Today was one to remember. First ward rounds of course, then surgery. But after half an hour I asked to be excused since I was still feeling terribly feeble; and there was no one I trusted to break my fall if I went down... So lunchbreak and back in the OR with Dr Rithy for an emergency laparotomy on a 18 year old girl with abdominal pains, fever, distention and all the signs of a complicated appendicitis. As first assistant i was scared of feeling queasy and the putrid smell of pus could have done it but we were amazed at the seriousness of the case; emptying yet another abdomen of liters of pus and blood... Dr Rithy meanwhile was constantly on the phone with the ENT surgeons who had a difficult case. And thus he left us to close the abdominal wall and went to look at this case of dyspneae and inspirational stridor. The only thing we heard were the gasping sounds of stridor of someone in the corridor as we were closing the skin of the young girl in the most hurried fashion imaginable ... since she was already completely awake and reaching for her stomach. The anaesthetist was too busy in the other room to come and sedate our patient for another 15 minutes for us to finish our sutures. But while Katie was escorting the patient to the recovery, I walked into the other OR out of curiosity to find the extraordinary sight of a seizing patient on the operation table. I get Katie and before we know it we are performing CPR and pumping away; with no EKG monitoring but our fingers to feel a pulse on a seizing patient. Meanwhile the anaesthesist is asking us what medication he should give and in what dose... Completely of our guards and not understanding why suddenly we were in charge just because we walked in when there was a problem we hesitated at first. Grasping that if we didn't act quickly nobody would we order Diazepam first whilst resuscitating and then with the seizures stopped and the definite absent pulse we quickly order 1mg of adrenaline IV and atropine after that... after a minute and many more seizures we finally get a pulse. With immense help of Marvin, a 76 year old retired american anaesthesic nurse, we have the patient ventilated and somewhat stable; but still seizing. The surgeon who was performing a tracheotomy on her declares that he hasn't got a clue what to do in this kind of situation, because he's just the surgeon. But his reassuring words are that he had spoken to the husband of the patient and if she were to die "it was ok!" and he laughed! With many conflicting stories and no official documents nobody is really sure about what happened and/or why. For a moment it looks as it they were about to roll the patient to the post op and order the family to keep ventilating her manually .. indefinitely. But a mechanical ventilator is provided and the patient is left to the surveillance of the family... Nothing more can be done. Nobody amongst the doctors or nurses seems in the least shocked or even disturbed. They go about their business in their jolly and smiling fashion as if nothing had happened...
We, as you can imagine, are less adapted.
Goodnight,
L.
No comments:
Post a Comment