The Doctor Will See You Now [Non-Fiction]

Chapter 126: Acute Medicine

During on-call, I was called to admit a post cardiac-arrest.

A man in his sixties with no significant past medical history, except diet-controlled diabetes and high blood pressure requiring only one medication, developed cardiac arrest.

The history from his adult son was that he was perfectly well that morning and had gone out for his regular walk. When he came back, he made lunch. After lunch, he mentioned some difficulty breathing. His son made him sit down and take a break, but all that time he was still talking, alert, and didn't seem particularly ill.

When the breathing didn't improve, the son called an ambulance. Whilst waiting for an ambulance, before the son's eyes, his dad keeled over.

The 999 operator instructed the son to perform CPR until the paramedics arrived and took over. The son accompanied him on the ambulance, via the A+E, and then to the ward admission. The total down-time (when the patient did not have a pulse) was over 40 minutes until he gained a pulse again, which is a prolonged down-time. When he came up onto the ward, he was intubated (a breathing tube down his throat), on maximum inotropes (heart-strengthening medication to maintain a blood pressure), and his pupils were fixed and dilated, a sign of brainstem death. His CT brain also showed changes due to prolonged blood deprivation. He was essentially brain dead with no chance of neurological recovery.

I saw his son and other children outside the ward and broke the bad news to them. The son who did the CPR appeared stoic and accepted further CPR, when (it was not a matter of 'if' but 'when' because his condition was incompatible with life) his father developed another arrest, would not be in his best benefit as he was already braindead.

"I don't want him to undergo [CPR] again," said the son, who had witnessed all 40+ minutes of CPR already that day.

The next day, his father passed away. His case doctor referred him to the coroner; we could not ascertain a cause of death.