ECG has to be done

I was confident today that i will take out the ECG perfectly after i had done it wrong the last 3 times. I pressed the button and the ECG started rolling. The 'first lead' came out good, the second was also nice, by the time i reached the third it stopped. "It must have run out of paper" with these words the nurse put to me in a ease.
               I was looking at the 'BPL' logo on the ECG machine and in my head 'Next i'll press this button and then that....' when suddenly my name rings in my ear breaking my analogue thought stream "Sarthak! Sarthak! come here fast". My duty time was already over nearly half an hour ago and next shift interns had already come in. I stayed behind only to do that ECG so that i'd be able  to handle things in states of emergency and no hands to help around. Dr. Durgesh had joined the institution as a MO just one month earlier to me and we get along pretty well. He taught me suturing, bandaging, NG insertion, catheterisation and pretty much all the basics of emergency medicine. Just like any other profession that needs team work Emergency Medicine also gets very interesting if co-ordination between partners click off.
                                       Same is with me and Dr. Durgesh who was calling my name at that moment just next bed from where i was standing. A young man of 38-40 had come in about an hour ago with loss of consciousness and alcohol withdrawal effects.We have had the the necessary and the patient's condition were stable. When suddenly Dr. Durgesh noticed 'NOTHING'. Nothing here means a lot, nothing to a militant is Safe, nothing to a teacher is a quite class, nothing to engineer means no errors in calculation, or simply nothing is nothing at all for anyone else but nothing for a doctor is a lot of things because none of the symptoms were present over that patient and we could see no movement of chest or limbs, absolutely NOTHING.

CPR

                             Without wasting any further time i reached the bed and immediately understood what Dr. Durgesh was calling me for. Within seconds my left palm was over my right which was placed over the sternum (mid point of the chest) of the patient. I was giving CPR (Cardiopulmonary resuscitation). "Get me the AMBU bag" - i cried for help to one of the replacing interns who immediately fetched me a over sized egg shaped self inflating air balloon which is used to push in extra air into the lungs of a person who is unable to breath or so. From the other side of the bed nurse was being directed by Dr. Durgesh to push in 1-1 ampule of atropine and adrenaline into the veins of the patient. With every five compression of the chest Dr. Durgesh will punch in a gush of air from the AMBU bag into the patients lungs. The power needed for the surge was so great that each time my body would rise from the floor while doing so, so at last i climbed onto the bed and started again with better stability.

Different age group AMBU bag

                                             I knew climbing on to the bed was a good idea from this morning where almost a similar situation had taken hold it's grounds and with a similar scenario setup i was doing CPR and Dr. Durgesh was pumping the AMBU. This man was 73 years old, heavily Diabetic and was brought in by his daughter with a hypoglycemic shock. Our profound measures to resuscitate him were going in vain and at last when there was NOTHING we decided to go in for CPR. After giving in all our heart we failed to start their hearts. This followed in the hardest part - Declaring the death of the person to the family.
                                     I was relaxed for i was sure i wouldn't have to do that but did wanted to watch and learn how to do so for my future references when it suddenly struck me 'The MO's were not declaring that person as dead. But WHY?!' This was something new & interesting to me. I knew the man was dead, the MO's knew he was dead, even the family was sure that the person was no more with them but then why was not he being declared dead? What did i missed from the scene? Was there still some hope? All these questions running inside my head and no answers were appearing i decided to ask Dr. Durgesh my only faithful companion in front of whom i could do silly mistakes and expect him to understand.
"Sir, what is going on and why isn't he being handed over to the family?" i inquired eagerly.
"The ECG has to be done yet" he answered  simply
"Why to waist ECG when we already know he's dead?"
"We'll it's our clinical proof & we can declare him dead only when the ECG turns flat" He understood my  confusion and cleared it out.

Flat ECG

                 But not for long was i satisfied - The ECG wasn't flat. Did that meant there is still chance??? And my very thought was answered by Dr. Krishna who explained the situation to the patient party since they were in a hurry to take the body with them. ECG will turn flat after sometime once the effect of atropine and adrenaline as well as CPR wears off. So until the CPR turns flat the body will not be handed over, death certificate will not be issued and the person will not be declared DEAD! During which so many mixed emotions turned up at the gates where the family is being consoled by the neighbors or by each other. Wives and daughters crying their lungs out and dehydrating themselves up. The only way to neglect all that is to make yourself useful again in saving other lives.
                                     The only humorous incident that happened that i had a bad stiff neck this morning but all the heavy exercise kind of did me good and i could move my neck in all directions again by the end of the day.

I want to see a Physician

My working days in the hospital as a intern has taught and showed me a lot of things in the past 3 months. So many recoveries, so many miracles, so many happy faces and equal number of deaths. People die in front of my eyes everyday, no matter how hard we try, their death somehow seems evident. Medicine saves lives but can't bring back the dead. Our life is in our own hands to cherish & nourish it.

