Its strange, I never knew it was possible to have such stark contrast in life. Yesterday, my day was going real well. I had a wonderful morning at work, where I did all the right things, and gave all the right answers when being grilled by my consultant about the evidence for simvastatin doses. I felt useful as a TI. There was tons of stuff to do on the ward. A good rewarding day. My house surgeon bought me lunch. It was all going so well….

Then, after lunch, I was supposed to consent one of the patients going to theatre for a BKA of his leg coz he had really bad PVD. He had had a fem-pop bypass a week ago, which completely thrombosed. And then got infected. And now, he had no blood flow to his foot whatsoever. And that was causing him a lot of pain, so he was on a morphine PCA for that. And even though he was septic, he was stable, waiting to go to theatre.

And then the nurse called us. His O2 sats were 86% on 4L, and his respiratory rate was 11 per minute. He had ODed himself on the PCA. Thats ok, happens all the time. No big deal. So, out came the naloxone syringe, and within 30 seconds of that, his sats were back up to 97%. And then came the most awful sight I have ever seen. Because the naloxone reversed all the effects of the morphine. Including the analgesic effect. And it was horrible. A grown man of 75, clutching his wife’s hand to the point that her fingers were white, writhing in pain, crying and screaming. Crying and screaming like the baby who got too close to the fire and burnt itself. Grown ups dont cry. We whine, and moan, and clench our teeth in agony. Occasionally, we shed a few tears. But we dont cry till our eyes run dry of tears. But he was. And it was terrifying to see how much pain he was in, from his ischaemic leg. And it was even more terrifying to look helplessly at his wife and tell her there was nothing we could do to stop his pain. And even she knew that there was nothing we could do to stop his pain.

Eventually, we took him to theater in a hurry, and started doing a BKA. And then we got in there, and found totally, 100% dead muscle. Completely dead. Nothing left that could survive. And that explained everything about the pain, and why it was so severe. So we were forced to do an AKA for him in the end. Except, now he is in ICU, coz he hasnt woken up yet. And his kidneys are also giving up. And things are getting worse. It will be the biggest christmas miracle if he survives this. I have seen patients in pain before. And I have seen patients die slowly before. But nothing like this. Nothing that makes you gravely question the point of intervening at all. Coz anything you do is only going to prolong the agony. Coz he is gonna die. And the kinder thing would be to just let him die, instead of chopping his leg off. You know, no matter how hard they try, they can never prepare you adequately for such stuff in medical school. Words such as empathy, and sorrow, are just mere words at such times. They dont even come close to describing what you feel. Fear. Maybe that describes the feelings better. Fear, that there is something worse than death.

OK…..Imagine this. Something that you have always been waiting for. You have dreamt about it. You have thought about it a million times, and imagined a million different scenarios in which it would happen. And then it happens.

Except, it happens in the one way that you had never thought it would happen. And yes, you are happy that it has finally happened. You have been waiting for it for a long time, and words cant describe your joy at that moment. But a bit later on, when you come down from cloud 9, there is also a sense that you wished it had happened in one of those million ways that you thought it could happen. And you are left feeling slightly cheated, for this very important thing didnt quite happen as you wanted it to happen.

So what do you do then? Do you then say to yourself, "I am glad it happened, no matter which way" and be happy with your lot? Or do you voice your thoughts and say "Actually, this shouldnt be how it should have happened"? Are you then being too demanding? And looking a gift horse in the mouth and finding faults with it coz it doesnt quite match up to your expectations? You are not an ingrate, but you are also a bit of a perfectionist, especially when it comes to important things. Dilemna.