Friday, September 25, 2009

The Grim Reaper Calls...

I was on call last night...not exactly the worst call in my life or anything..but lately my calls have been that crappy, i no longer bother to compare...my calls are making me feel more like a grim reaper than a doctor...patients just keep dying...i know people keep telling me i'll get used to it after a while...but it still gets to me every single time...

The day started out fine..as usual the action only starts after office hours...whole day i was practically jobless...and then after 5pm, the phone calls start coming...there was a medical patient who was having massive continuous lower GI bleed who was referred to surgery for surgical intervention... needed an ICU bed for stabilization before op...i was reminded of the acquired haemophilia uncle who had the same problem...he died eventually...thankfully not during my call...anyway, since they insisted that patient was stable for transfer and the surgical team will go in that night itself, i accepted the patient...meanwhile, my burn uncle was oozing blood-stained fluid from all 4 limbs and trunk... post wound debridement yesterday afternoon....losing fluid and blood faster than we can replace...blood pressure was low...initially started on single inotrope...then had to add another one...

GI bleed uncle came at 7pm...already on IV dopamine maximum dose...BP quite stable after running in fluid and blood...but blood was practically pouring out from his anus...i was humbled by the fact that 2 gastro specialists actually escorted this patient to ICU...well, i expected an MO to escort coz i didn't want to risk a patient like that with just an HO escort...but 2 gastro specialists is a bit too royal a treatment...i was actually having dinner in the MO room when i heard the voice of someone who always puts a smile on my face...his presence somehow made my stress more bearable...and to think he actually got the arterial line for the GI bleed uncle (you know how arterial line insertion is my bane), i'm forever indebted...yup, just about the only bright spot in my otherwise bleak and dark call...

So anyhow, i was resuscitating the patient...only had 3 pint of bloods...pale as sheet...got DIVC cycle so we were just pumping in that...saving the blood for op...was contemplating on intubating him early since he was getting a bit restless and confused...and it'd be easier for me to get in the central line...opportunity came when GI bleed uncle suddenly said he was dizzy..and he was gasping and all..so intubate!!...good thing wasn't difficult...then Chen Chen came from OT to help me out...she managed to put in the central line and we had to add IV noradrenaline coz uncle's BP was dropping further...we put in a Ryle's tube and blood about 500ml poured out into the bag....

The surgical team was debating on whether to go in or not..since by then uncle was no longer stable...his BP on maximum double inotropes was only about 50/30mmHg....i wanted to transfuse 1 pint of the blood in the hopes of bringing the BP up a bit...when they finally decided to go in at about almost 11pm, uncle became bradycardic and BP was barely recordable..no pulses...had to start CPR...pushed in the blood and all but i think it was too late de...irreversible shock...CPR for about 40 minutes...the grim reaper won....uncle's son was crying so hard, i couldn't bear to look him in the eyes...

So that was that...thank God the meningioma lady who came in post op didn't give me much problem...so i could concentrate on trying to save burn uncle...i had to call his family members to inform DIL coz i was so worried he wouldn't make it through the night...but i was pumping in FFPs and cryos for him...and giving him colloids hourly...he was also pale as sheet...blood bank didn't have O+ blood...but i managed to get him 2 more pints (after already transfused 3 pints of blood throughout the evening and night)....took the GI bleed uncle's leftover 2 pints blood (since he didn't need them anymore, plus they were O+ too) and gave it to burn uncle...of course i sent it back to the blood bank for them to re-cross match....

From after midnight to about 4am, i was sitting in front of the computer while looking at burn uncle's monitor...we couldn't get an arterial line thanks to his burn....so took BP reading every 5 minutes...thankfully, i was chatting with John on the computer...so i could stay awake to keep vigil on burn uncle...by 4am something, we've managed to taper off IV dopamine...and his heart rate came down from 140 bpm to 110 bpm....so i could finally get some rest...thank God i didn't get nightmare about burn uncle dying while i was sleeping...awakened by a call from boss about 745am...asked regarding the GI bleed and burn uncle...she asked if i was ok...which was rare...and proceeded to console me by saying that it was ok, GI bleed uncle was a no-hoper anyway...and she actually said 'good job'...to me...wow!!! i must have done something right huh? though that didn't change the fact that i lost GI bleed uncle to the grim reaper...

Came home after i passed over to Kevin...had dim sum for breakfast with Elaine..then sent her to the airport...came home and crashed...good thing i didn't crash on the way home...

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