A Night Duty in the Emergency Unit

 

“Sir!” I came running to the bedside where the postgraduate was desperately trying to resuscitate a patient who was rapidly worsening.

“Whats it Kiran?” He didn’t even look at me, and just curtly barked as he heaved upon the patient, chest compressions in full force.

“A fourth patient has gone bad. What do we do?”, my voice quivered slightly as I waited for my supervisor to make a difficult decision.

 

 Let me rewind a few hours ago.

AMCU. Acute Medical Care Unit.  A dark dingy ward in the King George Hospital where the patients requiring intensive medical care are lodged. A night duty here is the most difficult time of a House Surgeon’s life. Surviving a night duty without a death (or a wicket as the emotionally detached doctors would call them) is considered to be the equivalent of a miracle.

This was one such particular night duty. Night duties in our hospital usually last from 2 in the afternoon till 8 the next morning. One hour later we had to report for our routine rounds. It was 2:05 pm and I had just dropped my bag on the chair in the nurses’ station and extricated my steth from the bottom of it when I heard the staff nurse call out “ Doctor gaaru. Patient bad. Come quick”

Ten minutes later, I was scribbling notes in casesheet while the staff nurse was disconnecting intervenous lines from the rapidly cooling body of the patient. “Time of death. 2:10 pm”

“Madam. Looks like this shall be a night for fast bowling. Wickets seem to be falling faster than India’s batting line” This was the stale, recycled joke every house surgeon would crack with the head nurse on duty every afternoon at which she would throw a fake laugh and go back to counting her diazepam vials. Who were we kidding?

The evening steadily worsened. We had lost two patients by nine in the night. I had known they would die the moment I saw the case sheets. “BAD PROGNOSIS EXPLAINED TO RELATIVE” was scribbled across the header in bold in both the cases.

Patients steadily kept pouring in throughout the night. Monday duties were always horrible. Snake bites, Acute Asthmatic attacks, Pneumonias, Liver failures, Nephropathies, Suicide attempts, accidental ingestions of poisoning.

“Rajiv. Whats happening? Why the rush?” I spoke up as I entered vitals into a case sheet.

“Dont you realize who is on duty.? Amruthavarshini is the duty nurse. You are the house surgeon on duty. And Rajkumar is on night duty in the casualty. All three of you have reputations to attract heavy workloads individually. And today all the three of you are on duty together. It’s like three evil planets have aligned and are smiling crookedly over the ward. Malevolent intent”

“No need to be so dramatic man! Anyway I protest man. My shifts aren’t so bad.”

“Oh! Really? Don’t remember the Gynaec duty of 16^th March?? Its in the history books now. Your shift saw 8 C-sections in one night. That was a record. After that they start posting an extra intern along with you.”

“That I admit. I must have transfused 15 units that night. God only knows how I managed.”

 

Fast forward to present time. We were two house surgeons and one Post graduate on duty.

Four patients going bad. Three doctors on duty. Sophie’s choice.

“Who are these patients Kiran?”, my postgraduate asked , as he lifted the patient’s shorts searching for a femoral pulse.

“Mine is female. 42. Snake Bite. Her vitals have dropped. Bed 36. Outside first left. The trainee nurse is attending right now.

“Who’s your patient Rajiv?” I yelled into the distance “Male, 65, Acute Malaria. Bed 12, Inside last right”, shot the reply from within the bowels of the dim lit hospital ward. “I can’t find a vein sir. He is too irritable and is not cooperating!”

“And this is our third bad patient” He looked at his own candidate and then shouted over my shoulder. “Staff!!! Another ampoule of atropine! This fellow has a fighting chance. He is 26, Infective Meningitis”. The head nurse scurried to the bedside and unloaded the ampoule into the IV line. The pulse oxy-meter attached to the index finger seemed to have picked up this new push of drugs into the blood stream and beeped slightly strong.

“Who is the fourth patient?”, I asked the head nurse who was standing next to us, in silent anticipation waiting for orders. It was surprising how the experience of 25 years on the phenol soaked floors of the hospital wards would silently fall in line at the sight of a degree of 5 years.

“This is 35, female, Diabetic Ketoacidosis. Bed 3. Inside 4^th left. Her peripherals have started going cold.”

 “Looks like she might be going into organ failure. Just our luck”

“What do we do sir?”

Before he could say anything, the nurse spoke up. “I have already called up the Nephrology ward. The intern there is already tied up. Overseeing two dialyses. He can’t leave the post. IRCU doctors have a bad patient themselves. The surgery interns are in theatre. Some accident case. Paediatrics and Gyneac folk cant leave their wards. The Cardio intern said he might be able to come in half an hour, if there are no fresh admissions. The casualty is already backed up. Kiran sir just spoke to them.”

I nodded in assent. “What do we do sir?” the sense of urgency in my voice only rose a few levels higher as I saw my trainee nurse run towards me. Apparently my patient had taken a turn for the worse.

My post graduate looked out of the window for an instant. Took a deep breath, and spoke. He didn’t look at me but at the head nurse. “Leave the oldest. Attend to the rest”. She gave him a wry smile and rushed off in Rajiv’s direction with the case sheet of the snake bite victim.

A moment later Rajiv appeared running across the corridor into the other end of the ward, changing gloves midway without even breaking his sprint.

I still stood there, frozen in disbelief. “Sir? What was that?”

“It’s called triage Kiran. I am short staffed. I shall attend to the patient who has the best chance of surviving the night. Now go to your bed. This trainee nurse is already petrified. Five more minutes and she will need a bed.”

“Sir. This is not right. We don’t have the right to….”

“Get the fuck out of here Kiran. Your patient needs you. That snake bite is your responsibility”

“Yes sir.”,I broke into a run “ kutti ( looking at the Malayalee trainee), get me an NS line and double dose of epinephrine!

By morning, we had lost two of the above mentioned four patients. None of us had slept for a moment. We had skipped dinner. I had broken a bottle of 25% Dextrose and drank from it. I had spent the whole night at the foot of my snake bite victim, on a small stool, monitoring her vitals. She had made it through finally. She was discharged three days later. I never found out her name. For me she was always “Female 42 Snake Bite”.  Right now, in retrospect it doesn’t matter. All I remember is the yellow of her sari.

Life goes on.