Think warm thoughts

The first half of last night on-call was not that bad, the High Dependency Ward was as usual fully occupied. But all of them were pretty much stable, none on inotropic or ventilator support. Couple of cases in the general ward tend to be manageable in the usual manner.

The tone however changed by 12 midnight. The first call came in from Anita the House officer (HO) on call telling me that a patient with a severe stage chronic lung disease secondary from smoking had a poor oxygen saturation monitoring.

I hurried to the patient's room to find him not breathing with no pulse palpable.

"Call the code and push the resus trolley!"

I jumped on him and started CPR. The HO was rather junior and looked quite stunned with the whole commotion, she said she never saw a patient collapsed before.

"That's just great" I thought.

"Don't worry there's always a first time. Grab those gloves and use the ambubag to ventilate him, follow my lead" I tried my best giving her a reassuring smile.

We worked on him for 45 minutes, however unable to revive him. I called the time of death and broke the bad news to his family. They broke down in tears.

**

By 3am I managed to laid down in the on-call room and found myself in a colourful carnival, the sun was bright, it must had been a warm Sunday afternoon. There were lots of balloon and clowns.

At 6.30am got a long-distance phone call which in a way kept me awake till morning, which was absolutely all right since I did not want to go back to sleep anyway. By 8.15am as my shift had ended and I was on my way home, my pager beeped again. There's a patient with a crashing blood pressure. The in-charge doctor in that unit had left and the new shift oncall has yet to arrive.

I made another 200m dashed to the unit and found that the patient was already ventilated to a machine. The cardiac monitor showed a Ventricular Tachycardia, the blood pressure was dropping faster than my idle brain activity could cope with at that time. I ran fingers along his neck and found a pulse.

"Bugger me! There is something on line 15, paragraph 1, page 80 of that little black book that deals with this type of medical emergency" The morning after your on-call is never designed to deal with an emergency situation like this.

BING! BING! Suddenly I felt like someone just sent me an online medical article to my woozy mind, which I hope not from our friendly wikipedia. It became clear then.

"Okay charge the defibrillator machine with synchronisation" I told the nurse.

"Stand back. Clear."

I held the paddles to his chest, gave them a bit of pressure and hit the button.

The patient on the bed jolted as I zapped him with 300J of electical energy sending him back to sinus rhythm.

Less than 5 minutes he went back into VT, but thank God the second cardioversion managed to sustain the heart in sinus rhythm.

That was a close one.

I lost one patient and got back another. Another tiring post call day and all my body craved for this morning is a hot meal and hot shower...

.. and perhaps nice warm thoughts too.