Saturday, November 24, 2007

Sir Jerry

Surgery casualty was one of the postings I was looking forward to. I find Emergency Medicine (which is not available here) very interesting. Put it down to watching too much ER. Damn you, Noah Wyle. And traumatology is the main branch of the subject. In our hospital, trauma care comes under the departments of Surgery (for people who get coshed on the head, stabbed in the chest, and then have their breakfast disagree with them), Orthopaedics (for boyfriends whose limbs get broken by The Dad), OMFS (for those endearing personalities who pick fights in bars and pretty their faces) and ENT (for heavy metal fans who play their music REALLY loud). All of these can be achieved by simply getting drunk and then driving the next vehicle in sight.

We work in 3 shifts- 8AM to 11AM, 4PM to 8PM, and 8PM to 8AM. We are given these times so that we can watch TV at home with a guilty conscience during those hours.

The very first case I saw was depressing. An unconscious old man was brought to the surgery casualty- his wife said he had fallen and hit his head. The housie on duty tried to get the history of head injury (the usual projectile vomiting-convulsions routine), while the patient’s wife wailed in the background. She (the housie, not the wife) checked his pupils and breathing, and I noticed that the guy had blood tinged saliva coming out of his mouth. Then the duty MO took one look at him and yelled, 'MI, Medicine casualty stat!' We rushed him to the resuscitation room, and the Medicine PG immediately intubated him and gave him CPR. Shit, that was scary. Half the instruments wouldn’t work, the nurse couldn’t find any veins, and the PG was pumping away at his chest yelling instructions to the nurses. And then, for the first time in my life, I saw them using the defibrillator. ‘Stand back, we have to zap him.’ It was all done in a hurry, and I saw the paddles sparking. They tried it twice, but he was already gone.

I wish they would start a proper department for Emergency Medicine. It’s awful how patients need to be shuttled from one department to another because their illness encompasses many specialities.

I put 3 stitches. I hadn’t done it in more than a year, but the how started coming back once I started to stitch up a kid’s forehead. I’d forgotten how thick the scalp was, and how difficult it is to get the needle through. But I managed to finish it, and felt very satisfied. I hadn’t wanted to stitch up the wound, because the kid had vomited, and had bits of it sticking to his mouth.

Vomit and I have a very strained relationship. I can never look at it without wanting to add to it. I can resist the temptation until the smell hits me. Another repulsive body fluid is sputum. The revolting mallu habit of spitting on the roads has given me plenty of opportunity to get grossed out while crossing the road. This disgust does not a good doctor make.

Our SPM ‘study’ tour is coming up. After the heroic effort it took to convince my parents that we are going to Delhi strictly for ‘educational’ purposes, it got cancelled. We haven’t given up hope yet, though.

This is my last lax posting, and I have plenty of free time to catch up with my studies. So I spend most of my time on the Internet drooling over shoes. Strappy sandals are my best friends. We met when I was about 4, and their heels developed when I was 14. Take a look at this pair. I would cheerfully cut off my arm for them. And my other arm for these. And dear God in heaven, just look at them beauties. But I only have two arms, and they don't accept them as payment. My feet hurt from just looking at them, and my purse quit. I overheard my mom telling my dad that the internet connection wasn't such a good idea because I spend too much time on the net looking at shoes and crying. I hate my life. I think I’ll go jump from the roof or something. I’ll end up in the casualty anyway.

I am so unhappy. :(


Anonymous said...

is the first casualty posting during final yr? can't even recall now... the one thing i'd warn u about is against getting naively impressed by some atunt that some pg pulls off- u'll realise later that it was NO BIG DEAL!!! this is ofcourse the best place to practice ALS, as u've seen countless times on ER!!!

Compassion Unlimitted said...

Hmm..// Half the instruments wouldn’t work// however hospitals charge for
worried here if you got your right pair of shoes or not.Exams can any how wait
You have great way of expressing the contradictions of life and death!!

Adorable Pancreas said...

