam darah tak cukup, dah bagi high flow mask oxygen still pickup sampai 70% je. Sekali pandang dah tau dah patient ni kita kena intubate, he's in severe respiratory distress (read: gangguan pernafasan yang teruk). I could see on the monitors that his oxygen levels were falling by the second. 

"Pakcik, kita akan masukkan tiub pernafasan dalam paru2 pakcik untuk bantu pakcik bernafas ya. Kita akan tidurkan pakcik ya. Pakcik mengucap dulu ya." 

أَشْهَدُ أَنْ لَا إِلَهَ إِلَّا اللهُ وَأَشْهَدُ أَنَّ مُحَمَّدًا رَسُوْلُ اللهِ

Laillahailallah, laillahailallah. 

Decided for intubation, tapi oksigen paling tinggi after intubation pun 86% je. We have to manually pumped oxygen into his lungs to get a reading of 99%. Tapi tekanan darah makin lama makin turun, supported with triple inotropes (maximum that we can give to a living human). Kejap 86/43, kejap 72/26, kejap 113/86. Patient tak stable ni, kena cepat2 transfer to hospital berpakar. Tangan dah sejuk, memang tak cukup oksigen betul pakcik ni, we don't even know how much time do we have untuk patient terus bertahan.

Being in a district hospital, all unstable patients need to be transferred out to a bigger hospital with speacilists. Referred case to THREE tertiary hospital, semua kena reject. Discussed case with speacilists, consultants, superiors, ended up with the same answer.

"Sorry kita tak boleh terima patient, patient takkan survive dan kita dah overload. Explain to family members." 

At this point, I think KKM is right. We have reach to the extent that we choose which patient to be saved, to be treated, to be accepted. You are lucky enough if you're the chosen one, for having the higher chance of living, younger age, without any comorbidities. But it's unlucky for him, to have multiple issues, for being old, for having lower chance to survive.

Feeling worthless, after few attempts of intubation, pushing everything that we could to stabilize him, had few cycles of CPR and miracles did happen for a moment. Had few episodes of lowish BP and pulse getting really2 slow. He came back and gave us some hope. 

Until.. 

We have no other choice but to decide for terminal extubation (read: cabut tiub pernafasan). Poor prognosis with no ICU bed. No ventilator available for him. No empty bed for him. Minimal chance of surviving, hence we're letting him go. 

Slowly. 

Explaining to the family members is hard. 

Seeing them saying goodbye for the last time is hard. 

To witness his family members grieving is hard.

Trying to look away, when deep inside me is crying as well.

To extubate him is hard. To take off all the medications that are supporting him is hard. 

To see him go, is hard.  

To accept the fact that we are failing is harder. 

They came in with full of hopes for their loved ones, but ended up bringing back home a dead body.

I have never felt so helpless in my life

"Abah, jumpa nanti ya. Abah kena kuat tau, bertahan ya abah."

Little did we know, that was the last time they saw him. Little did we know his syahadah that day was his last one. 

And it got me thinking, why am I still here.

Why do we have to second-guess of decisions

There's been so much profound loss

I am frustrated. Paralyzed. Disappointed. And tired. 💔