Lessons in life

Being in medical posting means having to come with terms that death will occur anytime of the day, anytime.

So much of it is true during these last few months. During my on call on sunday, 2 patients collapsed during my call, 1 patient had a sudden decrease in conscious level, and I had a not very helpful medical officer.

Yes, I'm beginning to think that I am jinxed somehow. I also happen to be on call again tomorrow, so I'm hoping it will turn out better :s

Today I was a bit sad to learn that one of my patient passed away during an emergency endoscopy which came about because he was vomiting blood. His story was a bit odd. He initially came in to our ward complaining of passing out blood in his stools for a few times at home. We noted he had an upper gastrointestinal bleed, scoped him, stopped the bleed. A few days later in the ward during his admission, he developed another bleed. Just when we thought it was all over, (he was already in my acute cubicle by then), I was doing my rounds in the morning, and I noted that his bed was COVERED literally with his blood stained faeces.

After 8 bags of blood, and another scope, he seemed stable. We transferred him out of the acute cubicle to the subacute cubicle. He had no more blood in his stools apparently, and he seemed stable enough, reading his newspapers, asking when he could go back. Vital signs were all normal except that he was hypoglycaemic quite often on his last day in our ward. We dismissed it, stopped his diabetic medication, allowed him to go home.

That was yesterday.

Today, he came back to the accident and emergency (A&E) ward vomiting blood. Sent him for immediate emergency scope, found that there were some blood clots in his duodenal region, smart surgeon decided to wash it off, and then it happened.... the ulcer bleed non-stop, patient collapsed, and despite active resuscitation, patient died on the scope table apparently.

The image of him waving good bye to me as I walked past him yesterday before he went home, still haunts my mind. Worse still, I bumped into his children while I was sending some blood samples down to the lab. They looked drained, confused and shocked. I answered what I could, because I wasn't at the scene when their father went into shock, but I felt so sad for them and my patient. He could have gone for an emergency surgery, and the bleed could have been stopped, if he had been in a private hospital...

But fate is funny at times, cause he ended up in my hospital, and I got to learn from his story. I'm pretty sure it would be just shocking for anyone if their family member just passed away suddenly. This week we just seem to be having a lot of upper gastrointestinal bleeds.

I wonder, if he had stayed back last night, if he had gone for another scope this morning just to check if his ulcer was okay, would he still be alive? Would we have been able to resuscitate him sucessfully, by giving a lot of blood?

So many possibilities seem to swim in my thoughts.

Yesterday we had a prayer meet in one of the house officer's hostel room :) It was a good time of sharing and encouraging one another. I felt so much more uplifted as we sang songs of worship and praise to our God. I am hoping our cell group will grow, even though there is only 4 of us at the moment :)

The fellowship with my brother and sisters in Christ made me remember why I work ---for the glory of God. It is so easy to forget it especially in our position as house officers because of the mental and physical fatigue we have to endure. I have been unwell for the last 2 days, and I still drag myself to work everyday after popping panadol at home.

But God is with us. Through His words, He will encourage us :) And for that, all of us were encouraged.

So, looking at the 16 year old boy who came in yesterday with 10 episodes of seizure in my acute cubicle, I thought of God. This boy obviously has been injecting drugs into himself for some time-- although he vehemently denies it-- as there were many drug injection scars on his legs, arms, shoulders.. He also had pin point pupils and despite sedating him, he still could yell the ward down and curse us. He's restrained but still able to toss about..

What a waste of life, honestly. I probbed hard with his family, asking them if there were any problems at home, lack of attention that could cause him to behave this way-- he's the 6th out of 8 children, and apparently the most spoiled one according to his brother. No seizures so far, but as far as I can see, he's having withdrawal symptoms. And a big bonus for the day was when his urine tested positive for methadone@syabu@ais.

I wonder what is the antidote for that. Tomorrow I will be on call in my ward, and it'll be active. I'm wondering if I can give him some haloperidol to sedate him again. Apparently, if we give it intravenously, in his condition, he may be sedated for the next 2 days.. Sounds quite good to me :D

Unfortunately, I am not cruel. So yes, I will have to endure his tantrums and tossing about. My medical officer just asked to put him on Ryle's tube for feeding. The nurse and I were discussing the possibility of him pulling out his tube at least 10 times, with the tube being in-situ only when he's sedated :D


These are just some of the interesting thing I learn in my day. Busy as it is, I just have to learn to trust God to open my eyes to the things around me.

And learn to recognize the difference between hypoglcaemia and tiredness in me :)