                Everyday nearly 2-3 cases of poisoning reaches the emergency department who tried to commit suicide or moreover should i say tried to scare their family by making a drama. Drama because none of them take enough amount of poison that will kill them. They just make it hard for them selves and for the poor family members. Once during my duty hours they bring  in a patient who himself was accepting of having taken 'sulfas' a potent poison with 100% mortality rate. It's very rare when people survive after taking SULFAS. However this guy seemed alright except for looking drowsy. His family had made him drink soap water and make him vomit thrice on the way reaching here. Unless and until you know what poison has been taken it's very difficult to decide the antidote. We treated him according to the symptoms which clearly indicated some other poisoning. He had pulled this drama just to scare his family and to show them that he's a serious man who can even commit a coward thing like suicide. Each day number of such cases are being reported in our parts of the world.

Death comes as the end

                 Similarly a lot of other cases show up at the end stage of the disease. People keep on avoiding their problems and try out their home remedies to take relief. And when thing finally move out of hand that is when they remember a doctor. At this point it's difficult for us as well, people then not to reckon that. And over that they expect us to magically make the person fit in moments. We are doctors not magicians. Today with our advance life style and fast food fashion we invite a lot of unwanted and serious health problems. Surveys have shown even small children as low as age of 14 are having hypertension. People are now dying at an early age with Heart Attack being the most common cause. Every second person is having diabetes and every third is having arthritis or gout.
                 "What's the solution you ask?" The answer is simple - "Healthy Lifestyle". A complete self controlled and simple way of living promises you a long and disease free life. With the help of Lifestyle channels and the Internet people are well aware of what's good and what's not. To avoid the very common tormentors of life like hypertension, gout, angina etc. you should keep a check on what you EAT, the main culprit to all that is happening to your body. And the point where you have done your part comes in the role of a General Physician.

General Physician

                  A General Physician (GP) is your personal trainer to a healthy body, your coach to kick of diseases & your guide to a beautiful  ailment free life. A GP is your first step to the medical  world. He's the station master who directs you to specialists when required. Whenever we fall ill we shot for specialists which is not the very best idea. One should go to his family physician first as he knows you well, knows your medical history, knows your allergies and he is as good as a specialist when it's just a fever or stomach ache. He'll examine you and when things are out of his reach it's then when he refers you to a specialist. Going directly to a specialist has it's own merits and demerits like he will treat you in the same line of drug as GP if it doesn't require any special treatment. Also he'll charge double the physician's fee. It's hard to get a specialist's appointment and above all he can only treat and think in the direction of his specialization and none other.

ENT Specialist

Eye Specialist

Child Specialist

                
                                     For example a Cardiologist will keep on looking for something wrong with the heart and will not treat for any stomach related disorders and vice versa. Whereas a GP will look in general the whole body and it's different parts instead of referring to different persons for each part. A GP can treat from diabetes, migraine, jaundice, malaria, dengue, tuberculosis, hypertension, gout, arthritis, peptic ulcer, gastritis, psychosis, etc. to hypochondria, suturing minor cuts, fungal infections, psoriasis, alopecia, menstrual disorders etc. To sum up almost anything as long as it doesn't requires surgery or micro specialty like cardiomyopathies and nephrology etc.

                    
                               Sadly lack of this knowledge among the commoners is leading to a shortage of GP's in our country. As people shot for specialists in every medical emergency GP's tend to do specialization and are able to charge more. We can only help improve the health services in our country by demanding GP's and reducing the overall medical cost. The fist thing is you to have yourself a family physician whom you can reach over the phone or call home at time of emergencies, whom you can visit all year round and get your selves regular health check ups. Your GP can direct you to all the test you are to get done regularly instead of wasting your money on a big amount of tests which are not even necessary. He'll tell you what to eat and what not to if you have diabetes or gout. What to do or what not to when you have tonsillitis or hernia, and endlessly so many things. 
                   My 3 years of internship has taught me a lot of things but it has lead me to become a MD GP. MD because people slaves to their nature, will look for a specialist when ill and GP because what they actually need is a GP. Know more and help yourself, help the society or stay ignorant and witness the downfall.

A night at ICU

          My eye opened to a knock on the door. I checked my watch, it said 5:30 a.m just 2 hours since i hit the bed in the ICU doctors chamber. I could hear ventilator buzzers and nebulizers. I opened the gate and sister was standing mumbling something about a patient complaining about dizziness and blurring of vision. I knew what to do since i had attended her before going to bed. 

               Only last night i had joined the anesthesia department  which runs the ICU under it. It was my first day as well as first night. I got acquainted about the cases present there through the files. I being the only intern present there a anesthesia JR was to help me out. Out of 7 cases in the ICU 2 cases were in a very critical state and after instructing me how to handle them he left for OT at around 8 in the night. There i was all alone with two sisters to assist me and my only help was my knowledge.

