Chaos
Yesterday was just chaotic.
I only had 1 hour of sleep, probably less, during my on call. I was paged to take blood and set line in the wee hours of the morning at the 1st class ward-- I failed to take blood from the patient even after pricking her about 4 times.
I had to set line for about 4 patients, take blood, clerk 2 patients for nephro who came in in the middle of the night.
On top of that, I had two very critical patients in my chest cubicle who spent the whole night next to each other, breathing labourously, and hanging on to life. The two of them kept calling me to come and see them. I hate it when patients call me to come and see them when they are critically ill as I've learned it usually is not a good sign. However, I oblige everytime because
As expected, my first patient, the prisoner, was breathing labourously for a few days now. We had already put him on high flow oxygen mask. I knew it was too late to save him because he was probably having advanced HIV and he had a lung infection. His immune system was shutting down.
As I looked at his mother sitting by his bedside, with that dazed look in her eyes, watching her son breathe so heavily the evening before, his eyes already rolling upwards, I felt guilty. Guilty because I felt I did not do my best for him. My medical officers actually asked me to tap his right pleural space to take some fluid out and probably we will consider putting in a chest tube, but that day, I just knew it would be futile. I didn't think it would be worth the risk of tapping him as he was very unstable and his conscious level was falling.
I did test his conscious level the evening before, if he knew where he was. Through heavy breathing, he said he was in the hospital. I told him he had to hang in there, and that people are waiting for him to get better. He just continued breathing heavily. To make things worse, the hospital had run out of ventilators. And our head of department did not want to send anyone out of hospital at the government's expense for ventilation in a private hospital. It's all about the money in the end.
I listened quietly as my medical officers discussed in hush tones about the prognosis of both my patients: the 31 year old prisoner and the 48 year old man with advance esophageal carcinoma with direct extension to the lungs.
I looked at both of them practically side by side in the wards. Both breathing heavily. One on assisted ventilator, the other on high flow mask. And I quietly wondered which one would go first.
In the wee hours of my post call morning, I stole behind. I had received word the night before that I was to accompany a patient in my ward who had thrombotic thrombocytogenic purpura (TTP) to ampang hospital. Yes, for all of you who are wondering out there why I always get to travel here and there (I've been to USM, IJN and Ampang hospitals in the last two months now.. ), it's because it's the 4th call house officer's job. I almost got roped in to follow a patient to Sibu Hospital by helicopter the week before, but managed to wriggle out of it.
So, I chatted with my patient's family, telling my patient's sister the grim prognosis as lightly as I could. Both patients were still labourously breathing, but the prisoner looked much quieter now. I dropped by his bed next, and tapped him on the shoulder. No response.
Heaving a sigh of knowing what was to come, I asked the nurse to quickly come, and run 1 bottle of fluid fast, check his blood pressure, and checked his pupils. It was already constricted, slow reaction to light. The father stood quietly at one side. I quickly explained to him what was going on. I asked if he wanted active resuscitation. The poor man probably didn't know what else to say except yes.
Just then, another nurse called me, saying the ambulance was ready for transporting the patient to ampang :s talk about BAD timing. I glanced at my friend who was taking over for me for the day, and she looked grimly at the patients I had to pass over to her for the day.
Before I left, I gave orders to start the prisoner on IV dopamine stat, as his blood pressure was dropping. I passed over to my colleague that his family asked for active resuscitation. I slowly dragged my feet away from my patients to accompany the other patient down to Ampang Hospital. Duty calls.
When I came back at around 5p.m, it was chaotic. I discovered that I had forgotten to pass over to my on call colleague to take the arterial blood gas for my patient who was on ventilator, who had just passed away. Not that it would make a difference but it's been a long time since I left my work undone. My prisoner friend had long since expired from this troubled world after I left in the morning.
My 48 year old patient had passed away about 20 mins before I reached the ward despite active resuscitation. The story I got today was that his ventilator suddenly went blank, and refused to start despite the fervent attempts of my colleague and nurse to restart the machine. The family noted, panicked, alerted my colleague and nurse, and they started resuscitation as the patient's vital signs started crashing one by one.
Despite their prompt actions, the patient passed on. I don't know if it's due to the failure of the ventilator, or because of the cancer. But the family members were not happy, so we're expecting some medicolegal actions to come up soon as apparently the son of my patient was furious, and had shown his temper by hitting the bathroom door. HARD.
The story travelled so fast, it went down to the other wards by this afternoon :s I was half glad I was not around for the day as the rest of the ward was also chaotic. As I was half way through writing the death summary and certificate for my patient, post call, drowsy, back from travelling the whole day, another patient in front collapsed.
In total, 3 patients passed away in our ward yesterday. It was truly a grim day for everyone. I felt the depression fall like a heavy blanket over the staff and family. What a gloomy day..
Today wasn't that bad. I was happy that I am going back to KL tomorrow for a break. My medical officers were a bit sad to let me go, but break is break! I really learned a lot from them, and I am really grateful they share their knowledge with me so readily. I really look up to them.
I spent the afternoon monitoring another patient just transferred in to my cubicle, heavily breathing, but at least he's still conscious when I left. I pray he survives this ordeal. I would really hate to write another death summary tomorrow. Ironically, I have actually gotten to know the coroner quite well :s
This time I made sure I passed over to my colleague on call regarding the patient. The rest is up to her.
Reflecting on my patients, I feel numbness and indifference creeping in. Another patient, another resuscitation, life goes on. I've learned that for each patient, I want to give my best efforts to making them better.
And so, my learning continues..There is always the chaos before the calm in the storms of our lives. That was just one of them for me.
The Sovereign LORD is my strength;
he makes my feet like the feet of a deer,
he enables me to go on the heights.
