Monday, July 12, 2010
Heart and Shock!!
My last On-call at night in ICU was a shocking experience...We had this new Resident Doctor for our unit from last couple of days as our regular Resident had been on leave. Now let me tell you what roles a Resident doctor and an Intern plays in a hospital...A resident doctor is generally a Post-graduate student pursuing his MD while an intern is a fresh MBBS passout, while the resident doc actually does the main diagnosis and the treatment prescription in a newly-admitted patient in wards, the intern actually carries out all the procedures like blood collection, securing an Intravenous line,Naso-gastric intubation n many more.It is generally expected that residents train interns in all the things needed to be a Doctor proper, but there are some exceptions and sometimes,as in this case, they present to us a picture of things that shouldnot be done as a Doctor...
That night duty was pretty eventless with one or two isolated admissions of Snake bite or Chest pain to be attended, when at around 2.30am, this old lady was rushed by her relatives with complaints of severe breathlessness with chest pain since 1hour. Ideally when a patient arrives, the resident should wake up and check the patient and pen down his notes and prescription in the ICU. I immediately took her pulse and BP which weren’t very assuring and after ECG recording it was evident that patient was in Cardiac shock (roughly equivalent to heart failure in lay man’s term) due to massive Myocardial Infarction(=Heart attack) , I concluded that patient was bad and rushed to inform our Resident in his room.
By experience I had expected him to get up and come immediately for check-up but I was in for a rude surprise...After glancing sleepily at the ECG in his bed, he told me to start some tablets orally and turned the other side in his bed to continue his sleep. He didn’t even care to come and look at the patient...At first I was dumbstruck! Being my senior I couldn’t force anything on him but I wanted to take him along but he won’t budge... I went to the ICU again and started the necessary drugs he had told, I knew that was inadequate... I again went to his room and woke him to tell him BP was still feeble but he merely told me to increase one more drug and again drowsed back to his dreams. I found my temper raising but couldn’t help being polite.
In the dead of the night, after 12 long hours of Day-duty when already one himself is irked because of untimely waking, it’s very difficult not to get irritated easily and loose one’s temper and there we give chance for grave mistakes to occur... I was angry I admit and was on the verge of giving some Ear-music to him when I decided otherwise (fortunately) but then I just had only option remaining, to sit and look at the patient hopelessly praying that nature take care of itself...
That moment onwards my respect for that Ignorant soul was gone, I couldn’t help but curse that resident for being so devilishly impassionate for his job. A person comes to our hospital with an expectation that there will be someone to comfort his pain, to alleviate his sufferings or at least ease his journey back to the heavens with his compassionate words. And I think nobody of us has any right to breach the bond of trust endowed upon us by the innocent souls. I admit that things can’t be so idealistic every time, especially in our current setup but this incidence could have been avoided. Maybe it was her sheer survival instinct or probably someone Up there does help the helpless, that the old lady pulled herself up to see the next morning. If ideally our resident would have done all what I expected, I don’t know if she would have survived or succumbed, but that night, in a junior’s heart, the seniority of his senior did die!!!
That night duty was pretty eventless with one or two isolated admissions of Snake bite or Chest pain to be attended, when at around 2.30am, this old lady was rushed by her relatives with complaints of severe breathlessness with chest pain since 1hour. Ideally when a patient arrives, the resident should wake up and check the patient and pen down his notes and prescription in the ICU. I immediately took her pulse and BP which weren’t very assuring and after ECG recording it was evident that patient was in Cardiac shock (roughly equivalent to heart failure in lay man’s term) due to massive Myocardial Infarction(=Heart attack) , I concluded that patient was bad and rushed to inform our Resident in his room.
By experience I had expected him to get up and come immediately for check-up but I was in for a rude surprise...After glancing sleepily at the ECG in his bed, he told me to start some tablets orally and turned the other side in his bed to continue his sleep. He didn’t even care to come and look at the patient...At first I was dumbstruck! Being my senior I couldn’t force anything on him but I wanted to take him along but he won’t budge... I went to the ICU again and started the necessary drugs he had told, I knew that was inadequate... I again went to his room and woke him to tell him BP was still feeble but he merely told me to increase one more drug and again drowsed back to his dreams. I found my temper raising but couldn’t help being polite.
In the dead of the night, after 12 long hours of Day-duty when already one himself is irked because of untimely waking, it’s very difficult not to get irritated easily and loose one’s temper and there we give chance for grave mistakes to occur... I was angry I admit and was on the verge of giving some Ear-music to him when I decided otherwise (fortunately) but then I just had only option remaining, to sit and look at the patient hopelessly praying that nature take care of itself...
That moment onwards my respect for that Ignorant soul was gone, I couldn’t help but curse that resident for being so devilishly impassionate for his job. A person comes to our hospital with an expectation that there will be someone to comfort his pain, to alleviate his sufferings or at least ease his journey back to the heavens with his compassionate words. And I think nobody of us has any right to breach the bond of trust endowed upon us by the innocent souls. I admit that things can’t be so idealistic every time, especially in our current setup but this incidence could have been avoided. Maybe it was her sheer survival instinct or probably someone Up there does help the helpless, that the old lady pulled herself up to see the next morning. If ideally our resident would have done all what I expected, I don’t know if she would have survived or succumbed, but that night, in a junior’s heart, the seniority of his senior did die!!!
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