Recurring Nightmare 1

Please read Foreword first.


Recurring Nightmare – General Surgery

You stumble into your call-room at a little past 2 am, having finished the last e-case for the night. You tell yourself you will just lie down for a minute before you take your shower, even though you know there’s a good chance you will just fall asleep.

But you don’t get to sleep or take a shower, because no sooner had your head hit the pillow did your pager beep.

'Trauma standby. ETA 20 minutes.'

Alpha-numeric pager. The wonders of modern technology.

You groan and drag yourself out of bed to start walking halfway across the hospital to the A&E.

In the resus area the A&E MOs and Reg and you greet each other with a bored ‘eh’. Your Reg arrives a few minutes later, followed almost immediately by the patient.

Young man who lost control of his bike speeding down the highway. Barely conscious, blood from almost every orifice you can see. Same story.

You wonder who calls the ambulance in these cases.

The A&E Reg takes the head, your Reg takes the abdomen, you take the right arm, your usual place of honour.

Getting a plug in is almost never a problem. The fluids are running in before the machine has got a BP reading.

The BP is low. Your Reg decides to do a diagnostic peritoneal lavage. Your place a hand on the chest. The right ribcage feels like a bag of loose lego blocks. You decide to insert a chest tube before the Xray guy comes. You get some blood, but not enough to account for the low pressure.

You hear a sigh from your Reg.

'Blood.'

You look at each other. You both know that means no sleep for the night.

Just then the alarm goes off. Flat-line. The patient’s gone into asystole. The team pounces onto the patient and start CPR in earnest.

Miraculously, after fifteen minutes, you get a rhythm and a pulse. You look at the A&E team, slightly embarrassed that your disappointment is showing. But they understand. There is no reproach in their eyes.

You go to the nursing counter to call the operating theatre and rifle through the patient’s belongings.

IC, Driver’s License, family photo.

You look at his handphone, which somehow survived the impact. Wallpaper of him and his girlfriend (or wife?). Last call made to 'mum'. You wonder if you should hit the 'call' button.

It takes nine rings before the OT staff picked up. They too were just settling down for some rest, it seems.

'OK, can send now.'

The OT is eerily quite and cold at 3 am in the morning. The anaesthesia Reg is even less talkative than his usual self. You wonder if it’s because he is sleepy, or if he blames you for keeping the patient alive long enough to make it here.

Inside the abdomen you find a liver laceration, but most of the bleeding is actually retroperitoneal and you can’t do much about. The Reg decides to close before the gut gets too cold.

You finish writing up the op notes and change into fresh scrubs. Almost six. Still a chance to get some winks.

You walk halfway across the hospital to your call-room. No sooner had your head hit the pillow did your pager beep again. It’s the ICU. You dial the number without getting up.

'Surgical MO is it? Can you come and sign your patient up?'

You groan and drag yourself out of bed.

At least the cafeteria is near the ICU. You so need some caffeine.