Sunday, March 22, 2009

Can I get a lift, anyone?

Mr B's story:

I've mentioned before just how popular Sunday nights are in the trauma unit. Last Sunday was no different. I've often tried to understand why this is so? I've come up with these two answers:

1: By Sunday, the alcohol/drugs that were being consumed/injected/snorted since Friday have now worn off...and people are sober enough to realise that they are bleeding/limping/stabbed in the head.

2: Motivated by the awesomeness of the weekend, they are eager to extend it by just one more day, so invent random symptoms in order to get a sick note.

Mr B, however, was not one these patient's. He had just finished his late shift at Woolworths and was on his way home when he was assaulted and stabbed in the thigh.

He was stabbed in his right lateral buttock inferiorly and five cm laterally to the anterior superior iliac spine.

That is, nowhere near his abdomen.

However, despite the wound being less than 1cm in length and with no history of abdominal assualt, Mr B was groaning heavily about pain in his tummy.

We have no Xray facilities and no ultrasound in this trauma unit. We have our wits, basic equipment and our two hands. We noticed that Mr B's blood pressure was quite low, his heart rate was pretty fast, his abdomen was tender and that it was very slowly distending.

We quickly made a diagnosis of internal bleeding, put up two large bore IV lines to run in some fluid and called an urgent ambulance to take him to a secondary hospital. Ambulance control said they would send someone right away.

Mr B's vitals were currently stable so we kept a close eye on him while we waited for the ambulance and continued seeing other patients.

Two hours and numerous calls to the ambulance control room later, Mr B was still waiting, and his blood pressure was dropping. By this time, We were ready to load him into our own cars and drive him the fifteen minutes to the secondary care centre ourselves.

The damn ambulances kept on BRINGING us cases - nonsense non-emergency cases - but refused to TAKE our patients who needed to be transferred. When questioned, all we got was, "Sorry, take it up with Ambulance control, they decide where and what we do."
And then they'd leave, Mr B still waiting, his abdomen slowly getting bigger and bigger.

My colleague stepped outside for his first break in seven hours since starting work. At that moment, tired of trying to hold out until someone who cared came to fetch him...Mr B arrested. His heart stopped beating and he stopped breathing. We started the resuscitation mere seconds after his last breath...

Come on Mr B, you're 24 years old, you still have a long life ahead of you!

Endotracheal tube inserted, chest compressions begun

Don't give up now...I'm sure the ambulance is just around the corner!

IV adrenaline, IV atropine injected, continue manual ventilation and compressions.

Half an hours worth of CPR later there was still a flat line on the monitor and Mr B was showing signs of brainstem death.

We stopped resuscitating and cursed the ambulances to hell.

Mr B. died waiting for a lift. 24 years old, employed, only breadwinner.

We called his mother and asked her to come in urgently. We never give bad news over the phone. What was she thinking on the way to the hospital? Was she paralysed with the possibility of tragedy? Did her mind attack the fear with the weapon of hope?

The rest of that call was spent listening to her screams.


femail doc said...

What a tragedy, and dear lord, how sickening for all of you. What sort of place are you working in?

Dr S said...

I'm working in a "community health centre" - ie primary care centre in the peripheral ganglands of Cape Town, South Africa.It is not a hospital with wards or overnight stay beds. It functions as a chronic diseases clinic, baby clinic, HIV clinic and minor theatre during the day. We have a tiny 24hr "trauma and emergency unit" with basic resus. facilities and no more. We don't even have a ventilator. We do have an ECG machine but it only works sometimes. We have no Xrays at night. We have no ultrasound machine.

Basically we rely solely on our clinical judgement to make a diagnosis...our primary concern being...does this patient need to be referred up the chain to a secondary/tertiary facility or not? Once we make that call, however, we are at the mercy of the ambulances...the number of which we have in this Cape Town district is as inadequate as the number of doctors.

Spark Star said...

Oh God!!!
I have no more words...


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