Just another bad call...

I'm still on call actually...it's now 4.40am...and i can't wait till my passover round is over....i just want to crawl into my bed and crash...it's not like i've been busy till now...i just can't sleep coz i was awakened by my colleague's snores..i'm just too light a sleeper..

But until 9.30pm last night, i've been busy....and after yesterday, i really feel that i'm just not meant to work in ICU...it just stressed me out too much...perhaps my premature greying isn't just due to my genes...coz i'm definitely getting more white hairs over the last year...since i started as a GA MO...

Anyway, the morning started out ok..boss wasn't in a foul mood...we finished our rounds in ICU about 10am something...then we went to do peripheral round in the male and female wards...there was some problem with an uncle who was on epidural infusion...turned out that uncle was quite an important person in the health department so big boss was involved and there was quite an uproar over that matter...so big boss had to persuade the uncle to be admitted into ICU for observation...he refused initially...but eventually agreed after a few rounds of persuasion...

About after lunch, there was an admission...the lady had intra-abdominal sepsis...ventilated for respiratory distress..there was another whole story behind this one..but i think i shall skip...after settling her, had to prepare another patient for re-exploration of tracheostomy site coz he was bleeding from his tracheostomy site...the poor man had a thoracotomy and tracheostomy done the day before...

Just about before 5pm, i got a call from an HO who escorted a CCU patient for MRI brain and cervical...patient was ventilated and on inotrope (a fact which i wasn't informed earlier)...i was supposed to just help them set the MRI-compatible ventilator but when i went down, it still wasn't the patient's turn...i'm telling you, if bad things were to happen, they won't just come in 3 ok? they come in a whole bloody long stretch!!! that patient came with a bloody leaking tube...and the nurse insisted it was fine before they transferred the patient to SMC...i didn't want to change the ETT coz he could still be ventilated and i did not want to look for trouble by changing an ETT just outside the MRI room...and they didn't even bring a laryngoscope...so i went to do a pre-med while waiting for the patient's turn...

The HO finally called me again at about 7pm (imagine that..the SMC staff made a ventilated patient on inotrope wait for 2 hours)...the HO said the patient desaturated and they were bagging him...big boss was in ICU to attend to the epidural uncle who was just admitted into ICU around that time...so big boss and i went down with all the drugs and laryngoscope and bougie (patient was a burly Chinese man..so difficult intubation until proven otherwise)...when we reached the MRI room, the patient was back on his portable ventilator and the HO said his saturation improved..but then i noted that his saturation was actually 20% and he looked kind of blue..so big boss said we needed to bag him again...and guess what? the HO had been bagging with room air earlier coz they didn't bring the suitable oxygen connector for the ambubag..and to make things worse, the portable monitor's battery died...marvelous!!!

We had no choice but to bag with room air and rushed the patient to ICU for resuscitation...thank God he didn't go asystole...so big boss successfully re-intubated him and his saturation went back to 100%...his blood pressure was also quite stable...so we sent the patient back down to the MRI room for his MRI...and then i found out that the infusion pump in the MRI room can't deliver the inotrope at the rate we wanted...for whatever reason...hey i'm not a techie...so i had to ask the HO to manually infuse the inotrope throughout the procedure...and then patient was a bit restless despite us giving him sedation..so i wanted to paralyse him so he wouldn't move during the procedure...but they only brought 1 ampoule of tracium...which wouldn't have last him 1/2 an hour...i was quite pissed off by then coz it was taking too much of my time out of ICU and i was expecting another admission from OT...so i had to go up to ICU and bring an ampoule of esmeron for the patient...i was practically cussing all the way...

Finally i kind of settle the patient and went back to ICU just in time to collect the patient from OT...20 year-old lady...was involved in an accident..she was the passenger...post-partum 2 months...sustained intra-abdominal injury...liver laceration...splenic rupture...it was bad...she lost about 5-6 liters of blood intra-op...and she was in DIVC..her blood pressure was so low despite on maximum double inotropes...i couldn't feel her femoral pulses..when she came into ICU, there was no blood left..only platelets and cryo...so we were transfusing whatever we had...but she was probably still bleeding...she was in ICU for only 50 minutes when she became bradycardic and then asystole...we CPRed for 30 minutes..but she never came back...

I cried...while i was having my dinner...i couldn't save her...perhaps she was beyond saving..but perhaps i could have push in fluids and blood products faster...perhaps i should have started that 3rd inotrope earlier...but it's too late now...a 2 month-old baby just lost its mother...all these deaths are really making me doubt...i can't remember a single patient whose life i had saved...i can only recall those who died while i was on call...

Sigh...i really need a break from all this...or else i'm really gonna sink into depression...i'm so sleep-deprived...so emotionally drained...and i'm not even sure if all this is worth it anymore...