tears of guilt

69/ chinese/ uncle

was admitted for sepsis secondary to infected sacral sore, acute on chronic renal failure secondary to dehydration, infected left lateral malleolus DM foot ulcer, hypochromic microcytic anemia - post transfused 2 pints of packed cells, diabetic and hypertension

his wife noted that he was staring blankly at home, not responding to call and gave a history of poor oral intake for the past one week.

we did a plain CT brain for him and noted to have hypodensities over the right caudate nucleus and right external capsule. this is his 3rd admission for recurrent stroke.

started him on ryle's tube feeding and he was tolerating orally for the past 6 days

we had to maintain his low BP with inotropes.

his GCS was always 11/15. he had always wanted to tell me something but there was no voice

his non hemiplegic hands were always grabbing mine

somehow, i knew he was begging me to release him - we had to restraint him for he was strong enough to pull out his ryle's tube

that day, i weaned him off from his NPO2 as he had an oxygen saturation of 99 %
unfortunately, he started to desaturate that night itself and stopped breathing at 5.30am
pupils were fixed and dilated, unresponsive to light

his 'so called' filial sons came
i had to break the bad news to them that their papa was no longer around
they were then sobbing, squeezing out tears of guilt


they had never been to the ward, unless i called them over
i wanted them to learn how to feed the old man by ryle's tube and how to take care of the bed sores
i was at the verge of scolding them through the phone
what is the point of crying when it is too late to do so?


this is the first uncle who passed away under my care
i had blamed myself for weaning him off from his nasal prong oxygen
but then, medical patients are just so unpredictable
they just choose to desaturate and knock on heaven's door