You only die once

Chapter 7B Finding reasons

Chapter 7B

Finding reasons

Things happen. Why do they happen? Like this incident. What triggered a deadly response? Why? The element of chance? Fate?

A series of events. What if I hadn't turned? Would we have been slashed from behind? Did challenging him to a fight with the stance I took, with both arms raised, legs apart and one in front of the other, anger and not fear in my eyes and face suddenly stop him dead in his tracks? Or was it just the unexpected thing I did? I will never know.

Why did I do that? Well, I was actually just doing the natural thing. Flight or fight mode. Just as when you see two dogs or cats growl and snarl at one another, seldom will a fight continue (well sometimes a fight ensues). Just like two apes banging on their chest to each other. A challenge, no doubt. And maybe that was it. He retreated when he sized up that he may be the loser. Battles are not fought when one perceives possible loss.

Hmmmm. Similar as having nuclear weapons, I guess. Human nature?

At this point, I would like to relate to a true, very true story while I was in training. It was really an opportunity to experience it then.

When I was a trainee registrar in the Irish Republic, a series of events of immense medical importance took place.

Late one afternoon as the staff were all getting ready to leave, the senior registrar on duty was seeing a blood film, scanning for leukaemia cells. An urgent request had come in from Casualty. A middle-aged lady had presented with fever, confusion, semi-conscious state, and bruises over her arms and legs. Basically, she was quite ill and one of the possibilities was leukaemia.

The consultant haematologist was leaving and passed by the lab in his usual manner, asking if he was needed before he left. As fate would have it, the registrar asked him to confirm that she was right that no leukaemia cells were seen. He peeped down the microscope and moments later said, "See the things in the white cells. That's meningococcus."

That set into motion the discovery that changed the treatment of severe meningococcal septicaemia.

Instead of leaving, which he should have as there was nothing haematological, he asked the doctor in Casualty if he needed help. He was welcomed to attend to the case. He saw the patient, called up his laboratory staff, and told them he needed urgent blood tests. That night, they discovered that Protein C was near absent in the lady's blood. That night or the following morning, plasma (which contains Protein C) was given to her and plasma exchanges and infusions of plasma were given. She survived.

By criteria of severity in meningococcal septicaemia, she had no chance of survival, especially when the bacteria had reached so many in numbers that it was visible under a simple microscope.

We were at the beginning of a meningococcal outbreak in 1997. Soon, more severe cases arrived. Word of the miracle that happened to the lady spread. A series of patients were treated with Protein C concentrates. Most survived.

I still remember a phone call that came in from another hospital. It went like this, "I heard you all up in your hospital have done miracles with some treatment for meningococcal cases. I doubt if our case can be helped but would you all mind taking over the case." Seriously, there were serious doubters and non-believers.

Just around Christmas, the consultant's paper was published in the Lancet. There was much fanfare (deservingly) in the papers. Front page. Saviour.

Reflecting back, if it had happened today, I really wonder if things would have gone that way with the consents and SOPs that only proven treatments can be given. Otherwise, lawsuits are extremely welcomed by lawyers.