Monday, April 7, 2014

The Tough Battle





Hey kiddo, wake up! Stay with me. Dont close your eyes

Opening the eyes, looking at her surrounding. “My neck is hurt, my whole body is hurt.”

Palpating the neck region. “Does it hurt here?”

“Yes it hurt over there”

“Get the C Collar please,” All right what’s the situation here?

A young paramedic replies, “high velocity motor vehicle accident invloving a car and four wheel drive about half an hour ago. Victim 14 years old girl, brought by passerby. Five victims in side the car. Father and little daughter passed away at instance. Mother still stuck in the car, awaiting for transportation by ambulance.”

“How’s the vital nurse?”

“Holding up. BP is 140/80, PR 101, SPO2 100% under room air”

“Al right, let’s do a primary survey. Well, everything seems to be fine here. Nothing much in secondary survey as well. FAST scan also negative. Alright, get the trauma panel and downgrade her to the yellow zone.”

“Hey little kiddo. Stay in there ok, we will have a look at your family!”


*****

Quickly move to another patient with Fast Atrial fibrillation. Well, it looks like you no longer have the light headedness and shortness of breath. The propanolol and hydration seems working. And the cardiac monitor shows that the abnormal rhythm has reverted back to sinus. Just a paroxysmal AF. He can be downgraded to yellow zone as well. Probably need Holter later.

Another patient enter the resuscitation room. Three bells rang and everybody gathers again. The doctor, the nurses, paramedics and supporting staff.

“This is the mother. Front passenger of car.” She’s conscious but look very weak. Whispering slowly. Her sounds muffle and supress by the sound of the monitor alarm.

“Get the C spine, and lets start with primary survey. Airways is intact as well as the breathing.”

“Doctor, the BP is only 50/30 and pulse rate is 120.”

“There’s big scalp laceration. The left hand is deformed, the left thigh, the proximal and distal leg is deformed, there’s an open wound at the left thigh. And the right leg is also deformed.”

“Ok guys, let’s get three large bore IV line. Get the trauma panel, run the crystalloid. Give 1 gram of tranxenamic acid, 50 Microgram of fentanyl, 10 mg of maxolon, 50 mg of ranitidine and cover her with cefuroxime and flagyl.”

Damn! The line is just too difficult. Ten minutes of trying and finally manage to get the line. 500 cc of saline infused. BP still not picking up. Another pint infused and blood pressure still the same. Another IV access obtained!

“Run the Gelofundin and Voluven.”

Soft sound whisper? Voluven? I thought we are banning it usage now due to risk of renal failure?

“ In septic shock, yes evidence says it’s harmful! Increase the mortality rate as well as renal shutdown. But in trauma, evidence is still lacking. No conclusion made yet.”


****


Doctor! We have upgraded the 6 years old child. She’s a back passenger of the car. GCS on arrival only 11/15.

Damn, she’s fitting. Generalized tonic clonic seizure.! It aborts spontaneously but then starts to vomit.

Taking out the glove,” secure all the bleeding and get the blood product fast! Run at least 2 pints of packed cells.”

Prepare for intubation set. Get the midazolam, fentanyl and scoline ready! Pre oxygenation, induction agent and muscle relaxant in. tubing done. Infuse the sedation and prepare for CT SCAN.


*****


Then another two bodies arrive. Severely head injuries and possible thoracis injuries as well. Nothing can be done.

And suddenly the daughter in yellow zone cries loudly. Calling out her father, mother and siblings. 

“Who’s the stupid fellow who tell her about their family?”

“Be patience doctor, she deserve to know the truth.”

“She’s just 14. Give her time for God sake!”

And there’s a screaming from the outside. This time, it’s from the patient triaged as green.  The one with a very minor injury. The one with fever for only one day, or forget to take their medication in specialist clinic, or having a nail prick. People with mild tension headache who dont even bother to try over the counter pain killer first. And now they are making fuss for not being attended after one hour.

Will they ever realized that they should go and seek family doctor and not to come to emergency department at the first place?

Emergency is the place for a major trauma. A patient whom life is on the fast lane. They will die without an intervention. They could be your family or even yourself. Can you have the heart to let them be served first?


*****


The radiology image of the mother is ready. Surgical and orthopedic also finish their review. Blood on going and BP stable at 100/60. Lung contusion, open fracture of left mid femur, bilateral pubic rami comminuted fracture, left tibia/fibula proximal and distal fracture, right distal tibia/fibula fracture and foot fracture, scalp laceration wound. And urethral injury possible having internal iliac vessel injury. Pelvic binder applied. Prognosis guarded!

And the child having small intracerebral bleed, good survival chance.


*****


A message received a day after from a colleague.

“Sorry to inform, we loss the mother. She coded and  unable to revive her. And the worst part, the 14 years old daughter was placed just in front of her bad. And she witnesses the death of her mother.”

But the little kiddo with intracerebral bleed is making  a good recovery. We will soon extubate him.


*****


This is part of drama that a doctor needs to encounter day by day. A heart breaking story. Doctors are human, medicines are men made, we can fought, but we cant confidently say that we will win the battle.

In this battlefield, we doctor, also fought but not without gun..we don't have battleship but we have an ultrasound, CT Scans.  We dont have M16 but we have needles, syringes, suturing set,all those dressing..We dont have bullet but we shot them with IV drips,blood product and medications..after tough battle, we may save some of them.but sometime, Allah loves them more. We can only tries but Allah will decides. But you as public may help us too. Help us by not mis abusing the emergency facilities. Let us focus in treating the seriously ill patient. If you have minor illness, please visit your family physician or outpatient department. You may need to wait for hours, but you are doing justice to those with critical illness.

Wednesday, April 2, 2014

Cinta Pada Senyumannya


Aku relakan dia pergi,
Andai lidahku berdusta,
Tidak jujur dalam berbicara,
sekadar hiasan di pinggir bibir,
kelihatan manis tetapi hempedu.


Tidak aku tidak berjenaka,
jauh sekali aku tersasul,
dari apa yang dikata hatiku,
inilah rasa yang sebenarnya,
sudah berkali aku ungkapkan.


Seperti mana bicara hati,
Itulah yang terpahat pada bicara,
Sungguh aku terpesona,
Pada ukiran senyumannya,
Yang berbekas pada jiwaku.


Dekat tapi jauh,
larianku tidak sampai,
untuk menyentuh hatinya,
apatah lagi memegang jiwanya,
mungkin cukup setakat senyuman.


jacknaim,
Lahad Datu
1/4/14, 11.50 PM

Allah Matlamatku, Rasulullah ikutanku, Al Quran pedoman hidup, Syahid impianku.

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