Weekend calls are my bane...i'm sure it is for any MO...and i can never have a good call when i'm in Queen...i took over from Kean Khang yesterday...his call was worse...2 patients died...and he brought in 2 more...one of which died this morning...the other one he brought in was a HIV positive patients who is probably in AIDS already...he has Pneumocystis carinii pneumonia of which the Consultant on call over the weekend wanted him to be ventilated for...patient never needed ventilation during Kean Khang's call..or my call..but what was classically hilarious about this whole thing was that the Consultant actually said this.."guarded prognosis, but patient can be saved"....you're kidding me right? who/ what exactly are we saving this guy from? God? an eternity in the lake of fires? oh..maybe we can just prolong his life for another 5 years until some genius finds a cure for HIV infection? i have nothing against patients with HIV/AIDS...but this guy has a cluster of opportunitistic infection...and if the PCP doesn't kill him...something else will...
One of the aunty we extubated 3 days ago took a turn for the worse yesterday...background history of decompensated liver cirrhosis...Child's C already...came with pneumonia which we thought had resolved...but i guess AIDS isn't the only immunocompromising disease around...liver cirrhosis is just as bad...by afternoon, i decided to re-intubate the aunty coz her oxygenation was worsening..and her conscious level was deteriorating...after induction, her blood pressure dropped to about 70/50...and i think she developed a myocardial infarction...had ventricular tachycardia..rate about 150bpm...shocked her twice...not reverted...blood pressure picked up a little after i ran in fluid..so gave her amiodarone...rate kinda slowed....ECG showed new onset left bundle branch block...wasn't there before...but surprisingly the cardiac enzymes weren't raised...only the LDH was high (due to the shock)...but even after intubating her, i couldn't maintain good oxygen saturation... high settings but couldn't ventilate...recruited her lungs twice...managed to get her saturation about 95% on FiO2 100%...then her blood pressure dropped again...started one..then 2..then 3 inoptropes..nothing helped...DILed her...called her family early in the morning...but she was still holding on until i left...boss DNRed her...sigh...i think the induction tipped her over...
The other aunty's lungs went into APO despite the fact she was undervolume...the problem with sepsis...i was giving fluid challenge after fluid challenge to maintain her blood pressure..and she was initially on single inotrope..severe metabolic acidosis...waited for dialysis...but she only got her dialysis at 10pm...had to start a second inotrope to get her through the 2 hours dialysis..but i think it was too late...didn't improve her acidosis...and couldn't ventilate her...saturation was 80% plus only...7.30am..the nurse called me, patient went into asystole...started CPR....came back after 10 mins...but blood pressure and saturation was still as low as ever...5 mins later...went into ventricular tachycardia...shocked her...then went asystole..CPR for 5 mins..came back...by then, we told the family that she's quite a goner already..boss DNRed her...she died at 8.15am...apparently the guy who died the morning before (on the same bed) had the same problem..low saturation..low blood pressure...i try not to magnify coincidences...but well...
Anyway, i guess this is all in a day's work...i think you need some amount of masochism and self-flagelation to survive as a doctor...boss said we've fulfilled our mortality quota for the month.. and it's only aug 3 today...more to come...that's all i can say...went to change AUD after my call this morning...dang! rm2.94 for 1AUD...it just keeps going up...oh well, need to use...so had to change... 2 more days...1 more call...and i'm outta here..for a while...can't wait..can't wait...
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