Thursday, July 15, 2004
Medi-mayhem
We had an ER day today.
I haven't felt like this since I was a med student. Back then, tailing along at the rear, sorta from the cameraman's positition, it was exciting and interesting.
Today from the perspective of one of the soldiers in the trenches, it was vaguely terrifying.
Everything hurled itself at us today, and the seams began to buckle at the edges.
1) The missed barn-door MI - how could that possibly have happened? The rest of us wondered. But, no doubt the department was heaving, and we all have our, cough, model moments (phrase stolen shamelessly from a model, hmm must butter her up or she will get angry, gorgeous, intelligent model who rates perfect girlfriend on some random poll thingie out there) so we all empathised, and heck, empathy is our bread and butter.
But I think we were all secretly wondering - when will that happen to us - making a major mistake out of... fatigue? Overwork? Stress? And hoping fervently that it never does. Stave off the odds, dancing on the thin razor's edge a little longer.
2) And then the "MI" that was thrombolysed - due to language failure. My colleague showed me some ECGs and asked me what I thought (I was so engrossed that I didn't notice the really pretty blonde medical SHO sidle up next to me and stare at the ECGs too)
I wasn't terribly impressed - they didn't *quite* look thrombolysable to me. Borderline, maybe with the eye of faith just meeting the criteria. I said so, and he replied that we'd already thrombolysed.
Shrug. Oh well, okay. The med SHO shrugged too. She's so pretty when she shrugs. laughs.
Then I found out they'd done it on a very weak history based on what they had gleaned from hand-signals - language difficulties. "No english". Ooo. The hairs on my neck stood up a little. I went and saw the dear little old man - a dear, little old chinese man.
Who couldn't understand my faltering mandarin, and only shrugged when i asked him if he spoke cantonese, in my pidgin cantonese.
I told them he couldn't understand me, but came back later to try again, and realised that he was actually a bit deaf to boot. So I shouted at him in mandarin, and he replied in cantonese, and eventually I elicited this history :
never had chest pain
had bad back pain
called GP, GP sent to hospital.
Oooo. hairs on neck start wilting in fear.
The med SHO comes up to me with the Chest X ray and says, guess what?
There's a widened mediastinum, and the cardiology consultant's opinion is this truly is a dissecting thoracic aneurysm.
oops.
I wondered when my turn would come.
3) It came with The Cardiac Arrest.
an elderly gentleman who suddenly had chest pain and collapsed at home, downtime 30 min, went into VF nine times in the ambulance. a no-hoper from the moment he trundled in the door. The call was taken by my senior, with another senior intubating (I wanted to do that!!) and myself as the supernumary SHO establishing access and doing all the superfluous stuff that we do.
It was a flawless exercise in futility - it was one of those calls when it all clicked together. The senior at the head end slid the tube home, I slammed first one, then another venflon home with almost unreal accuracy, and then needled a pulseless femoral artery with uncharacteristic accuracy (eh? first time lucky??) and the lead nurse defibbed the pulseless VF he came in with. Everything went like clockwork.
Then, just as we were about to call it, the last thing we expected happened - the patient came back.
The senior, standing at the head of the bed - "I've got output with this rhythm". I corroborated that almost immediately.
We paused for just an instant.
Then went into the realms that we rarely do - external pacing, and all sorts of weird and wonderful things I only remember from my med school days.
After five minutes he went off again. And this time we couldn't bring him back. I did get enough chest compressions in to completely ruin my gym session (much) later this evening. I won't write that I spent my evening plucking petals from a flower staring at the phone. laughs.
Quite literally an ER day. Too many things in my head, all at once, and nobody to tell them to. And writing just isn't the same.
Also, running just isn't enough. I don't get no satisfaction... need to feeeennnnnccceeee.
I haven't felt like this since I was a med student. Back then, tailing along at the rear, sorta from the cameraman's positition, it was exciting and interesting.
Today from the perspective of one of the soldiers in the trenches, it was vaguely terrifying.
Everything hurled itself at us today, and the seams began to buckle at the edges.
1) The missed barn-door MI - how could that possibly have happened? The rest of us wondered. But, no doubt the department was heaving, and we all have our, cough, model moments (phrase stolen shamelessly from a model, hmm must butter her up or she will get angry, gorgeous, intelligent model who rates perfect girlfriend on some random poll thingie out there) so we all empathised, and heck, empathy is our bread and butter.
But I think we were all secretly wondering - when will that happen to us - making a major mistake out of... fatigue? Overwork? Stress? And hoping fervently that it never does. Stave off the odds, dancing on the thin razor's edge a little longer.
2) And then the "MI" that was thrombolysed - due to language failure. My colleague showed me some ECGs and asked me what I thought (I was so engrossed that I didn't notice the really pretty blonde medical SHO sidle up next to me and stare at the ECGs too)
I wasn't terribly impressed - they didn't *quite* look thrombolysable to me. Borderline, maybe with the eye of faith just meeting the criteria. I said so, and he replied that we'd already thrombolysed.
Shrug. Oh well, okay. The med SHO shrugged too. She's so pretty when she shrugs. laughs.
Then I found out they'd done it on a very weak history based on what they had gleaned from hand-signals - language difficulties. "No english". Ooo. The hairs on my neck stood up a little. I went and saw the dear little old man - a dear, little old chinese man.
Who couldn't understand my faltering mandarin, and only shrugged when i asked him if he spoke cantonese, in my pidgin cantonese.
I told them he couldn't understand me, but came back later to try again, and realised that he was actually a bit deaf to boot. So I shouted at him in mandarin, and he replied in cantonese, and eventually I elicited this history :
never had chest pain
had bad back pain
called GP, GP sent to hospital.
Oooo. hairs on neck start wilting in fear.
The med SHO comes up to me with the Chest X ray and says, guess what?
There's a widened mediastinum, and the cardiology consultant's opinion is this truly is a dissecting thoracic aneurysm.
oops.
I wondered when my turn would come.
3) It came with The Cardiac Arrest.
an elderly gentleman who suddenly had chest pain and collapsed at home, downtime 30 min, went into VF nine times in the ambulance. a no-hoper from the moment he trundled in the door. The call was taken by my senior, with another senior intubating (I wanted to do that!!) and myself as the supernumary SHO establishing access and doing all the superfluous stuff that we do.
It was a flawless exercise in futility - it was one of those calls when it all clicked together. The senior at the head end slid the tube home, I slammed first one, then another venflon home with almost unreal accuracy, and then needled a pulseless femoral artery with uncharacteristic accuracy (eh? first time lucky??) and the lead nurse defibbed the pulseless VF he came in with. Everything went like clockwork.
Then, just as we were about to call it, the last thing we expected happened - the patient came back.
The senior, standing at the head of the bed - "I've got output with this rhythm". I corroborated that almost immediately.
We paused for just an instant.
Then went into the realms that we rarely do - external pacing, and all sorts of weird and wonderful things I only remember from my med school days.
After five minutes he went off again. And this time we couldn't bring him back. I did get enough chest compressions in to completely ruin my gym session (much) later this evening. I won't write that I spent my evening plucking petals from a flower staring at the phone. laughs.
Quite literally an ER day. Too many things in my head, all at once, and nobody to tell them to. And writing just isn't the same.
Also, running just isn't enough. I don't get no satisfaction... need to feeeennnnnccceeee.
