IF ONLY!!!!

my on call sucks

It was OK in the beginning. I helped my friend to cover his ward this weekend. Besides I am on call hence I don't mind at all. My on call started with signing a death certificate for a patient who has been sick for a while and planned not for an active resuscitation. I got the feeling that it was not a good sign but I just ignore it. "Superstition la", I told myself.

Around 5.30pm, I was just arrived at ER as they called me to review some of the patients there. Suddenly, they pushed 3 patients into the ER.

The first one was a referral back from Sibu, patient was fine. Plan for admission. Not a problem at all.
The second patient looked like a case of stroke. So, it wasn't a problem either. Stabilize him first overnight and can send to Sibu CM for CT brain.
The third patient gave me a shock of a life!!!

A young Indonesian man, alleged a timber camp accident, sustained injury at his right leg. It occurred at 9am and came to me at 530PM!!!!!..I got a bad feeling about it. No need to say much, once they removed the patient's right sock, I put whatever i was holding at that time and gave orders immediately. "Come on people, set lines, big lines, run fluids, run gelafundin, put on oxygen, take blood crosstmatch, STAT!!!"

The right foot was pale, as white cloth. No perfusion at all. No pulse at all. It was dusky. The knee was even horrified. The tied the wound with pieces of cloth, no active bleeding fortunately but the wound was so big, ragged, filled with dirt and mud, nearly amputated with bone exposed. The moment i removed the piece of cloth that acted as a torniquet, the patient suddenly gasped, complaint of chest pain. Reflex, I ordered them to torniquet it again.

Blood pressure was low, pulse was very fast, patient look pale. From the look at it, you know that the limb is not salvageable. There is only 1 thing that is definite. Above knee amputation. I gave him lots and lots of fluid while waiting for his blood to be ready. I wanted to send to Sibu. Immediately. Now. But in view of his low blood pressure and very fast pulse. He is not fit for a transfer. I quickly called the Orthopaedic surgeon on call. He also sounded worried over the phone. Both of us felt helpless at that time. We both ended with "what to do, then do whatever you can do best there lor"

Here is the part where i felt hopeless. You know that patient needs urgent operation, you want to send to Sibu but you couldn't because no transportation available after 6pm. You know he needed operation but you don't know how to do it. (I've seen BKA once but...sigh). The whole night, I've been playing God. Trying to fight with the Grim Reaper. And looking at that helpless guy in pain and weak was very demotivating. What am I doing?

I talked to him earlier on. Forseeing that there is a possibility that the outcomes may be fatal, I told him frankly.
" You are in a VERY serious condition. Your leg is already dead. The only thing that can save you is to cut off your leg. But we unable to do it here. We need to send you to a bigger hospital. With specialist and proper care. However, we can't send you now because we don't have the transportation. We only be able to send you by tomorrow. However, since it will be a long hours to wait for the next morning, there are possibilities that you need to know. The wound is so extensive that there is possibility that you may...err..die. Do you understand what am i trying to point out?"

He replied " Its up to you doctor, I only follow whatever you think that is best for me. I know you have done your best. I rely on you. Do whatever you can."

As if he has put his life on my hand. And waiting for me to decide whether to hold it firmly to let it grow or to crush it instantly. I felt hopeless. Truthfully, there was time i felt that hopeless, i felt it would be best if the patient collapse. It will be easier for both of us. But I know that is not possible. Not even ethical. And you call yourself a doctor?..
I wish I know how to perform the op. I wish at least I can do a proper debridement for you. I wish I can have my own helicopter to send you there. I wish and keep on wishing but none of them become true.

Felt like want to give up on surgery and ortho. I felt not save. I felt that I may cause more fatality rather than good.

It gave me a goosebump to tell your patient that you may die. I felt like a Grim Reaper himself. A shinigami. A death God.

I asked for opinions from various people. the aneast, my ortho colleague. I want to keep him alive overnight so that he will be able to be sent to Sibu the next day. What should i give? what should i look for? What else can I do? Mostly supportive.

Alas, with God's mercy and love, the patient was stable enough to be send to Sibu. He managed to thank me before he left. But frankly, in my heart, I don't think it will be a smooth sailing though. But I've tried my best though.

Similar goes to the case I attended when i was relieving in Sarikei. A 12-year-old child came in after alleged accident, I intubated him, I gave lots and lots of fluid. He sustained multiple fracture, open right femur and pelvic fracture that caused him to lost a lot of blood. I could not save that child. The damage is already too extensive. I could only pray for the best.

If only....


I don't want to say that word anymore. I want to be able to say.

Its ok, I can do this....


Hence, I need to read more. more and more.