Final year, part I.
Do I know it! People go 'oooh' and 'aaah' when I get them to listen to the coin test.
I've never performed it, only watched it being done. But I've worked the ambu a couple of times, and the patient died both times. They were gone by the time we were called, but it didn't do much good to my confidence.

@compassion unlimited:
Oh, no. We don't charge anything for our services. Patients need to buy only medicines and stuff like that, and that only if it's not available in the hospital.
And thankyu. :)

Tys on Ice said...

how does it feel whn someone in ur watch dies?

but i never knew that defibrawhatever is wht u giys call them things the docs on tv shock those people into living...

forget the shoes....wudnt want a doc tripping over her heels and falling on me whn i get rolled in there with OMFS...hmmmm, on second thoughts, buy those damn things..steal ur bros credit cards...

the stygian sailor said...

if it is a govt hospital, then dont bother about the working condition of instruments. in fact it will prepare you to tackle emergencies even in remote areas like antarctica where you wont have any instruments. (why you ll be in antarctica is another question)
save the 'jumping off the roof' stunt for later, you may not need it.
second thoughts, PSM? you might need it after all.

Thinking aloud said...

ever since i've started reading your posts, its all coming back to me - why i never took up medicine..i would be an emotional wreck half the time...

hey!! u're right to feel so upset...the sandals are worth dying for :))

Wanderlust said...

I am amazed that a medico finds humour in her work...Cheers mate ...Lovely reading!!!

Sreejith said...

What about the psychiatric ward? One way to get into that would be to buy one of those sandals :D

breakfast disagree.. well put!

Keshi said...

**Half the instruments wouldn’t work,

thats a bit freaky.


sinusoidally said...

Oh thats so sad that people cannot be resucitated first before determining what department they belong to. What an inefficient method as you rightly point out.

ursjina said...

first time..and i must say i liked it here

Vinesh said...

you might've just spoken on behalf of the whole world about the way you feel about vomit and sputum!

Xorkes said...

hey nice blogs!

Adorable Pancreas said...

@tys on ice:
I haven't watched that many patients die, the ones I did see were more or less gone by the time I got there and all the resuscitation measures were only a matter of routine. Makes me a little upset for a while, and then the next patient comes. At the end of the shift, the only things you can think of is how much your feet hurt, and how you can't wait to sink into bed. So much for compassion.
I'm trying to steal the, but he started hiding them after my last fiasco involving ebay.

@stygian sailor:
I always wonder why they train us to work in PHCs while we are in a tertiary care centre. 'If you are in a PHC with no X ray facilities, how will you confirm your diagnosis?' is a frequent question. With the rural posting becoming compulsory, looks like I'll need all the practice I can get.

@thinking aloud:
But you also get a huge kick out of successfully dragging someone from the brink.
I salivate all over the keyboard every time I see them.

Dunkoo. Someone who doesn't find my humour inappropriate.

It's more like the Orthopaeics ward, from breaking your ankle. :D

It's scary all right, but we always manage, the awesome surgeons we are. :)

I'm hoping it won't be this bad after the new trauma care centre becomes functional.


Oh, yes, but some have more a stomach for it (pun unintended) than others. I'm not one of them. :(


Tea N. Crumpet said...

I used to do Hospice work. (I'm a liberal arts major who volunteers, for those of you who don't know me. I have too many kids to be able to do medical school so I am hoping to teach English at the college level) What kind of medicine are you going to do? I've had patients die on me but it was expected-- your side sounds scary as your patients and their loved ones are not ready for it.

One of my children was playing out side the other day and cut her finger. It needed stitches. Our family doctor was getting ready to go when I called but he said to come down. My daughter was freaking out (she is 12.) I asked the doctor for some medicine to calm her down. He looked at me like I was silly, thinking she'd settle in a moment but he wrote me a prescription for a single Valium and I went across the hall to fill it-- his nurse rolled her eyes at me as she thought me silly. Five minutes later she came to me, "Did you give them the order?" I said that I had. She went up to the pharmacists and said, "Please give her two and do it fast, and she will need two more for when she comes in for the stitches to be removed so give her mother a total of four."

I thought it was funny because they thought I was being silly. . .