Aug 19, 2009

H1N1 death and me

Someone actually tell me if he hears anyone (anyone including me) talk about H1N1 again, he’s going to freaking kill that person. Well, if he’s so freaking bloody nuts about sending someone 6feet down under, he shouldn’t be reading further. This entry touched a bit about H1N1, but mostly it is about something else. Anyway, technically, I am not ‘talking’ about H1N1, I am just writing it.

In the middle of the night, as I was just about to lie down in that lousy bed in my on call room after a heavy morning, noon and evening of Caesarean marathon, my phone rang. Yes, most of my clinical story began with the phone. That’s why we’re on CALL.

“Patient in HDW with ILI (influenza-like illness) asystole. You’re the primary unit. You gotta come”


I reached there all tired, weary and exhausted like Meredith Grey of Grey’s Anatomy, and pulled a full scrubs and face masks before I entered that isolation room. One of the nurses was heavily pumping unto the patient’s chest. The attending Anaest colleague was bagging and shown me the bilateral fixed pupils. My medical colleague informed the medical specialist on call. The patient, a Day 6 post Caesarean mother, clearly didn’t have any hope to survive, her heart beating without any perfusing pulse completely dependent on the chest compressions and the multiple doses of atropine and adrenaline pushed into her. I finally called it as per protocol, and I calmly sat down gone over her thick medical record briefly and signed the death certificate. Her husband who was previously counseled about her poor prognosis accepted my final word of confirmation of her passing away. He had bloodshot swollen eyes, probably had been crying whole day and night. Just probably. I double checked. Her infection of H1N1 was still pending.

After that entire ordeal, I was called to attend another obstetric patient which the houseman informed me as ‘the patient came in all anxious and headache and BP 200/120 by machine reading’, not even knowing the patient’s age, gravidity, parity and gestation. Obviously, nowadays, economy wasn’t the only thing in crisis.

“You need to review and summarize the case history of the deceased patient and type it out to be presented” bugged the nurses at such ungodly hours, while I was reviewing that patient with impending eclampsia.

“I had a LIVE patient with emergency I need to attend to. You understand what I am talking about?”

“OK, later.”

“Yes, but this is maternity mortality review. I believed the specialist should be called in to analyze, not some small fry like me. Comprehend?” (In Malay, of course)

Next working day, the nurses called again. This time, she pulled in the Matron, for more weightage, power and all. I am totally like ‘Duh’.

Matron K: You need to type, review and I need to save in Pengarah’s pendrive to be sent to KKM

Me: Usually maternal mortality, needs specialist review, I am just small fry. I don’t think I have the priviledge to do it. I can do it then get specialist double check, can I have the records?

MK: you need records? You can’t just write?

M: Huh?!?!? How to write?

MK: Your department so mar fan (troublesome)… [mumbled something]

M: I will pretend I didn't hear that. Please get us the records, my specialist will review it. That’s the protocol, and how things are being done CORRECTLY. (didn’t raise my voice, just highlighted it)

MK: What ever. [Shut down phone]

For the record, that was the first and the last time I saw the patient, I didn’t know head and tail about that unfortunate mother. All I heard was that her oxygen saturation was hooked on 60% on air and 80% on high flow mask for several hours without any intubation as her conscious state ‘doesn’t correlate’. Thereafter, repeated and repeated ABGs shows severe acidosis and low oxygen saturation but still, she wasn’t intubated till her GCS dropped and collapsed. Only then, the Anaest team decided to tube her. There must be a solid professional reason why intubation was withheld earlier. I have yet to find out that exact reason.

Secondly, to send in report about ILI deaths urgently without any professional systematic review is just plain pathetic and irresponsible with total Malaysian-style apathy. If all deaths were reviewed in this cincai manner, no wonder our H1N1 battle strategies are becoming laughing stock.

On top of that, countering own childish unprofessional demand by insulting my department’s professionalism is beyond doubt the most horrendous medical attitude of all time.

DANG! Should have recorded that piece of ‘fine’ conversation for my personal library.

No comments: