Friday, April 29, 2011

Around the ward 1

It was my first on call in surgery.

A rectosigmoid cancer with ovarian metastasis patient just came in to the ward after a long surgery since 10am; underwent total colectomy with ileostomy. She was on epidural analgesia.

I was greeted by the family members with, "Doctor! Why this patient is not sent to ICU? The surgeon has promised me that this patient will be nursed in ICU after the operation!"

"I see. Please hold on. I need to check the notes first."

I reviewed the note. It was a long surgery. Estimated blood loss was around 1.6L. She was transfused with 4 pints pack cells intraoperatively. There was also episode of hypotension and she was put on single inotrope during operation. In recovery room, the anaesthetist decided to send the patient to the ward as she was stable there.

I explained to the family members about the decision.

"I don't care about it! They have promised me to send her to ICU and I want to claim my right!

What kind of right was he talking about? huhu.

"The anaesthetist decided to send her to the ward. They knows better about in-and-out of the ICU."

"Ok. Fine! I'll come later and find your specialist!"

"Ok. You can discuss the matter with my specialist. For now, she is in ward and I'm going to take care of her tonight."

Then, I heard my staff nurse called me, "Dr. Su, her BP is 70/50!

Oh, really? I repeated it myself. It was vey low; I barely heard the Korotkoff sound. Narrow pulse pressure. She was tachycardic with very low pulse volume. Dry looking. Edematous. Low urine output. Stoma loss and drain loss was 800cc (after 1 hour of transfer!). Luckily, the anaesthetist reserved a big neck line for me. But that was the only one!

Every single minute following that was really a challenge for me. Adrenaline and noradrenaline remained at the peak of graph througout the night.

Oh, come on...this is not my first on call...I've had enough collapsed patient before...this is not the first time for me to resuscitate a patient.

Pushing fluid challenges and at the same time struggling in setting the line as she was very edematous; and doing these while the family members were watching me resuscitating her as they were so 'stubborn' to stay outside the curtain were really a challenge - to remain confident-looking, calm and at the same time to think and do things fast.

Meanwhile, other patients in the acute beds were in pain needed attention that I just couldn't attend stat. The least I did was to ask the staff nurse to give analgesics and maxolon before I could attend them. I also had enough marathon from 8th to ground floor that night. I used to do all those things but that night it was just too much for me.

Managed to stabilize her before my MO came (I've informed the condition beforehand - remember, calling for help and informing MO for emergency case are very important - every houseman should know where is our limit). Plan of management was improvised.

12 days later...

The patient was better. So much of improvement. Able to sit up. Able to take soft diet. No more oxygen, IV drip, TPN, drain, CBD, CVL etc.

"Doctor, I would like to thank you for taking care of my wife."

Smiled. "I was just following order from my boss."

"And I would like to appologize from being rough and rude to you that day. I just couldn't control my anger."

Smiled. Satisfied. Syukur.

"At that time, I have to put myself in your shoes. I have to try to understand if the patient is my family member."

"It's good doctor. But still, as a human, I felt guilty for that. If you are not a doctor, what would you actually feel?"

"Pray hard so that she will recover faster."

Prof Nasser used to say, "Treat your patients as if they are your mother, father, sisters and relatives. Don't only serve your specialist, serve your patient."

It is very very true Prof. But it's not that easy to do it. Thanks for teaching me the value.

43650 Bandar Baru Bangi

Note : I write this because I want to remember it for life and I want to remind myself about the value that I should possess. This is only a small piece of everyday life stories...but this one really gave an impact for myself.