Tuesday, May 4, 2010

A ride to remember

As a part of our community medicine posting during internship, we have to do a week being the transfer intern- this intern has the privilege to ride with the referred patients from the secondary care hospital to our tertiary hospital.. My first day as transfer intern was surprisingly light, i had only 4 transfers, all of them were pregnant women, with previous LSCS or PIH or some other minor condition, and though i went for each of these transfers paranoid that one of these panting ladies might just give a big push and i would be forced to conduct a delivery with my (then) nonexistent knowledge of childbirth, thankfully the day went of without a hitch. So on day 2, when i received the summons, i cooly walked into casualty with a smile on my faceto the sound of "oh good, transfer intern is here, Patient is having chest pain, here's the ECG.. I have spoken to chest pain unit (CPU).. They'll be expecting u there.. NOW GO !!!" The smile faltered a little as i asked , " do i need to take anything or be prepared for anything?" " No, no the patient is stable, jut put him Oxygen though" was the reassuring reply from my senior.So with the smile back in place i waited as we shifted the patient into the ambulance, only then i realized the patient had no bystander, i was going to be alone on this ride... i don't know why but i felt a few 100 ml of gastric secretions pour into my stomach at the thought.. The ride started.. 2 min into the ride my patient looked like he'd fallen asleep... 'i called his name, ayya yenna aachu?' no response.... my heart started to race, for no better reason than that i dint know what else to do, i checked his pulse and auscultated his chest.. was i picking up a pulse or was it my heart hammering ???i screamed at the driver "anna, lights and siren please.. we have to go fast, really really fast." While i massaged his chest, wondering how and what and if i should do anything at all, the patient twitched.. ah, he's alive.. relief flooded my body.. till he twitched again, jerked, had tonic spasms... oh shit.. its a seizure.. no pulse.. hypoxemic seizure... I started CPR ( Cardiopulmonary Resuscitation).. With no proper equipment, no help, in a vehicle that was now going full speed such that i was thrown across the ambulance every few seconds, i figured il just increase Oxygen to maximum and hope for the best, I started chest compressions.. he had occasional spontaneous breaths, my only sign of him being alive. The ambulance took a u-turn, i was thrown on the floor, the patient fell on me, as i scrambled out from under him, i realized he was 90 kgs, i din't even try to put him back, i continued Chest compressions, kneeling on the floor beside him...he had hit his forehead when he fell, small abrasion with some bleeding.. last of my concerns.. every second felt like a year, here i was, knowing that i was the only one who could keep him alive, and i wasn't even sure if what i was doing was correct and enough.. Finally we reached the hospital, CCU.. the ambulance doors open, im still on the floor giving cardiac compressions.. a few nursing staff are standing there... "Sister i need help, im not getting a pulse on him"one of them said "sorry, duty doctor has gone for lunch, we cant accept the patient" i was shocked, i was still on the floor, exhausted from the effort of giving compressions for so long and the last thing i expected was this.. i had no words, no response... The driver said," doctor shall we take him to casualty?" "yes" i screamed, all i cud think was yes please go somewhere, please, where real doctors would come and do something, please don't let him die like this, with me.... We went to casualty, where they continued compressions, intubated him, gave adrenaline, atropine, shocked him 4 times and finally got a pulse on him... I stood around, wondering want to do, a part of me wanted to ask if he would die cause i wasn't good enough, d other part of me din't want to know the answer to that EVER.. Finally, when the patient was stabilized, a registrar walked upto me and said " u did a good job, if u hadn't started compressions, we would have declared him brought dead. U can go back, we'll take over" I left casualty.. i learnt the next day that he'd arrested again 8 hours later, and died. i know i had done my best, i had done everything i could but sometimes i can't help but wonder, was my best just not good enough... maybe someday il know the answer.

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