Lost in Limbo

"What are you trying to say, Doctor?"
I had done this many times, far too many to be healthy, and I was supposed to pull this off easily. That was what I kept telling myself. But it never got easier. If it was possible, I would have looked anywhere but at her eyes. They expressed her fear, her anguish, but worst of all, a glimmer of hope. Hope that I had to crush with what I had to say.
"There is nothing much we can do. His organs are failing and he may not have much time left."
The snuffed hope was more than I could bear. I shifted my eyes from the lady in front of me, her shoulders already shaking with sobs she was failing to repress, to the subject of our conversation. The man was lying on the last bed in the ICU, immobile except for the regular rise and fall of his chest, in time with the sound of the ventilator attached to him via an endotracheal tube. Twelve breaths per minute, if I counted, just as the setting on the machine. He no longer could breathe on his own. The left half of his shaved head was swollen, the skin over it glistening with tension. The sutures holding the surgical wound were crusted with dried blood. Beneath the swollen skin surrounded by the sutures, was his edematous brain, covered only in a piece of cloth-like tissue. That part of the skull had been removed to enable the edema to expand without compromising the rest of the brain.
But the craniectomy performed three days earlier only helped in prolonging his life for a few more days. The impact from his accident had caused a massive intracranial bleed, and with that much dead brain tissue, he would be paralyzed for life even if he did survive. Even with his face swollen and bruised, the patient looked young, in his late thirtees. Much too young to die.
And his family surrounding his bed agreed with my unspoken thought. Although they were vocal about it. They were conversing rapidly in Cantonese, and even though I could not understand the words, I could grasp its meaning. They were angry, and anguished, and could not accept this revelation.
The lady in front of me made a small sound that snapped my attention back at her.
"But…but he was doing so well after the operation. His eyes moved when I called his name. He even moved his fingers…" The patient’s wife was having a difficult time holding back her tears.
In truth, even my nurses would attest that the patient had not moved one bit post-operatively. Even with extreme pain stimuli that would have had other peoply jumping, cursing with agony, we could not elicit a response from him. But people needed to cling to hope so badly they were willing to see anything, believe anything.
A man who had slight resemblance to the patient’s wife stepped up and steadied her shoulders. He looked at me with a defiance that bordered arrogance. "What about lobectomy? You haven’t tried that. When he gets better we can take him home and my sister can take care of him."
The drawback of Internet. Freely obtained information makes people think they are smarter than others. Frankly, I sympathized with the lady sobbing in front of me, but I would not have myself talked down by someone who didn’t know what he was saying.
"You want us to remove part of the swollen and dead brain," I replied in clipped tones. "Then what? If he survives, Mr Kong will be a vegetable for life." I took out the patient’s CT films from a side compartment of the desk at the foot of his bed and showed the man the bright image occupying most of the front part of the patient’s left brain, extending to the back, which signified the extent of the bleed prior to operation. "He’s right-handed. Which means his left brain is dominant. If we remove that part of his brain, and he survives, he won’t be able to talk, think, or even function."
Realizing I was starting to raise my voice, I took a deep breath to steady myself. And I studied the man’s expression. It wasn’t arrogance; it was the last remnants of hope trying to set foot. And with hope crushed to abruptly, the man just looked older, and tired.
My voice was softer when I continued, my tone kinder. "I’ve talked with your sister earlier. She is a housewife and she has three children to take care of. If, if your brother-in-law survives, he will be lying on a bed for the rest of his life."
"But we can visit them every day and help out," a lady who could have been another sister interrupted.
I looked at her, compassion in my face as well as my voice. "Yes, but for how long? Whatever we do, his brain has already stopped functioning. If I take out that tube in his mouth, he will stop breathing."
A collective gasp. More rapid Cantonese that I couldn’t understand but could comprehend the meaning.
"You can’t do that! It’s illegal!" The brother who was supporting Mrs Kong stood straighter with anger.
"Yes it is," I agreed. "Unless if Mrs Kong, and only Mrs Kong requested for it." I had to emphasize the importance of the decision, even when I could see it was killing her. I shifted my gaze to the sister who spoke to me.
"And if he survives, he will have to depend on a machine like this to breathe. Mrs Kong has three small children to think about at home, and you’re asking her to take care of Mr Kong and at the same time find a way to make money to support her family. You may come and visit, but she has to live with this the rest of Mr Kong’s life."
I knew it was harsh, even if my voice was anything but, yet I had to show them the reality and the gravity of the situation.
"I came here to tell you that his heart is also failing. You see the small tubes connected to his arm? He’s on two inotropic agents to help his heart pump, but even those are not working. His heartbeat is slower, and his blood pressure is dropping." I showed the whole family the readings on the patient’s cardiac monitor.
Mrs Kong cleared her throat to get my attention. She looked so much older than she was supposed to be; dark lines circled her tired eyes, which are red from all the tears, and her face was gaunt with fatigue. She was also wearing the same clothes I saw her wearing the day before.
"How long?"
She did not have to elaborate. I was expecting this question.
"I’m not God. I can’t tell you hor much longer he has. But he may not last the night."
And if saying it did not break my heart enough, I had to watch the lady before me crumple and wail loudly, a keening, high-pitched sound that would likely haunt me for years to come.
I kneeled in front of her and whispered. "I’m sorry. I’m sorry."

This entry was posted on Saturday, August 30th, 2008 at 6:29 am and is filed under Short Stories. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.