Sunday, November 25, 2007

For Whom the Bell Tolls

My patient died. Ten days ago, he was an energetic 10 years old boy, playing football and looking forward to the long year end holidays. He was bitten by an Aedes mosquito carrying the dengue virus. He has had dengue fever before and the ‘second infection’ theory holds that subsequent infections will be bad.

He was admitted four days ago, complaining of fever and abdominal pain. The dengue virus caused his blood vessels to be more permeable and he lost fluid rapidly. He went into shock as his blood pressure crashed. We poured in plasma, plasma expanders and fresh blood to replace the volume loss and infused powerful medications to bring up his blood pressure. The fluid that leaked from his blood vessels filled up his lungs and abdominal cavity.

He developed difficulty in breathing so we have to artificially ventilate him with a machine. His platelet count dropped and he started bleeding profusely. We attempted to stop the bleeding by infusing him with platelet concentrate and anti-bleeding medication. We use the latest drugs, the latest technology, the latest treatment protocol, and we prayed. In 36 hours the blood pressure stabilised and fluids loss were less.

We thought we have won, have made a difference. Unfortunately the time of prolonged hypotension has damaged his brain, heart, liver and kidney due to inadequate perfusion. One by one his organs failed. My patient died.
With all our knowledge, medications, technology and prayers we could not save him.

No man is an island, entire of itself;
every man is a piece of the continent,
a part of the main.

If a clod be washed away by the sea,
Europe is the less,
as well as if a promontory were,
as well as if a manor of thy friend's or
of thine own were:

any man's death diminishes me,
because I am involved in mankind,
and therefore never send to know for whom the bell tolls;
it tolls for thee.

These famous words by John Donne were not originally written as a poem - the passage is taken from the 1623 Meditation 17, from Devotions Upon Emergent Occasions and is prose. The words of the original passage are here


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Blogger pearlie said...

I am so sorry.

Abide With Me
Abide with me; fast falls the eventide;
The darkness deepens; Lord with me abide.
When other helpers fail and comforts flee,
Help of the helpless, O abide with me.

Swift to its close ebbs out life’s little day;
Earth’s joys grow dim; its glories pass away;
Change and decay in all around I see;
O Thou who changest not, abide with me.

Not a brief glance I beg, a passing word;
But as Thou dwell’st with Thy disciples, Lord,
Familiar, condescending, patient, free.
Come not to sojourn, but abide with me.

Come not in terrors, as the King of kings,
But kind and good, with healing in Thy wings,
Tears for all woes, a heart for every plea—
Come, Friend of sinners, and thus bide with me.

Thou on my head in early youth didst smile;
And, though rebellious and perverse meanwhile,
Thou hast not left me, oft as I left Thee,
On to the close, O Lord, abide with me.

I need Thy presence every passing hour.
What but Thy grace can foil the tempter’s power?
Who, like Thyself, my guide and stay can be?
Through cloud and sunshine, Lord, abide with me.

I fear no foe, with Thee at hand to bless;
Ills have no weight, and tears no bitterness.
Where is death’s sting? Where, grave, thy victory?
I triumph still, if Thou abide with me.

Hold Thou Thy cross before my closing eyes;
Shine through the gloom and point me to the skies.
Heaven’s morning breaks, and earth’s vain shadows flee;
In life, in death, O Lord, abide with me.

2:40 AM  
Blogger Paul said...

Sorry to read about his death. "There but for the grace of God go I ..."

4:03 AM  
Blogger Alex Tang said...

thanks pearlie and paul,

after almost 30 years working as a doctor, my patients' death still hits me hard.

8:21 AM  
Anonymous alwyn said...

this is very sad, not least b'cos i speak as a parent with a boy a third of that age.

2:28 PM  
Blogger Alex Tang said...

yes, alwyn, it is so sad. And it was his only son too. Love your son well for he is very precious.

1:53 AM  
Blogger Kar Yong said...

I am a bit late here - so sorry to hear of this.

I wonder how you draw the line - whether one should allow one's feelings to be involved with one's patient?

Like in counselling - we are told to be detached from the person we are counselling.

In pastoral ministry, I have also been told to be detached as much as possible with our congregation.

But how can we be effective if we are detached, as if we don't feel the pain and hurt?

Afterall, didn't Jesus walk as we walk, feel as we feel, hurt as we hurt and suffer as we suffer?

12:42 AM  
Blogger chrizsim said...

I'm sorry to hear that.

I just stumbled across your blog and realised that you taught my seniors in JB. And I'm part of the next batch coming down next year! It's very encouraging to see such faith in the medical field too.

Here's my blog address:

2:54 AM  
Blogger Alex Tang said...

hi Chrizsim,

welcome. I look forward to meeting you next semester and hope you will enjoy your medical course. Enjoy your holidays first.

3:05 AM  

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