     

Monitoring of the patients

                            I was supposed to monitor for patients Blood pressure changes, heart rate, SpO2 (measure of oxygen level in the blood) and a few other medical standard measures like pulse, temp. etc. I took a round and sat in my seat with the idea in my mind that they are all peacefully sleeping (or more likely unconscious) and i will sit for a few hours and leave at around 12 o'clock. But little did i know i would be working for the next 18 hours.
                           As soon as i sat down the sister calls for help. "Doctor! please open the vein of the patient at bed number 8, it's very feeble & i can't find it". If you couldn't how would i?! i thought to myself but still went in for the challenge and after a series of pricks and blood drops all over the bed sheet i achieved success. After wiping the sweat from my forehead i was just about to sit down then suddenly patient party of bed number 4 starts panicking as the cardiac monitor was not showing SpO2 readings. They thought that patient was gone but only the SpO2 probe wasn't working properly & i asked the ward boy to change the probe and things were back to normal again.
           "Doctor! BT Note" requested the sister. BT note stands for blood transfusion note which is a formality before transfusing blood to a required patient in which we write the transfusion details asking to stop immediately if any such transfusion reaction occurs. BT note was not a big deal for me, i had done that before also. But this time i realized i was the only doctor around and if some reaction does occurs i will only have to take care of the patient. My worst fear had  come true and patient did showed signs of transfusion reaction. Thankfully it was only high grade fever and not any other fatal reaction which i feared. "Stop the transfusion and give her paracetamol" i asked the sister.

Nurses Station

             While waiting for her temperature to come down BOOM! comes in another case from emergency medicine. Case of alcoholic liver diseases who also was suffering from withdrawal symptoms. Withdrawal symptoms are something that occurs in an addictive patient weather alcohol, smoking or drugs when it is stopped suddenly. The patient becomes heavily agitated and same was the condition over here. Patient was tied down to the bed and was screaming incomprehensibly. I called upon the JR for help. After few minutes of his arrival we were fixing canula in the patients hand. I was holding the patients hand with all of my body weight other wise the needle may break inside his body and will create messy situation for us. We succeeded eventually some how saving me from the patient who tried to bite me. "Give him a combo of Phenargan and Serenec (heavy sedatives) and he will sleep now" the JR directed me and left after reviewing the critical cases once again. But those heavy sedatives also didn't do us much help. The patient was still very hyperactive and free himself from the bondage 3 times. We again and again with the help of the ward boy tied him down and increased the dose of sedatives uptill 12 o'clock.
                                          Then rises yet another challenge for me when the SpO2 of the patient  decreased suddenly and immediate oxygen supply was required. I asked the ward boy to open the oxygen cylinder and started pumping oxygen through the Endotracheal tube directly into the lungs while the sister started suction on the bronchial secretions. After a desperate attempt for 10 minutes and heavy backache i could bring back the patient's blood oxygen to a satisfactory level. Her secretions had become very thick and i had to change her NG tube (naso gastric tube that is put through nose upto stomach, also known as Ryle's tube) which was again a very tricky job the patient being unconscious. How ever i had a good practice of this when i was posted in emergency medicine so without much difficulty i could change her NG tube.
                            After the last vital check ups of all patients i checked my watch - it was 3 am. I sat down at the nurses station and was surfing the my phone for any pending messages when a patient party approaches me "Doctor please tell me will my son live or not?!". "What?!" i said surprised getting up from my seat and looking for the patient if something just happened. "I don't care about the money, i have already spent 4 laks and i can spend more. I'll sell all my fields. Just tell me what to do?" I understood the patient party was emotionally exhausted. I tried to calm them down and give them hope, but there is not much hope left when the prognosis is negative. Their 4 year old child was struck with Gullien Bar disease in which their is very very minute chance of survival.

Nurses Station, Old man keeping
watch over his son's heart rate

                          Another case was of a young teenager who tried to commit suicide and  was brought in as a case of unknown poisoning. He was having sleep bradycardia and each time he falls asleep his heart beat will drop massively. His attendant his poor old father had to stay awake all night and kept waking him up each time his heart beat will fall below 40. That old man kept staring at the cardiac monitor. I asked the sister to inject 1 ampule of atropine so that the old man could also get some sleep and the boy's heart rate would stay stable for some time.
                              I looked at my watch it was 3 a.m and it was getting very hard for me to keep my eyes open. "Doctor, go and have some sleep. we'll manage now" the nice sister told me and i went to bed. In the morning things looked very different. How funny when you experience some trouble with your computer of bike and you take it to the service center it works just fine. Similarly when the JR's from anesthesia, medicine, pediatrics and surgery arrived in the morning all the patients were stable and looked good. I completed the daily S.O.A.P note (subjective and objective assessment plan) of the patients and left the ICU at 9:30 in the morning when releaving intern came in.
                                I helped my self to the anesthesia department for my attendance to the HOD where i was caught to attend the daily presentations. I sat there for next 1 hour with my eye half open and thinking of the event of the night. How every patient had to be looked upon, the mental status of the  patient parties, someone is ready to spend laks, some one is unable to understand the critical condition, some one wants to take the patient to higher centers. I sat there and thought of the life waiting for me in the future, the life which is not mine anymore but for the betterment of the mankind. To help the poor, the needy and most important of all to save a life. I returned to my room in the hostel at around 11 in the noon and within no time was fast asleep into my dreamworld.