Half-baked Doctor

It’s Black Saturday and we entered into our very first skeleton duty at the emergency room. My group mates before us told of a toxic night at the ER, receiving no less than 20 orthopedic cases, a huge jump compared to the four cases we got on our first night in.

Duty starts at 7am, so naturally I was there to relieve my group mates by 6:30am, for I have never subscribed to the so called Filipino time. They say being early and getting excite for duty loses its novelty after awhile and that pretty soon we’d be skipping duties whenever possible. I wonder how long I will last?

So our first skeleton duty started off like our first day, and we were praying it remained that way. But as the song lyrics say, you can’t always get what you want, and so not even halfway through the morning, a case of vehicular accident comes in and we were all roped into assessing the patient. Patient #1 was female and came in looking exactly what you would expect a victim of a vehicular crash would look like - bloody and banged up! I was one of the first respondents when she arrived at the trauma and the one to assess her banged up leg. Now firsts things first, this was only my second duty at the ER and 4th day as a junior medical intern, and I have yet to get a case of vehicular accident, so I didn’t really know what kind of injuries to expect. Sure we have an inkling or a vague idea on what happens when two objects in motion collide, but to see it first hand and have no time to react is a different ball game all together.

And so I unwrap the elastic bandage that was used to stabilize her leg while in transit, I didn’t even have the time to put on my gloves and the only thing I could do as I reached the final later of gauze was stop for a few seconds as I saw the gaping would below. The patient’s right thigh was blue and twice the size of her undamaged right thigh but it was her knee was completely blown open and you could clearly see the white of her bone surrounded by a mangled background of blood and muscle. I jolted back from my brief shock when the resident ER doctor pushed me slightly to the side as he took out his phone to take a picture of the wound as evidence, and it was back to work trying to debride her wounds. It would not be until later on when after we’d finally assessed all her injuries and cleaned her wounds that I noticed that my hand was full of the patients blood.

I am not scared of blood but there was an entirely new sensation that had somehow come to me in that moment as I walked to the sink to wash my hands. It was a feeling of desensitization, it was like having the blood of another human being on me was nothing - completely normal. In my chosen line of profession it is expected that sooner or later we become desensitized with all sorts of horrible things, but to realize that even this early on I was already numb to it was both unnerving and exhilarating.

Then as I gather new materials and finally put on a pair of gloves in comes Patient #2, the second VA patient and Patient #1’s boyfriend, the driver of the two. His injuries were more or less the same as Patient #1’s injuries, same gaping wound on the knee that this time I had the chance to take a picture of. I would love to show the picture here, but as my mother nearly emptied her stomach when I showed it to her, I don’t think it’s wise to do so here. So the entire morning was dedicated to treating these two VA patients while a few minor cases trickled in the interim. We received patients with back pain, shoulder pain, bent fingers and all sorts of benign cases that will give you cause to sit down for awhile and relax from the high octane energy needed in caring for trauma victims.

But the reprieve from the morning’s adrenaline rush would be short lived as another VA patient, this time an elderly male was rushed into the ER. Now this patient was not at all as bloody as compared to our earlier two patients and  was very much coherent. His only problem was that he would not move his hips. Of the VA victims were received in the entirety of our skeleton duty, it was him that I felt sorry for the most and one that I would never forget. It’s because it would not be for another 5 hours before he was fully assessed by the doctors and the diagnosis of posterior hip dislocation is very much a time sensitive diagnosis as ever hour counts if one is to recover fully and regain maximum motion of the joint. At first the residents tried to manually perform a close reduction and this is what is forever engraved in my memory.

The patient was given Ketamine, a type of dissociative sedative, before the residents laid him down on the floor and performed all manner of twisting, tugging and pulling just to put the joint back in place. It was truly painful to watch. I knew that the patient would have no memory of what was being done to him but watching them climb on top of him, trying with all their power, sweat trickling profusely down the doctor’s faces, to repair his dislocated him was mind-numbing. My fellow female group mate and I were helplessly standing stock still on the side as all the boys put all their power into reducing the joint. In all that time I was waiting for the sound of bone cracking, because in my mind there was no way an old man’s bone would survive the weight of a heavy set men in their prime bearing down on him. When the reduction failed while the patient was laid down on the floor, they tried for the second time with the patient prone on the gurney, but much like the first few attempts, these failed as well and the patient was left limped on the bed. I was so very glad he would never be aware of what had been done to him.

