Saturday on-call was eventful up till 5am. That was when my imaginary guardian angels (... well you know what i mean) finally decided that my battered knees and sprained right wrist could need a bit of a break.
8.05am - Ashraff, the senior A & E registrar called in from the resus room, a 65y man with sudden onset breathlessness, fever and cough had a high cardiac enzyme which may signify a heart attack requiring a CCU bed.
12pm - 2 patients in CCU needed a central venous line each. "Well, no problemo gentlemen. Just show me your lower necks. I'd love to puncture those areas with my sharp 18 gauge needles."
5pm - Suraya, a super bright and vibrant 2nd year internal medicine MO called in for a CRW bed. She wanted a bed for her 60y old lady with fast atrial fibrillation secondary from thyrotoxicosis. Rate about 110/min, no failure symptoms. BP holding on with no inotropes.
10pm - another man with a heart attack had gotten worse. His type 1 respiratory failure had now complicated by severe metabolic acidosis, slowly poisoning his vitals organs and could push him into comatose state within next few hours. Respiratory fatigue will be inevitable. His BP was rather low with 3 inotropic support.
Shit. Time to intubate him.
"Uncle, you're not doing too well at the moment. We need to put you into sleep in order to make you feel better. Now before we do that, I want you to think of God in your heart and mengucap okey."
He looked weak and nodded quietly.
3am - intubated man now developed coffee ground coloured material inside his nasogastric tube.. ?? We dealing with an upper GI bleed until proven otherwise. DAMNIT. Well at least there is no malaena.
"Okey, start IV pantoprazole 80mg STAT, followed by 8mg/hour infusion. Gotta call in the bleeding team."
At that point, the patient's wife looked at me. Tears started to flow down her cheeks "What have you done to my husband, doctor... ? He was well 5 hours ago. Now he bleeds after you connected him to that breathing machine..."
I tried to comfort her "Auntie, your husband is very ill... he might be bleeding from his tummy, but it is not related to the intubation, I will..."
I couldn't finish my sentence. She already left the room with tears flowing heavily.