Monday, March 30, 2009

This is no Teddy Bear's Picnic

My apologies for the severe lack of posts. I'm sure this one will do two things: that is, make up for it, and explain the blog silence:

Please sing this in the style of the Teddy Bear's Picnic song:

If you start work in the trauma unit,
You're in for a big suprise,
If you start work in the trauma unit,
You'd better be in a doctor's disguise!

For every doctor that ever there was,
Is frightened of that moment that comes,
When you have to do something that you've never done befo-oore!

Last Friday...oh no no no...wait! Let me first set the scene...

It was a gloomy grey Friday afternoon, and a lonely young lady doctor was the only medical service available to a very large, poor, sick community...

This was the first time ever since I qualified three years ago that I have been the only doctor at an institution. Everybody pisses off early on a Friday and the poor schmuck left in trauma has to be the heroine/villain until 5pm when the night staff arrive.

The trauma unit was pretty busy, and in the midst of the mad mayhem, the undertaker arrived with the request that I certify a patient that had died at home.

On my way out to the undertaker's death van, I am immediately accosted by a frantic nurse from the Midwife Obstetrics Unit. (MOU)

The MOU is a unit providing basic obstetric care for mums who have uncomplicated pregnancies. They have their antenatal care visits there and give birth there. There are no doctor's involved, it is run entirely by midwives. Although the MOU is on the premises, I avoid it at all costs as screaming mothers in labour, amniotic fluid, placentas and the like are really not my cup of tea.

I see the nurse gesticulating wildly and hear those dreaded words: "Come now! Emergency!". She disappears back into the unit.

My brain goes into paroxysmal neuronal short circuitry as it computes that, oh shit, I'm probably going to have to deal with one of two things. A dying mom, or dying baby.

Please let it be the mom,please let it be mom, please be mom, please be mom...the last time I dealt with dying babies was two years ago...

Nobody hears my plea.

As I burst through the MOU swing-doors, I'm confronted with a just-delivered, 5 minute old neonate. The baby is blue, gasping for air and barely moving.

The Mother looks at me with desperation in her eyes.

The Midwives visibly relax as I arrive, "safe" in the knowledge that "the doctor" is here and therefore everything will be ok.

The Doctor ( that's me) is silently freaking out as I have NEVER resuscitated a neonate before in my life. Oh in theory yes, I've been taught how, but have never actually had to do it.

"Today's the day sweety" , the evil bitch spinning my fated threads cackles, "let's see how you handle this!"

I. Am. it. there's no-one else to call. Weeks of pregnancy,a long difficult delivery and the parent's dream of a family are all riding on my next move.

I ask for the laryngoscope and intubation tube to pass through the baby's throat into it's trachea to help it breath. The nurse hands me the miniscule instruments and I try...

It's difficult, I'm working in a tiny space about 6 cm in diameter and the vocal chords are hard to see. Three, four five times I tried and eventually I got the tube in. At that moment the baby started making more of a respiratory effort and so naturally expelled the tube I'd tried so hard to insert. Dammit!

Should I try again? I check the baby's oxygen saturation and it is miraculously rising up from 50% to 70%.
Baby is no longer blue and is turning a nice shade of healthy pink. What is happening here? Did merely fiddling with the kid's breathing apparatus by trying to intubate stimulate it's respiratory drive? Shit I don't know.

I decided to apply nasal prong oxygen instead of trying to intubate again. O2 Sats picked up to 93%. By this time baby was pink, crying and although breathing quite laboured, was making better respiratory efforts.

Everyone looked at me like I was a genius. I felt like the village idiot. I wasn't exactly sure what I had done to improve this kid's situation, but whatever it was it worked.

Baby was stable so we called the ambulance and referred the child on to a specialised neonatal unit for further care.

I had been away from the trauma unit for an hour stabilising that baby. I wearily made my way back, but was hardly in the door when the patients start accosting me.

"Doctor! I've been waiting to see you since this morning!"
"Where were you, were you taking lunch while we were just sitting here being sick?"
"I'm so sick of this damn hospital, the service is terrible."

I take a deep, deep, deep breath, and look at the clock. Fifteen minutes left of my shift. I am hoping to collapse into my chair, but there is a lady patient sitting in it.

I look at Sister Em with confusion. She just shrugs her shoulders and says the lady is refusing to move. I ask her how I can help her. She says that she has been waiting for 11 hours to be seen.

I look at her folder and according to the triage notes she has a very minor condition that will not get seen before all the serious ones, which is why she was still waiting. I explain this to her, but she just looks at me and bursts into tears.

I exhale that deep deep breath and decide to break all the rules. Someone has to give this chick a break. I quickly diagnose her with the flu. I give her the box of panados from our limited stock that we'd go and buy at the chemist, but that she'd been waiting all day to get.

By now it's Five pm, but I'm too tired to be excited. I just pack my bags and get the fuck out of there.

Driving out I see that lady waiting in the rain... soaked, exhausted, and disappointed by our "health system". She is fumbling in her bag for a few coins and is making a forlorn phonecall.To whom, I don't know....maybe somebody who cares about her. Despite the almost dead babies, and general trauma, somehow this scene is the most tragic thing I've ever witnessed.

I can't be brave anymore. The enormity of this community's plight is suddenly and inexplicably triggered. The floodgates of despair open and I sob like a bereaved widow all the way home.


Ketan said...

Dr. S,

You make me feel ashamed for all the things I'm probably not going to do or feel in my life!

You're such a wonderful human being! That's one of the biggest compliments I could pay you, and still would be insufficient. You're like a buffer--absorbing so much of circumstance- and human-inflicted pain on people you don't even know!

Well, I might've said it a few times in less clearer ways before too, but I admire you a lot. Just wish you manage to find happiness, peace of mind and a sense of fulfilment when it would matter the most.

Take care.

Dr S. said...

Hmmm....that was a bad day. I don't know why it always happens that the most trivial things can upset the lady making a phonecall.

I'm not sure if it's a culmination of all the real trauma that I've had to ignore to get the job done, that is suddenly triggered by some small innocent act or what???

Either way, thanks for the support!

I don't really feel sorry for myself doing this job, and I'm not depressed.

It just makes me angry that there is so little being done for our poor, and the lack of love shown them by our government is disgusting.

I know you probably have the same experiences and feelings in India...

A lot of the time I have lots of fun at work and it's very rewarding...but one always remembers the bad experiences and I guess those are the ones I need to write about and thus make it onto my blog....

I'm going on vacation soon....a nice long break with my husband and then a short few days away with my girlfriends...CAN'T WAIT!!!!


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