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.

Holding on

Tonight I find my self back in my empty condo. The invincible cats are no longer making noise. It's either they had run away or my neighbours have adopted them for good, feeding them with a make believe Friskies. Lolly, the overweight pooless pink panda has gone asleep. Hope she has a good dream.

The sound of the ceiling fan keep me company for a while. Just enough till the broken clock in my bedroom strikes 11pm.

I suppose nothing in this life is for certain, right? Make use of our existence in a good way. Do not cause harm to others. For all we know is that all despair needs is for good men to do nothing. And I have this sneaky feeling that there is only few good men left in this world.

Good night Lolly.

Different angle

The young man with leukaemia who slept opposite my bed is no longer there this morning, either he has passed on or they have transferred him out to an isolation room sometime late last night.

The old Chinese man in room 1 has definitely moves on to a better place. I made the visual confirmation as I walked passed his room earlier today. Ironically he was pretty much 'alive' and looked well at 12am last night. We exchanged glance and nodded off to each other like any regular Asian gentlemen. He did not exhibit any particular characteristics indicating that he is going to meet his maker (well mine too) anytime soon.

Anyhow, his stiff cold body is now tightly wrapped in a white cloth. You could easily tell which side is up. I am sure rigor mortis had set in for few hours now.

In hospital, your perspectives on life and death are different depending on whether you’re staying as a patient or working as a staff. Your mental and physical fitness offers a different tone to the way you perceive things.

Even though I have seen death so many times before, yet I feel vulnerable this time around. Yes there is a soft glaze of fear in my eyes.

Well, I got to stay in for another few days to complete my antibiotics. Okey I better continue with my work now, I have promised someone that I’ll get busy and get some of that done today.

The patient

The patient is a middle age Malay male who came to the Emergency Department shortly before 9pm. He complained of fever since 5am the same day. By noon his fever became high accompanied with chills and generalised muscle ache and joint pain. By dusk, his sore throat became more evident. He told me that he was otherwise healthy.

The Prof (our respiratory physician), a man in his mid 40's happened to be in the ED that night briefing the ER crew regarding the latest Press Statement made by Tan Sri Ismail Merican on the worsening crisis of H1N1. Prof took one look at the patient in front of me, and quickly said

"We need to admit you because you have Influenza-like illness, but since you have been exposed to a lot of H1N1 patients last week, we can't be too careful."

I arranged for his bloods investigations, chest X-ray the whole lot and sent him to the ward.

I checked back on him 2 hours later and by then he had already received his antibiotics, antiviral and on IV drip.

That's when he asked me, which I thought was strange "So how are you feeling, much better?"

"I dunno... I still have the fever, I guess it's too soon to tell" I replied.

I looked back at the figure who asked me that question, it was actually a lady nurse who came to checked my vital signs and changed my IV fluids. That man had disappeared, and I am the patient after all.