TAUREEF MOHAMMED
IN MY first month of training in Canada, I learnt someone can be alive and pulseless.
The man, who was probably in his sixties or seventies, had heart failure - his pump was weak - one of the commonest conditions on any adult medicine ward. I searched for his pulse, pressing my fingertips on the points of his body where I expected an artery to be pulsating, and felt nothing. Then I auscultated his chest and, instead of hearing the classical lub-dub, heard a continuous whizzing sound.
To say I was perplexed is an understatement. Meanwhile, the man with heart failure, who had what looked like a battery pack strapped to his torso, chatted away with me, saying he felt fine.
It was either the nurse or the patient who had told me about the left ventricular assist device (LVAD) - an electrical device, smaller than the palm of my hand, implanted in his chest cavity - that continuously pumped blood forward, making up for his failing heart.
Two years later, in the ICU, I encountered another pulseless patient.
Covid19 had destroyed the middle-aged man's lungs to the point that a ventilator, which depended on some lung reserve, wasn't enough. So, his blood was shunted away from his defunct lungs, out of his body via tubes, to a machine at his bedside which oxygenated his blood before pumping it back into his body - a process called extracorporeal membrane oxygenation (ECMO).
The continuous flow from both devices did not produce a pulse as a beating heart would.
I had never seen any of these interventions before and the unfamiliarity made me uncomfortable. I struggled to wrap my head around the idea that someone can be alive and pulseless.
They weren't dead, but surely without a pulse they weren't too far? If they weren't too far, then they were dying? But, my patient with the LVAD didn't look like he was dying. If his LVAD battery died, however, he probably would. So, he wasn't far. Hopefully his cardiologist had explained all of this to him because I couldn't.
In TT, where I did medical school and worked as a junior doctor for a short time, I had never found myself in such a conundrum. Although there were advanced interventions, compared to Canada, their availability was much more limited.
Maybe the problem was me, an islander unprepared for the big, modern world.
But by my third year in Canada, after seeing things that I would never have seen in TT - for example, the fatal brain bleed my patient on ECMO got, likely from the blood thinner that was used to keep the circuit running smoothly - I wondered if having less was a blessing in disguise. In TT, I simply had not seen so many people hover between life and death, and then die so miserably.
Was 21st-century medicine making it difficult to die?
I asked Dr Wael Haddara, chair of critical care at Western University. A critical care doctor for the past 17 years, he has seen the limits pushed for better and for worse.
Dying, he said, was becoming complicated for two reasons: 'Our ability to do more and more with technology an
