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.
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.
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.
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.
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.
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| Monitoring of the patients |
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.
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| Nurses Station |
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.
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| Nurses Station, Old man keeping watch over his son's heart rate |
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.
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