ED Hell Continues

Today I was again at red, where I feel that I'm more and more like a Jonah (is that how we spell it?) in that zone.

ED Serdang is feeling more and more like KK Jaya Gading: med students have power to manage patients, the problem being that they're life and death patients and the doctors in-charge sometimes go MIA, forcing decisions to be made by med students and support staff. How about "Hello Mr. X, I'm your medical student in charge for today, literally" as the greeting of the day (of course I didn't say that)? Not being able to key in requests on behalf of missing doctors made things worse. And it's all because of a doctor seeming to have what I think personal problems, taking time to cry and weep for an unknown reason, before disappearing off someplace.

And the system of waiting for investigations before departments accept patients made things pretty stressful. There was one patient who had an obvious case of ruptured/impeding rupture of an ectopic pregnancy: generalized lower abdominal pain referred to the shoulder, difficulty in taking deep breaths, LMP with positive UPT and PV spotting with pallor. GP trans-abdominal scan showed no POC in-utero. But we had to wait for blood results which only returned 2 hours later: Hb was dropping down to 7. Then did the O&G MO see her, and found an adnexal mass with free peritoneal fluid. Of course she was sent to OT stat. I felt tempted to perform a cervical excitation test to just get her referred already.

How about over-triaging for political reasons? There was an elderly lady with 3 days of acute gastroenteritis, and clinically only mild dehydration and hyperventilation without Kussmaul breathing. Past history suggestive of BPPV without seeking medication, and HPT/DM/LVH on meds. The dagger? She was tolerating orally! She was here in red because she's the mom of the previous director. Only managed with maintenance fluids and nourishing fluids brought in by the ex-director (contradictory, no?).

Of course boss had to attend to her (being in red) with me accidentally stuck there as I attended her before the MO; better manpower could've been sent to the patient with CKD, decompensating CCF, DIVC with underlying septic shock. He was there from morning to evening, as departments argued where to send him, until ICU decided to accept him, but pending on waiting for a patient to be TO'd.

Had an interesting case of hypokalemic paralysis, but couldn't clerk her as I was busy seeing other patients and she was sent to the wards when I was a bit free.

Having to pick up the slack for the MIA doctor, Nu'aim and I only returned home at 6 pm, one hour late. Totally screwed my plan to go to the gym tonight, as I was completely drained, forced to "lead"* the management of a patient with hypoglycemic coma with almost impossible vascular access (got an ankle access on our 7th try), as there were no doctors around when he came around 5 pm. Soon after, the yellow zone doctors had to cover the red, while one of the green doctors shifted to yellow when they knew of the MIA doctor.

I felt some pity going back, but hey, you shouldn't overwork if you're on office hours duty instead of shifts.

But stress leads to good timely humor. Quote of the day of an ENT MA to an uncooperative patient a week back:

"Aiyoo, uncle, tolong duduk diam...Sudah pukul 5 lah! Saya mau balik..." (Uncle, please sit still, it's 5 already! I wanna go home!)

Or at least something like that. But seeing others post pics make me jealous, as I don't have a camera, and can't take pics anyway as there's no time to slack off from "work"; at least any sort of humor relieves the stress.

*Not a good thing, especially when other doctors/patients/relatives think that you're a doctor. There can't be responsibility without power, just as it goes the other way around.