3 posts tagged “er”

9:32 am. 

Someone comes down from a red car and knocks on the glass door of the ER.  "Stretcher," he shouts, "and fast!"  The nurse opens the door and a nursing attendant pushes a stretcher out.  A young man is carrying a cachectic old woman onto the stretcher.  We notice her pale skin immediately.  My co-intern touches her forearm, then shot a meaningful glance at me across the stretcher.  She immediately pulls out her stethoscope and listens for her heartbeat as the stretcher is being rolled in.  A few seconds later she looks at me again and shakes her head.

I say one word which mobilizes both my co-interns and I:  CODE.

Intern C starts doing CPR.  Intern V grabs the ambubag, hooks it to oxygen and starts bagging.  I check the patient's forearm and see an existing heplock.  I say to the nurse next to me "Ma'am, one epi," and head to the supplies saying "IV line please."  All three interns automatically go into action to resuscitate the patient. 

For a split second all three of us stop and we suddenly notice that none of the nurses are responding to our call.  The sad reality suddenly slips in.  Anywhere else we could run a code.  But in that particular hospital, we were just interns.  And none of the nurses would carry out something we ordered.

The fellow on duty was paged and arrived shortly.  He stood there at the foot of the stretcher and simply said "Epi.  IV line."  Then, everything was a flurry of motion as the nurses rolled into action to get the crash cart, start a line and prep for an intubation.

A sad day at the ER.  A no win situation.

        Things have been going really well in my OB-Gyne rotation.  Yesterday I was on 24-hour duty at the ER (saw about 50 patients and admitted 33).  The resident with me during the day surprised me by saying that OB-Gyne seemed to suit me and that I would probably do well as an OB-Gyne practitioner.  One:  I never even considered taking up OB-Gyne for residency.  Two:  this is the first time that someone thought that OB would suit me.  And three: although I don't cringe anymore when someone shouts out that the patient we are examining has a cervix that is fully dilated, I am still basically taking baby steps to learning the appropriate management for common OB-Gyne conditions.

       Speaking of fully dilated cervices, I never got the chance to explain the four words that I dreaded the most.  Fully  - would mean that a pregnant woman has a cervix that is fully dilated to 10 cm and if all goes well would probably deliver her baby in the next few minutes or within the hour.  After the (once) cringe-inducing announcement of full cervical dilatation would come the awkward shout of table.  At this point the patient is transferred from the stretcher to an operating table and placed in lithotomy position in preparation for delivery. Calling out table is actually directed to nurses and nursing aides to assist in the transfer of the patient, but most of the time we wheel the patient to the delivery room ourselves and transfer them onto the table.  And then there's baby out which is pretty much self-explanatory.  Lately, these words haven't been so scary.  They've transformed from loud hairy, red-lettered words in my head to small, furry animals which scurry along the path they're pre-directed.  Cute, really.

       Having said all these I am really enjoying my rotation so far. 

       Cheers!

            I remember dissing roommates in college, not out loud nor to their face, but just generally frowning upon what they called as a dorm-life boon of ramen or instant noodles.  Of course there’s always some place cheap to eat on campus but when it’s the middle of the night and you’re in your jammies the last thing on your mind is to go out and get some food from a lutong bahay or food kiosk at the corner.  While I highly question the nutritional value of instant noodles, the nutritional value is not what I’m worked up about.  Although most of the time I think a nice sandwich would be better, I do know that a sandwich with overly sweet jam would come to the same thing.  My point is, in my current state in my Pediatric rotation I’m eating my words and find myself really glad to come home post-call to an apartment with instant noodles in the cupboard. 

        My last 24-hour duty in the Pedia ER was horrible.   I was feeling a bit off early in the morning already since my allergic rhinitis has been acting up for days.  Plus, I had a feeling an asthma attack was imminent.  So I prepared for it.  I took an antihistamine, a decongestant and a couple of actuations from my Salbutamol inhaler and things were fine with my health and the general flow of patients in the ER in the morning and the better part of the afternoon until all hell broke loose in the evening.
        I had a day old baby who arrived with no pulse, no spontaneous breathing and completely devoid of color.  I had a 15-day old septic-looking baby brought in by her 17-year old mother.  I had a newborn with gastroschisis delivered at home, long segments of his intestines extruded from an abdominal defect.  I had 4 or 5 patients who came in due to febrile convulsions, two of which convulsed one after the other in the ER.  I had a couple of patients who came in from another hospital after being treated and given home medications go through the whole Pedia ER work-up again because they weren’t convinced that they were managed appropriately by the previous hospital.  The irony of it was, we treated the patients the same way and during the course of our observation the parents ended up deciding to take the patients home against medical advice anyway.
        Half of the patients I saw came in due to difficulty of breathing, all of whom we subsequently diagnosed with pneumonia except for a couple who had bronchial asthma.  These children had been having fever, cough and colds for days.  Half of them had not seen a physician prior to consulting at the ER.  The Pedia resident on duty, in her good humor and genuine concern, kept on berating each parent for waiting until the kids were already in respiratory distress before seeing a physician when they could have easily brought them to a local health center when they were still having simple colds or cough.
        Oh, don’t get me wrong.  It was a great night on call at the ER.  I just wish I wasn’t so drained the morning after that it is all I can do to take the short jeepney ride home, take a shower and get into bed without eating breakfast (or lunch!)  I woke up 4 hours later to find an empty fridge and only a packet of instant noodles to tide me through the day.  Yes, I suppose in this case instant noodles are indeed a boon.