Ambushed!

What should have been quite a quite on call yesterday had turned 180 degrees into 'the battle for internal jugular vein' by midnoon. Not since the Japs surprised the Yankee navy armada in a remote Pacific naval base called Pearl Harbour, has human history witnessed the kind of shock and awe I get when I found out that I had to perform an elective internal jugular vein catheterisation on a warm Saturday afternoon, for a what supposed to be a regular haemodialyis.

Despite a massive radar support via an ultrasound machine, the vein seem to shy away from my 16 gauge needle.

Thank God I didn't hear any 'popping sound', the last thing I want on my bloody hands today is an iatrogenic pneumothorax, bilaterally.

Have I renewed my medical practice insurance policy? Gulp!

Flashback

I was called up to see a late referral at 1am the other night. The surgical had messed up this one pretty good. What started as an upper abdominal pain was seen and dismissed because per rectal examination was omitted and it's only late at night when someone realised that the haemoglobin had dropped from 10 to 6 g/dl.

Intravascular volume depletion is the name of the game and they managed to do some damaged control by pumped in multiple bags of pack cell transfusion and colloid drip to stabilise the blood pressure and planned for an urgent scope.

I arrived at the scene and almost had a heart attack when I saw the patient in the most unimaginable state. I could almost here the sound of 'exorcist' music tune played in the background.

"Hey don't look at me, that uncle like it that way" Ganesh the surgical MO gave me the defensive look.

"Well just tell him that fashion is so 70's, plus be careful of what you wish, coz you might get it" I gave him a dry smirk.

After completed my assessment I fixed my eyes on Ganesh "Here's the scoop buddy, urine's is kinda slow here but that's because he's dry, don't worry he's non-acidotic and potassium in normal. You fix the tummy and pour in the blood, once the bleeder is caught, his hydration and kidney would behave like a good boy".

As I walked out of the ward, I heard Ganesh's spoke over the phone to the scope room "Okey guys we're going in!"

I smiled. That somewhat sounds familiar.

Home sweet home

The mother of all rotation supposedly ended at 5pm today. Still I found myself working my ass off from one case to another at 7.30pm.

The last case was a 34 year old disco bouncer with a history of ecstasy use ended up in the A & E with a severe acute renal failure. Traces of protein and blood in his urine. Part of his kidneys are ballooning out due to possible obstruction which wasn't obvious in the ultrasound.

He's as dry as a a Legionnaire's army on the Sahara. I pumped in normal saline into his body 1 pint an hour and another 7 pints overnight. The fact that somehow he was pouring out urine like tap water is a good news so far. Let those baby out boy.

On my way out, I spotted a little guy hidden away among our equipments. A nurse told me he has been living there for almost 2 years now.

I wanna take him out, put him somewhere nicer. But hmm changed my mind, he has found his home there. I'm sure he's happy.

My sunshine

I have this tendency to sleep and wake up early these days. Hope it's not a sign of premature ageing. I just re-discovered that my sensory acuity is better in the early morning around 5 -6am. Thank God Lolly made a cup of black coffee every morning to help me ease my way during those semi-somnolence time of the day. I guess another reason for that is perhaps the fact that I begin to read textbooks and do MCQs again. Scary thought.

Waiting for sunrise to appear every morning has become my ritual too. The intensity of daybreak never fails to capture my attention. Let me share with you the best of part of my day is for that brief moment before I enter the main hospital building is to steal a glance at the bright sunshine and the thought of her come to my mind.. every single time. Hoping that she is safe and sound on her bed dreaming beautiful things in this whole wide world.