For Whom the Bell Tolls

My patient died. Ten days ago, he was an energetic 10 years old boy, playing football and looking forward to the long year end holidays. He was bitten by an Aedes mosquito carrying the dengue virus. He has had dengue fever before and the ‘second infection’ theory holds that subsequent infections will be bad.

He was admitted four days ago, complaining of fever and abdominal pain. The dengue virus caused his blood vessels to be more permeable and he lost fluid rapidly. He went into shock as his blood pressure crashed. We poured in plasma, plasma expanders and fresh blood to replace the volume loss and infused powerful medications to bring up his blood pressure. The fluid that leaked from his blood vessels filled up his lungs and abdominal cavity.

He developed difficulty in breathing so we have to artificially ventilate him with a machine. His platelet count dropped and he started bleeding profusely. We attempted to stop the bleeding by infusing him with platelet concentrate and anti-bleeding medication. We use the latest drugs, the latest technology, the latest treatment protocol, and we prayed. In 36 hours the blood pressure stabilised and fluids loss were less.

We thought we have won, have made a difference. Unfortunately the time of prolonged hypotension has damaged his brain, heart, liver and kidney due to inadequate perfusion. One by one his organs failed. My patient died.

With all our knowledge, medications, technology and prayers we could not save him.

No man is an island, entire of itself;
every man is a piece of the continent,
a part of the main.

If a clod be washed away by the sea,
Europe is the less,
as well as if a promontory were,
as well as if a manor of thy friend's or
of thine own were:

any man's death diminishes me,
because I am involved in mankind,
and therefore never send to know for whom the bell tolls;
it tolls for thee.

These famous words by John Donne were not originally written as a poem - the passage is taken from the 1623 Meditation 17, from Devotions Upon Emergent Occasions and is prose. The words of the original passage are here

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