When she was admitted into the hospital, she was fully conscious, even able to stand comfortably and walk with some support. She scored 15/15 on the Glasgow Coma Scale, 154 indicating that she was as conscious as a normal, healthy adult would be. I think this is quite remarkable for an 81 year old lady whose hemoglobin level was just 4. Even fully healthy adults can become unconscious at this low level as their brains and other vital organs would be receiving much less oxygen than they need.
She was in the hospital for just two days.
At the end of the first day, having been transfused with two units of blood, she appeared to have almost fully stabilized, had a good appetite, and spoke well. For some reason her hemoglobin levels had not increased even after transfusion of two units of blood, but this did not somehow bother me much and I thought she was home and dry – make it her 11th.
I spoke to her thrice while she was in the ICU and all three times she said just three things: she was hungry, father should have food, and I should take her home soon. Hardly things said by people at death’s doorstep. (The fourth thing she briefly mentioned was that she had severe leg pain the earlier night – RLS was not willing to part with her until the very end).
Blood transfusions of course present risks, especially to old people. Internal bleeding complicates things a bit more. But with the hospital already confirming to me, based on her CT scan, that there was no leak from her aortic dissection, the internal bleeding was likely from her gastrointestinal tract, and this bleeding was most likely chronic and not acute – so, the rate of daily blood loss would not be very high providing her body enough time to get replenished with new blood and also providing the doctors enough time to repair whatever was the cause of internal bleeding.
She herself had had blood transfusions twice earlier, once for anemia (due to minor bleeding from the gastrointestinal tract) and once when she had lost large amounts of blood from a fall. Both times, she was home within two days.
All these pointed to a favourable outcome, and made me feel quite relaxed. Honestly, I had completely stopped worrying about amma’s condition – she had won much tougher battles.
In fact, when I went to see her the evening before she died, she said “Take me home”, the same words she had used – albeit far more feebly – almost 10 years earlier while she was being wheeled into the operational theater for her ascending aortic dissection surgery. Then, almost sure she wouldn’t survive, I had given her a longing look and kissed her. This time, on hearing the same words, but spoken aloud by a healthy-looking amma, I spent less than a minute with her, just enough to inform her that she should be home within two days.
I stayed back at the hospital overnight. Early the next day, I got a call from the ICU. Early morning calls from ICU are rarely good news.
I went in with a blank mind, only to see her twitching and turning like someone having epileptic fits. I was shocked, as she was absolutely stable only the previous evening. I touched her hand and called out “amma”. She did not recognize me or respond.
Something had gone wrong.
The attending cardiologist took me aside and explained. Her heart had suddenly gone into an acute atrial fibrillation (flutter). He was not sure why it had happened, though he made some intelligent guesses.
He was not very optimistic, as he felt this was typical of a heart at its end stage. I was thoroughly shocked and did not even know what to ask, but was optimistic – we are talking about amma, after all.
The next 30 minutes, they tried to stabilise her heart through defibrillation.
Sadly, all their attempts failed. When I went in to see amma again, she was still technically alive, but no longer conscious. The doctor apologetically said he had tried his best but she was, for all practical purposes, dead.
I did not know what to say, being completely disoriented. He looked at me, and said softly, “You are actually lucky that she lived this long with her aortic dissection.”
I think I said, “I know”.
It was not completely over though. There was a small chance (5%, in the doctor’s opinion) that her heart would recover if she was provided ventilation, given some injections and if need be, administered CPRs. 155
Should he go ahead with ventilation given that it was an almost lost cause? It would cost a bit.
I remembered my dad’s voice almost 10 years earlier, “We will go for it at a 5% chance”.
I said, “Of course. Just go ahead”.
I went near her and looked at her peaceful face. I just kissed her on her forehead. And left the room.
She technically died an hour later.
The two young doctors who had attended to her in her last minutes told me that she had multiple cardiac arrests but her heart had, after recovering four times through CPR, finally bid adieu.
Amma had moved on to her next life, wherever it is.
I did not fully realize until ten minutes later that she was gone forever. I started crying.
155. Cardiopulmonary resuscitation (CPR) is an emergency medical procedure for a person in cardiac arrest that combines chest compressions with or without artificial ventilation, in an effort to manually preserve intact brain function until spontaneous blood circulation and breathing resumes or is restored.
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