It’s 9.30 pm. The admissions to the emergency room continue to pour in – the beds have been exhausted, but the floor still has a few square feet of room. The interns and residents rush to complete their unfinished tasks, constrained by the limits of a 24-hour day. Away from this hustle and bustle, patients in the wards prepare for bed. The ward workers roll out their mats, hoping it will be an uneventful night. It rarely is.
In the meanwhile, far from sight, four of the hospital’s senior
consultants gather in a small unassuming room on the sixth floor that holds a
single patient.
“9.41 pm, ventilator disconnected”, calls out the nurse, as
all eyes glance at the rhythm on the ECG monitor and the saturation on the
pulse oximeter. The 26-year old boy on the bed lies motionless, without
breathing. The trained eyes of the people in the room are nonetheless able to
see the chest pulsate with every impulse of the heart – a heart that continues
to beat in a body that has become incapable of living. The silence is punctuated
only by the alarms from the disconnected ventilator and the scratch of the Anaesthesiologist’s
pen as he meticulously records the patient’s vitals every few seconds.
The minutes roll by until the nurse calls out the time again
– 9.49 pm. The Anaesthesiologist draws a blood sample and reconnects the
ventilator. The Internist reads out the blood gas analysis, and records his
findings in the case sheet: “Second apnoea test positive”. The patient is now
essentially a living cadaver.
Brain-death occupies that very precipice between life and
death, when the brain, the seat of consciousness, has completely and
irrevocably ceased function, yet the patient continues to have an intact
circulation; a beating heart. Oblivious to its predicament, the intrinsic
automaticity of the heart ensures that, when supported with artificial
ventilation, it continues to pump blood, even if it is to a dead brain.
Yet from this grimmest of
circumstances, this particular patient’s final act is one of noble sacrifice. A
few hours from now, in the dead of the night, three or even four individuals
will be rushed into operating rooms across the city to prep for surgery – a surgery
to replace a failed liver, a failed kidney, even a failed heart – an organ
obtained from the still body of a young boy on the sixth floor.
“So
long as men can breathe, or eyes can see,
So
long lives this, and this gives life to thee”
- Sonnet 18