Habakkuk 3: 19
I only had 1 hour of sleep, probably less, during my on call. I was paged to take blood and set line in the wee hours of the morning at the 1st class ward-- I failed to take blood from the patient even after pricking her about 4 times.
I had to set line for about 4 patients, take blood, clerk 2 patients for nephro who came in in the middle of the night.
On top of that, I had two very critical patients in my chest cubicle who spent the whole night next to each other, breathing labourously, and hanging on to life. The two of them kept calling me to come and see them. I hate it when patients call me to come and see them when they are critically ill as I've learned it usually is not a good sign. However, I oblige everytime because
As expected, my first patient, the prisoner, was breathing labourously for a few days now. We had already put him on high flow oxygen mask. I knew it was too late to save him because he was probably having advanced HIV and he had a lung infection. His immune system was shutting down.
As I looked at his mother sitting by his bedside, with that dazed look in her eyes, watching her son breathe so heavily the evening before, his eyes already rolling upwards, I felt guilty. Guilty because I felt I did not do my best for him. My medical officers actually asked me to tap his right pleural space to take some fluid out and probably we will consider putting in a chest tube, but that day, I just knew it would be futile. I didn't think it would be worth the risk of tapping him as he was very unstable and his conscious level was falling.
I did test his conscious level the evening before, if he knew where he was. Through heavy breathing, he said he was in the hospital. I told him he had to hang in there, and that people are waiting for him to get better. He just continued breathing heavily. To make things worse, the hospital had run out of ventilators. And our head of department did not want to send anyone out of hospital at the government's expense for ventilation in a private hospital. It's all about the money in the end.
I listened quietly as my medical officers discussed in hush tones about the prognosis of both my patients: the 31 year old prisoner and the 48 year old man with advance esophageal carcinoma with direct extension to the lungs.
I looked at both of them practically side by side in the wards. Both breathing heavily. One on assisted ventilator, the other on high flow mask. And I quietly wondered which one would go first.
In the wee hours of my post call morning, I stole behind. I had received word the night before that I was to accompany a patient in my ward who had thrombotic thrombocytogenic purpura (TTP) to ampang hospital. Yes, for all of you who are wondering out there why I always get to travel here and there (I've been to USM, IJN and Ampang hospitals in the last two months now.. ), it's because it's the 4th call house officer's job. I almost got roped in to follow a patient to Sibu Hospital by helicopter the week before, but managed to wriggle out of it.
So, I chatted with my patient's family, telling my patient's sister the grim prognosis as lightly as I could. Both patients were still labourously breathing, but the prisoner looked much quieter now. I dropped by his bed next, and tapped him on the shoulder. No response.
Heaving a sigh of knowing what was to come, I asked the nurse to quickly come, and run 1 bottle of fluid fast, check his blood pressure, and checked his pupils. It was already constricted, slow reaction to light. The father stood quietly at one side. I quickly explained to him what was going on. I asked if he wanted active resuscitation. The poor man probably didn't know what else to say except yes.
Just then, another nurse called me, saying the ambulance was ready for transporting the patient to ampang :s talk about BAD timing. I glanced at my friend who was taking over for me for the day, and she looked grimly at the patients I had to pass over to her for the day.
Before I left, I gave orders to start the prisoner on IV dopamine stat, as his blood pressure was dropping. I passed over to my colleague that his family asked for active resuscitation. I slowly dragged my feet away from my patients to accompany the other patient down to Ampang Hospital. Duty calls.
When I came back at around 5p.m, it was chaotic. I discovered that I had forgotten to pass over to my on call colleague to take the arterial blood gas for my patient who was on ventilator, who had just passed away. Not that it would make a difference but it's been a long time since I left my work undone. My prisoner friend had long since expired from this troubled world after I left in the morning.
My 48 year old patient had passed away about 20 mins before I reached the ward despite active resuscitation. The story I got today was that his ventilator suddenly went blank, and refused to start despite the fervent attempts of my colleague and nurse to restart the machine. The family noted, panicked, alerted my colleague and nurse, and they started resuscitation as the patient's vital signs started crashing one by one.
Despite their prompt actions, the patient passed on. I don't know if it's due to the failure of the ventilator, or because of the cancer. But the family members were not happy, so we're expecting some medicolegal actions to come up soon as apparently the son of my patient was furious, and had shown his temper by hitting the bathroom door. HARD.
The story travelled so fast, it went down to the other wards by this afternoon :s I was half glad I was not around for the day as the rest of the ward was also chaotic. As I was half way through writing the death summary and certificate for my patient, post call, drowsy, back from travelling the whole day, another patient in front collapsed.
In total, 3 patients passed away in our ward yesterday. It was truly a grim day for everyone. I felt the depression fall like a heavy blanket over the staff and family. What a gloomy day..
Today wasn't that bad. I was happy that I am going back to KL tomorrow for a break. My medical officers were a bit sad to let me go, but break is break! I really learned a lot from them, and I am really grateful they share their knowledge with me so readily. I really look up to them.
I spent the afternoon monitoring another patient just transferred in to my cubicle, heavily breathing, but at least he's still conscious when I left. I pray he survives this ordeal. I would really hate to write another death summary tomorrow. Ironically, I have actually gotten to know the coroner quite well :s
This time I made sure I passed over to my colleague on call regarding the patient. The rest is up to her.
Reflecting on my patients, I feel numbness and indifference creeping in. Another patient, another resuscitation, life goes on. I've learned that for each patient, I want to give my best efforts to making them better.
And so, my learning continues..There is always the chaos before the calm in the storms of our lives. That was just one of them for me.
The Sovereign LORD is my strength;
he makes my feet like the feet of a deer,
he enables me to go on the heights.
Habakkuk 3: 19
posted by yeoslian at 8:57 PM
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