Angry Doctor

Wednesday, November 16, 2005

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.

5 Comments:

  • I think I should commend all those, like you, who are still doing all these and not running away. The whole system would collapse if doctors only think of a 'better', easier life rather than fulfilling this calling.

    By Anonymous dryvlee, At November 16, 2005 10:18 am  

  • Sounds awfully familiar. Did we work together before angry doc?

    But seriously it is kind of fun when we remember those really bad calls. It's fine when you are single and can tell such "war stories" to the girls at Mohammed Sultan.

    But I found out that once I had a family, and children, I preferred to be with them at home on a night having dinner, reading to them, playing the Xbox with them, than attending to such high stress emergencies.

    I suppose it's a choice. Everyone is entitled to a choice on what is their calling in life. For some it might be to be a good father. For some to be a great dedicated surgeon. The trouble with us doctors is that we can't mitose and be at two places at a time.

    Life is never going to be easier for anybody. But it can be DIFFERENT. And the choice to change is up to the individual.

    I do not think we have a right to chastise anybody for making choices in their lives.

    Is dryvlee trying to say that GPs who felt that doing calls and having no sleep was not for them, but preferred office based practices are also "running away" and not "fulfilling" their calling? Everyone has a place in the system. Even the aesthetic medicine doctors.

    By Anonymous Dr Oz bloke, At November 16, 2005 11:35 am  

  • I think the experience is pretty familiar to anyone who's done a surgical posting. :)

    By Blogger angry doc, At November 16, 2005 11:43 am  

  • To dryvlee: unfortunately I had neither the heart nor courage to stay in this.

    By Blogger andrew, At November 17, 2005 12:32 am  

  • yea, certainly can relate to bad nights like that.
    i think every one of us has some nightmare tales that haunt us for the rest of our careers. even when one of done with oncalls.
    hang in there.

    By Blogger vagus, At November 18, 2005 8:32 pm  

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