3am... somewhere in KL

BEEP ! BEEP ! BEEP !

What aa... what's dat?

Silent.

Darkness.

BEEP! BEEP! That sound again....
whadda .. where am I .... oh it's the damn pager

I stared at the screen ... #3652

Reaching in the dark I almost knocked the phone over. Bugger.

"Yaa, who's thiiiss..? " My half asleep voice was hoarse due to a gallon of Malibu dream earlier.

"Hey u gotta come to ER stat! I got a guy here who drowned himself by drinking too much water, and i can't intubate him " a desperate female voice echoed on the other line.

I recognized the voice, it belongs to Linda, one of my close buddy in the emergency room whom I got a short fling with many years ago. Sounds like she got herself in a shitty position, and unless u're in an ER's toilet, that's never a good thing.

"Gimme 2 sec, I'll be there, remember whatever u do make sure u can ventilate him" I reminded her what she already knew.

A 300m dashed to the ER at 3am is never recognised as an extreme sport, but 2 shakes of a lamb's tail later I arrived at the crime scene and only to find it as bloody as hell.

"The tube just won't go in" Linda's voice shaken, I sensed the agony and frustration reflected in her light brown eyes.

BP 75/40....Pulse rate 30/min ! - someone yelled in the background.

"Start chest compression. 1 mg adrenaline & 1 mg atropine IV bolus" my voice widely awaken now while positioning myself near the patient's head relieving Linda.

I snapped the laryngoscope's blade open and shoved it down into the man's throat, hunting for his vocal cord - but the view was obscured by his own frothy tracheal secretion.

"Suctionnn pleasse"

PSSRRRRFTTTTTTT !!! The yonker suction made a screaming noise while suctioning a 1/4 litre of secretion resulting in a clear view of Mr Vocal cord.

Thank God it's a Cormack Lehane I and with a bit of magic from cricoid pressure that Linda gave.. steady steady... my right hand maneuvered the ETT tube and gently tuck it home beyond the cord.

"He's in V. tachy... no pulse" She yellled.

I grabbed the defib paddle, charged it to 200 Joule... "CHARGEED! CLEAR !"

*ZAPPPPP!!!* -- no response --

CPR continued with multiple boluses of adrenaline.

"He's in V. Fib".

"CHARGED! CLEAR !"

-- no response --

"Agaiin!" No movement.

Flatline.

It's been over an hour since we started work on him. His pupils were fixed and dilated, no spontaneous breathing, BP was unrecordable.

Pulseless.

We decided to call it.

"Time of death 0414"

Linda broke the bad news to the family.
Silent. Followed by anguished cries from his loved ones.

Apparently, this 30y old guy overdosed himself with illegal drugs 3 weeks ago resulted in liver and kidney failure. He was treated for 2 weeks and was discharged well a couple of days ago.

However, despite advice from his doc he overloaded himself with water up to a point where his recuperating kidneys can't take it anymore and he went into acute pulmonary oedema (wet lungs) as if he had jumped into a river and drowned himself. For some reasons, he was determined to end his life.

Appparently, the first attempt was not a cry for help after all.

I went back to my on call room to sleep off any residual morning I had left.

Moments passed.

BEEP ! BEEP! BEEP !