Mar 25, 2010

response and responsibility III: state of busyness

My active call the day before was over the cloud apparently. And instead of going back after my postnatal round, I stayed back for the Cardio update course which was a worthwhile thing to do. And finally rested for a while before the awesome futsal session with my colleagues.

I was getting around the hospital so much that I think I used up the cardio work out limit of the week.

Now, being busy can be a good thing apparently, it was associated with lower death rates, which is what being in this profession intended to do.

I was introduced to the term 'Jonah' for being very eventful during on calls by Dr. Nara, my previous surgical MO, during my first posting as a house officer. He's now an aspiring surgeon.
Being inquisitive and all, I did ask him why the name 'Jonah'. His answer was "Jonah. Jonah lar. means you're busy lar." Apparently nobody bothers to find out the origin of this. I made an effort. Searched the web, asked a few more seniors - but there was any answer. Probably someone just made up the word 'Jonah' and over the years, juniors picked them up and used it.
Probably Jonah is just another MD who always has too much to do.

Anyway, my middle name was temporary being Jonah yesterday.

The height of moment came in after lunch hours. I got a call from Kev.

"Hey you gotta see this, MVA pregnant lady 33weeks. Got PV bleeding. Yellow zone, OK."
"OK, I come over.OK, Yellow zone. Patient stable"
"Yes, stable."

Rushing through my mind was the mother with uterine rupture post MVA that I had back then when I was a HO.

I settled a brief referral note in my gynae ward and called up my reliable HO down at PAC to bring the scan machine to the zone, making sure my assessment will proceed speedily once I reached.

I reached.


The unfortunate mother was lying there. Lucid. Awake. She detailed to me the whole incident.
She felt some chest tightness due to impact from the stearing wheel, but was not breathless.

Wall Waterfall

She felt her whole driver seat soaked with liquor, but no blood. Findings of my examination was of equal.

I took a deep breath of relief.

Her baby was still moving, and my ultrasound revealed the strong pumping heart of the baby. However, the major trauma bankrupted all the liquor around the little soul. I thought I saw a retroplacental clot, a small one.

Cardiotocograph of the baby revealed tachycardic at 180.

I called up my Paed colleague immediately, reminding her about the imminent delivery.
My surgical colleague came, assessed and cleared her chest injury as probably soft tissue injury. The chest radiograph was unremarkable by naked eye.

My anaest colleague was temporary at a lost whether to house the C-Section in the Maternity OT or the General OT. Something of a logistic management. But for me, just to be on the safe side, clearly General OT was the safest bet. Always expect the unexpected.

The op was done swiftly, intraabdominal examination by surgical team was optimistic for the patient.

I was too busy to find out about the 1.5kg baby until my Paed colleague passed the word to me about the gloomy condition of the baby in the middle of night when she was on standby for a Ventouse performed by another good HO, fully supervised.

Upon delivery, the condition of the baby wasn't that bright to begin with. The fontanelles was bulging and the eyes were slightly protruding. Intubated immediately and bagged.

My Paed colleague was very furious at the nurses in the OT for their lack of respect for humanity. As the maternity nurse was bagging continuously, she commanded for 'transport' to NICU. The OT nurse was 'busy' entering their swab and instrument counts in to the PC, ignoring her, probably believing strongly that this isn't under her job scope. She had to yell sarcastically to get that nurse to called up Labor Room for the transport.

I told her that this is just the tip of the iceberg that you're experiencing.

Their disrespect for humanity is a culture, rather than the exception.

There was another time when there was massive postpartum haemorrhage post C-Section and everybody was busy with even my specialist, Dr. J was called in. And as we need more instruments to secure the bleeders, the Assisting Nurse was nowhere found. She popped up later, telling everyone boldly she went for lunch. Well, gotta give her brownie points for honesty.

The baby was fighting for his life when I was postcall, struggling with multiple inotropes, but prognosis being poor was frankly conveyed to the father.

The fact that the delay would have much impact on the outcome isn't something that we should get ourselves acquainted with.

However, the fact that we should always do our best in the matter of life and death is probably what defines us as a human, not some ignorant beast.

Lens Piggy


seahorse27 said...

One question:

Does the case of ignorant nurses and/or doctos happens MOSTLY in GOVERNMENT HOSPITALS or also in the private hospitals?

If ever I get married and give birth, I think I'll do it in the pigsty... no one to blame for any mishap... just blame it on the ... pigs...

pilocarpine said...

i think private hosp can't afford to be ignorant. their livinghood is at stake.