No Cardiac-Pulmonary activity

I grew up as a curious little girl, always asking "Why?" whenever I didn’t understand something. One day, my world was shaken. My grandfather passed away after heart surgery, and it left me completely bewildered.

“Daddy, if Grandpa went for a heart surgery, how come he died?” I asked, my voice trembling with confusion.

“I don’t know,” my father replied quietly. I could see the sadness in his eyes, the kind of sorrow that he probably wouldn’t let me see in front of him. As per tradition, men were supposed to be strong, and crying was not an option. I did not see my father cry—not even my uncles, despite the heartbreaking news.

“Did you ask the doctor why?” I pressed, needing an answer.

“The doctor can’t know everything, Ana. He’s only human,” my father said softly.

“But who will know why the surgery didn’t work?” I insisted.

He gave me a sad smile. “The other doctor who doesn’t need a medical degree.”

I stared at him, puzzled. “Which doctor is that?”

My father looked up at the sky, his expression distant, and said, “God.”

We escorted the body of my grandfather to his Chiefdom. We were not allowed to see his grave; the royal burial grounds were off-limits to anyone, even family. It was a place reserved for the great chiefs of my village. His body was said to have been mummified with special herbs and preserved in a cool place for a year until his grave was built. Apparently, he had died after the sorghum was already harvested, his body needed to wait until the next harvest so that the fresh sorghum could be used as a paste for the walls in his grave.

I heard that chiefs were buried in an underground chamber, their bodies carefully kept from decomposing by the earth. On the day that he was buried, the kamangu drums were beaten and word spread that the 10th Chief of my tribe had died. When my father heard the news from the village, he arranged a funeral mass for my grandfather in the capital city. As we attended a funeral without a body, I still wondered why my grandfather had died after what was supposed to be a successful operation. 

My father was a general manager for an agricultural parastatal company. In his free time, he was a brilliant hunter, and from time to time, he would bring home a dead wild animal, which he would skin, clean, and cut into smaller pieces. The pools of blood would make me sick, and eventually, every time he brought a dead animal home, I would stop eating meat for at least a week. Over time, I became afraid of blood. Even when I got an open wound, I preferred someone else to clean the blood.

When I was 12, daydreaming about my future, I wrote in my diary that I wanted to be a doctor because I dreamed of caring for sick babies, even though I couldn't stand the sight of blood. However, when I entered high school, that dream began to fade. Literature and English quickly became my favourite subjects, even though I was doing extremely well in biology. I started to think that law might be a career I could pursue.

Then, one holiday, during the school break, I picked up a pathology book and was stunned by the raw images of the human heart. It was like Shakespeare's pound of artistic flesh making its case in the court of my dreams. The heart appeared brown and bloodless, with the coronary vessels creeping toward its apex. The conus branch curled from the larger right coronary artery as it descended, spreading out to the base of the heart. Inside the heart, the thick muscle walls were clearly visible, and the chambers, though shrunken, had smooth, almost polished walls. The most striking feature, however, were the strings of chordae tendineae, arranged more strategically than the strings of a musical harp, connecting the papillary muscles to the mitral valves.

It was in that moment, gazing at the image of the heart, that I made my final decision: I would pursue my original dream. I wanted to be a doctor.

On my first day at medical school, as I stepped into the anatomy building, I felt as though I had entered a grand museum—one packed with history, mystery, and untold stories, waiting for the visitor to decipher. Throughout my time in medical school, I began to see the human body as a story being woven into my mind, layer by layer. I was in awe at the labyrinthine design and the pliability of the human body. Every single cell seemed crafted to strengthen this incredible organism.

When I saw blood pouring from a patient on the surgical table for the first time, I was no longer afraid. I began to understand its deeper story—its vital role in life, its colour and smell, and its importance in the sinuous dance of health and disease. By the time I graduated, I felt invincible, empowered with the knowledge of the human body and the diseases that could threaten it. I had come to appreciate not only the science of prevention, treatment, and rehabilitation but also the profound responsibility that came with it.

On my graduation day, one of my professors gave a speech and finally said, “Congratulations, you have now become gods.” I couldn’t help but think of shows like Grey’s Anatomy or House, where doctors were portrayed as all-powerful figures, in total control of the patient's fate.

When I first entered the ER, I experienced a similar sense of authority. I had the power to decide who stayed and who left, to manage the emotions of distraught relatives, and to determine what interventions the patient would receive and what would be withheld. In those moments, it felt like I was the one guiding the patient's journey, making critical decisions that could change their lives forever.

Nina, a 6-year-old with sickle cell disease, was brought in in respiratory distress and running a fever. Within minutes, her condition worsened — her eyes rolled back, and she went into shock. I immediately called for the nurse, and we started administering intravenous fluids, oxygen, and intravenous antibiotics, among other treatments. A few hours later, we were giving Nina a blood transfusion, and her vitals began to stabilise.

It was then that Nina seemed to rally. Her fighting spirit returned. She began crying, her tiny hands pushing us away, clearly frustrated. She frowned, her little face scrunched up with confusion and fear, probably wondering why she couldn’t see her mother. When Nina finally caught sight of her mother and reached out, her eyes were full of curiosity — but there was a hint of distrust too. It was clear she wasn’t fond of the medical team, likely associating us with the discomfort of needles and the invasion of her personal space. Despite her small body being overwhelmed by the sickness, the spark of childhood resilience was unmistakable.

I looked at little Nina and thought to myself that she would grow up to be a beautiful, but fiercely stubborn young lady. Her big eyes—eyes that could shine with laughter, fill with tears, yet still hold onto hope—spoke of a strength that would define her.

“I really am a god,” I whispered to myself, the words more of a quiet affirmation than a boast.

She began to play with her fingers, lost again in the world of a six-year-old’s imagination. I walked out of the ER, confident she’d be just fine. At least, I thought so—at least, for the next 40 minutes.

Her pupils were dilated, and non-reactive to light. There was no trace of joy, no sign of sadness, no wonder in her gaze. Only a hollow emptiness. I heard her final gasp-like breath—aloud, shuddering sigh that seemed to echo through the sterile silence of the room. And in that moment, I realised: I had failed.

She lay there, face up, ashen skin, her limbs cold as ice. The sight of her lifeless body was unbearable. I stopped the blood transfusion—it was no longer necessary. I disconnected the fluids, and with a slow, reluctant motion, I covered her with the hospital blanket, leaving her face exposed, resting in a peace that would never be disturbed.

I sat at my desk, pen in hand, and wrote in her file: no cardiac-pulmonary activity. As I did, my mind replayed the events in the ER over and over. I had followed the protocol—everything by the book—just as I had with the other two children with sickle cell disease. But this time, it hadn’t worked. Seven years of training, building on more than a century of medical knowledge, felt like nothing more than a stark reminder: I was not the god of the ER.

While I rushed through the ER, shouting orders during a resuscitation, I couldn’t help but wonder if there was an angel standing quietly nearby, holding the final decision in His hands. When the patient survived, I walked around for days with an inflated ego, convinced of my own skill. But now, the file of my first-ever mortality sat open on my desk. It was time to document Nina's time of death. I asked myself, almost in a whisper, Why hadn’t the treatment worked?

I ordered an autopsy, but I knew deep down that it would only tell me how she died—not why. The answer came later, in a quiet realisation of something my father had once said: Only one doctor knows why. He was the only God in the ER, and unlike me, He didn’t need a medical degree. That day, I became human again.