The return of the Angel of Death...

I was on call yesterday...was a relatively good weekend call i must say...although the 2 cases we did in the morning ended up pretty complicated and we only finished at about 3pm...after that, went for lunch with my senior MO and his wife and baby...his wife was shopping for a friend's farewell present... and he wanted to shop for his wife's birthday gift...so after lunch we were at Charles & Keith (coz they were having sale)....

After his wife left, we went back into the store to buy some shoes that she liked...i ended up buying a pair of black strappy heels with studs which was going for 70% discount...so i only paid about rm53 for the pair of heels...i actually preferred the brown or the cream-coloured one but they only have my size in black...oh well, black still looks good...

We went back to do on call rounds and everything was pretty quiet though i had to go back to the hospital once to see some new admissions...thought maybe i could rest at home that night coz i wasn't feeling too well...but i guess the Angel of Death wanted to make a comeback...got a call from my specialist on call about 10pm telling me that there was an UGIB patient coming from Queen casualty...massive bleeding...but as with Malaysian efficiency, the patient only reached the OT at 12am...

Patient was intubated when he arrived...and blood was practically pouring out from his mouth and nostrils...and his nasogastric tube free flow was about 1 litre of fresh blood...so we proceeded to perform an on table OGDS to try to look for the source of bleeding...but all we could see was gush of blood...so we proceeded to exploratory laparotomy immediately...when we opened up the stomach, we found massive amount of blood clots...but no bleeding source...so we moved on to the duodenum...nothing in D1 and D2 but blood...

We were racing against time coz the blood and blood products were taking rather long to reach the OT...i could see the patient's heart rate steadily dropping from 100 plus bpm to 90...then to 80...to 70...to 60...and we still hadn't find the source of bleeding...but my surgeon suspected the worst so he opened up D3 and D4 and we finally found the source of bleeding...it was an aorto-duodenal fistula...we couldn't proceed to repair as patient was too unstable...by then his heart rate was 30 plus...and his pulses were no longer palpable...and we couldn't proceed with CPR due to medical futility...

The poor uncle...may his soul rest in peace...it's a horrible feeling...watching a patient die...and you can't do anything to save him because it was too late...and the indignance you feel when you know the patient could have reached the OT way earlier if not for the gross mismanagement at the referral level...sometimes you wonder if this was all really written in the Book of Life and Death...did God really plan for the 12 hours delay to OT? did God really plan for this uncle to die because of the gross mismanagement of his condition? oh, sorry, activated the God-complex mode...

Sometimes you would think that medical personnels are cold and heartless...coz even in the face of death, we still joke and laugh...forgive us, we don't mean to be cold and heartless...for some of us, it's a defense mechanism to deal with deaths...and many of us have seen too many deaths that we'd all sink into the dark abyss of depression if we allowed them to affect us...and it doesn't help that some of us are the Angel of Death incarnates...