The intensive care doctor who nearly died in her own ward - and what it taught her

By: Guest Author | Posted on: Feb 06, 2018

This article was originally published on nzherald.co by Dr Rana Awdish. View the original article by clicking here. Cascade Training Center

Dr Rana Awdish, an intensive care doctor in Detroit, was seven months pregnant when she lost her baby and nearly died herself as a result of catastrophic bleeding, caused by the rupture of a benign tumour.

In an extraordinary memoir, titled In Shock: What I Learned About Medicine's Inhumanity, she details her experiences as a patient in the health system in the US, offering a searing critique of the inability of medical staff — including herself — to see the patient behind the disease.

Dr Awdish now campaigns to improve communication in medicine, the Daily Mail reports.

The pain was excruciating and unsustainable. I knew instinctively that if pain of that magnitude continued, it would kill me.

It had otherwise been the kind of featureless day I would have easily forgotten, had it not ended so disastrously. I had a day off and planned to run some errands before dinner — first, taking my swollen feet shopping for new shoes.

I was into my seventh month of pregnancy and my body was bloated and heavy. As I entered the shoe warehouse, I realised I didn't remember driving there.

I wondered if my sleep deprivation was catching up with me. I'd just come off a demanding month working in the intensive care unit (ICU), spending every fourth night on-call — had I lapsed into a microsleep while driving? I touched my pregnant belly, almost as an apology. I knew I had to be more considerate of my body, given the baby.

I found an area that had a series of unattractive practical shoes. A woman repeated: "Excuse me, excuse me," with increasing irritation as she attempted to pass me in the aisle. I shook off the fog and realised I had been standing, blocking the aisle, staring at the shoes in my hands. I was meeting my friend Dana, who was also a doctor, for dinner. Perhaps she could help me brainstorm why I was feeling so bizarrely off.

At dinner a few hours later, I was suddenly overcome by a breathtaking wave of pain. The look on my face told Dana far more than the words.

She drove me the two blocks home. I saw the bicarbonate of soda on the counter when we walked in. It reminded me that my acid reflux had been terrible that morning, I'd taken the bicarbonate of soda to try to calm it naturally. I'd been attempting to avoid any medication that could interfere with the baby's health — even very innocuous antacids.

Dana and I walked to the living room, where my husband Randy found me 10 minutes later on the floor, kneeling, compressing a pillow tightly against my abdomen to reduce the pain. I eventually found that by lying horizontally across the arm of the sofa on my right side with my right hand on the floor, the pain would just slightly quell.

I had no way of knowing the pressure from the sofa was slowing the blood gushing from my liver, and that I had less than two hours before that blood loss would empty my arteries, veins, and heart entirely.

"When I lie like this, it's not so bad," I announced. Randy and Dana shook their heads, unimpressed, while debating if we should drive to the hospital or call an ambulance. An ambulance seemed the safer choice, but it meant I couldn't control which hospital I'd be taken to and I wanted very much to go to my own institution. I trusted us.

When I arrived at the labour and delivery unit, my vision tunnelled. My mind felt bubbly, as if it had gone without me on an effervescent New Year's Eve binge. I realised that I was experiencing shock.

Could I give them a urine sample? I imagined the co-ordination involved and shook my head. I was turned over to the obstetric nurses with the single-minded intention of evaluating the baby.

"The baby ... is fine," I grunted, breathless from pain, "but something ... is wrong ... with me. Please ... call surgery."

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"I regained consciousness to discover I was wholly dependent on machines." Photo / 123rf

The doctor ordered morphine, which caught my attention. Oh my God, they are giving me morphine. We almost never give pregnant women heavy intravenous narcotics, understanding that it puts the baby at risk.

How had I gone from not wanting to take an over-the-counter antacid to getting intravenous morphine in just one day?

The trauma surgeon on-call was someone I had worked with. Dr G checked my lab results, winced, and began listing the possibilities. "Liver failure, perforated ulcer, ruptured appendix ..."

I heard and thought: No, I'm dying faster than any of those can kill you. This is worse.

By now I'd received 50 milligrams of morphine in total — enough narcotic to kill me had I been well, but due to the ferocity of my pain, my body barely acknowledged it.

My intuition that I was dying was validated by a second set of lab results: I'd lost nearly my entire blood volume somewhere in my abdomen. This served only to amplify concern for the baby, and they wheeled an ultrasound machine to my bedside.

"Bear with me," the obstetric resident [a junior doctor] warned, his foot tangling in the cord. "I'm not great at these yet."

He didn't need to be. From the first grainy images I could see, the heart was still and pulseless.

"There's no heartbeat." The words cascaded out of me on a torrent of agonised breath.

"Can you show me where you see that?" he asked. I shuddered in a shock of pain. As my breath caught, I stared at him, incredulous. Could I show him how to interpret the ultrasound images of my dead baby?

I realised his perspective in that moment was aligned squarely on himself. His detachment reveals an unsettling, largely unspoken reality.

As doctors, we aren't trained to see our patients. We're trained to see pathology. We're taught to forage with scalpels and forceps for a diagnosis. We excavate in delicate, deliberate layers, test by test, attempting to unearth disease.

The true relationship is forged between the doctor and the disease. This bond is disclosed when we re-encounter these diseases: we greet them respectfully as the worthy adversaries they are. The patients are at risk of becoming an accessory to the whole affair.

As his question echoed, I discerned genuine curiosity and I realised, with an uncomfortable tug of recognition, that indeed I was not a person to him, but a case. And an interesting case at that.

I affixed my eyes on to his, willing him to see me. I instinctively felt that if he didn't see me, if he didn't connect with me, he might not care enough to do what it would take to help me to survive.

The baby, having declared her own distress, meant the surgery came easily now, briskly even...


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