The day moves on quickly after that as a mixed bag of patients were rushed to the emergency room, it was extremely difficult to find a moment to take a short breather. It’s also interesting to take note of the comments of the patient’s relatives as they wait for results. Because most of the time it’s those accompanying the patients that are difficult to manage and not the patient itself. It takes a lot of people skill to diffuse a frustrated mother, calm a terrified mother and remain objective to an indecisive mother. And all that the social maneuvering gets very difficult when coupled with the late hour and no sleep.

By 1 am the ER had a slow buzz to it with only a few patients remaining and all of us wishing it would remain so until 7 am when our shift comes to an end. But a last minute patient comes in, another VA and he brought with him all of his friends and family. This patient, a teenage male apparently fell of his motorbike and had already been seen in another hospital but since the first hospital did not have the specialist needed to treat him, he was transferred to us. He had sustained an avulsion on his forehead and elbow as well as multiple abrasions on his extremities, and since all of these were a few hours old, his wounds were all pretty dried up and dirty.

Now you’d think cleaning up wounds is easy, many of us to it a few times at home, you take some water and betadine and that is it. But not in a hospital setting and this poor teenager had the misfortune of getting his wounds treated by fairly inexperience junior interns as most of the senior interns had gone up to the call room to rest for the night. Emergency debridement entails using NSS (water and salt mixed together - OUCH), betadine, soap, gauze, and a whole lot of elbow grease. We were basically scrubbing the patient’s would like one would do stains off a bathroom wall, all the while the patient and his mother were crying in pain. If this one being done to me I would probably be screaming bloody mary as well, but as I was the one on the other end of the situation and the one having to lift the patient’s leg while scrubbing it, I was annoyed with all the moving around. I guess it is true what they say, that sometimes Doctors appear cold and clinic.

It would take the best part of two hours clean the patient up before he was prepped for minor surgery for his forehead and elbow, and I have had no sleep as I leave the emergency room at 5am together with my group mate to do our rounds in the charity wards before skeleton duty ends.

April 2, 2015, twenty four hours of ER duty later and here we are. It's Maundy Thursday, a holiday and as it so happens we are now status post duty, meaning we are  relieved of post-duty work, such as attending to the out-patient department or assisting in either the operating room or the recovery room.

The emergency room, arguably the one place in the hospital that sees the most action and a myriad of cases that are more often than not coupled with the most bizarre of stories - and this happened to the first place I was assigned to on my first day a medical junior intern, a full 24 hours of ER action.

After three years of medical school confined to theories in the classroom, yesterday, April 1, 2015,  was Day 1 of our final 365 days before graduation. It would be an utter insult to my love of Harry Potter to say that none of us were nervous and completely at a loss at what to do, just after the first two hours of duty. 

Having been assigned to the Orthopedics department for my first rotation, Day 1 started at 7am, wherein we were decked with patients we had to stay updated with for the duration of our duty, after-which we separated to our respective post.  As mentioned earlier, I was assigned to the ER with three other group mates. 

The emergency room was exactly what I had imagined it would, chaotic! Although according to the doctors in the ER, last night was extremely benign, I shudder to think what a truly busy ER would look like. As it was, our ER post was sandwiched between the trauma area and the urgent care area, therefore it was safe to say we were in the center of action. 

The first primary ortho patient we received at the ER was an elder male suffering from a  recurring swollen right foot. Now as a future a doctor, one has to get their hands dirty, but I for one was a tad bit reluctant to get my hands on the patient's dry, swollen, erythematous appendage. It looked like cellulitis, and in fact that ended being one of the differentials to consider, and you do not want to get infected with that - ergo I was not the one to assist that patient. Maybe once my immune system starts getting better, I'll be more comfortable handling infectious patients, but unfortunately I had the flu on my first day. 

It would be for a couple more hours before the Ortho OPD would refer to us a case of an eleven your old boy with a bone deep laceration on his index finger. The story goes that the boy had been climbing a tree using sharp metal bar when slipped from the bar and injured his aforementioned digit. It was like pulling teeth trying to clean the patient's wound, not that I could blame him, just looking at it made me want to look away. And after seeing the bone, urgh... In the end we watched as the resident gave the boy a couple of stitches. It was all very interesting.