16 April 2010:
Clocked in at 7.51am & started my day at work (being ON-CALL) in ICU. Morning rounds with my boss, off-going fellow MO & beloved nurses were going quite uneventfully (disregarding few nagging by my boss … until my nurse called me to attend an asystole patient. An 80 y.o lady, with impending BKA & low GCS + multiple co-morbidities has just gone asystole..whew! Resuscitated for 10 minutes and I decided to let her go in view of her holistic poor wellbeing.
At around 10AM; left ICU, with breakfast in my mind. Stopped by to see a post EVD patient in MSW; which eventually resulted in me having my “breakfast” only some 2 1/2 hours later. Soon was called to attend a just intubated patient in MMW (shall call him Pt.A). As I’m done arranging ICU bed for him, I noticed my 200kg patient (Pt.B) (3 of ventilation) struggling with his ETT. (And my medical colleague who just reviewed him did not notice this…huh!) Alas! The balloon punctured & air leaking out of his mouth & nostrils..in other words, he needs an ETT change. Quickly ran to my OT to get “bougie”. Came back to MMW and attempted ETT change using the bougie, with assistance of my fancy MMW nurses. BUT…the abdomen was bloating as we pumped in Oxygen via his ETT…”s*** the ETT has gone into oesophagus. Reintubated him the usual way! Alhamdulillah…uneventful.
After the drama, I left to see my elective cases in Maternity ward, lunch. Also to my ICU to get my nurse in-charge to call Pt.A fast…but she mistook me and thought I was in bad mood…for the fact that I was pushing her to call the case fast; as they (MMW) have already been bagging him for 2 hours & MMW has turned into a kind of fugitive camp..damn packed! (Have already told her to call the case 2 hours before)
1.30pm; walked into MMW to check on my Pt. A & B...(without anticipating any surprises). They were preparing to transfer Pt.A to ICU but suddenly the Sister noted no heart rate on cardiac monitor…apa lagi asytole suda la! CPR + Defib X2 = 10 minutes, pt revived. 2 HOs attended the case but medical MO in-charge & on-call both never turned up. I lost my temper & called the specialist to inform the matter (after stabilizing Pt.A) but to no avail…
Called up my boss; informed the progress…plan changed; Pt.B to ICU instead of Pt.A. Then I moved to gynae to see another pt for op.
3pm: in ICU…checking out on patients; bumped into my boss & got nag by my boss for not referring 2 cases for freaking non-urgent trachaestomy. Tried telling what happened but got a short lecture on “prioritizing ur work” (?trachae referral before resus)..huhu. Thus, called my ENT colleague immediately at 4pm to refer those “urgent” trachaeostomy.
4.30pm: Took over OT…continuous for few hours..well for many hours indeed…till 2am! In between went out to see few ventilated patients in the ward & attended my huge Pt.B in ICU, who was already had 2 inotropes running via a 20G branula on his arm. Set a CVL for him; then later at 1am for pt.A (whom was tenaciously pushed for ICU bed by my Medical colleague for HD kunun). Well Pt.B’s inotropic support kept on creeping up.
Managed to get some sleep at 3 something (without having done my Ortho pre-meds) Woke up some near 6am…had my subuh & went to ICU at near 6.30am.
As I walked into ICU, my Pt.A noted to be not doing well. Within a minute, asystole. Resuscitated him again for another 15 minutes before I called it a day. There goes my 3rd mortality of my call. (Ahah…forgot to mention, my 200kg Pt.B passed away at around 3 am..I was not called, only Medical HO attended).
7.10 am: Went for a “quick” pre-meds of my orthopaedic pts who are going for op that morning. To put icing on my “great on-call day” had 2 pts on the list with some risks of post-op ventilation; who might need ICU back-up. Informed my bosses bout that at 7.30am (huhu…so “early”)
7.50am : Came back to my ICU & my boss was waiting me with a question, “Azlam, wat happened last nite?” Huhu…gave some short compact story to cut short the story. Then a big commotion set off, my boss just exploded on O&G team as they had planned for op on a pt, without informing Anaes team. As to rub salt on wound, she got more pissed off when apparently O&G team had ordered 2 cycles of DIVC regime to stand by for the op. My efficient Kak Imie had already prepared those 2 cycles, but O&G team tried to deny that they had requested so as the did not write down on case note…but for the fact their MO did gave verbal order as so, the night before.
9+am: My other boss called me because one of the patient whom I pre-med had high BP just before the op. Reason, ward did not serve morning dose of anti-HPT & I did not order midazolam for that morning because I only saw that patient at 7.30am Well she did not nag me but advised me to do pre-med earlier next time. Am I to be blamed for this? Well...partly ya:)
That was a day of my on-call…exhausting & frustrating too at certain points…resulting in me losing my passion to be on-call…U r damn tired, doing 2 persons job, yet expected to perform with zero defect>..
