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My 1st week in neurology department is Blur-ing, Hectic-ing and Exhausting especially when i was allocated to the front-line - The emergency department of Neurology.
Not going to elaborate much as i still have tons of book awaiting me to read them. Phew~~ seriously don't have time to study, every day just busy with hospital work and during back home, i had thoroughly exhausted, I could still directly fall into sleep right after a cup of coffee, or I should try 2/3 cups instead ?
Still have alot to catch up... and I still stuck in Physical Examination of Neuro ONLY. =.="""
28.04.2010
Sharing my 1st experience of facing a dying patient in the ward of neurology with you guyz...
I was ALONE with NO seniors and doctors ,observing all the patients under that ward. ( around 20 patients. ) ohya, with nurses of course... but most of the nurse went to sleep , left 1 nurse who was alert.
Around 1.00am, when i was checking the vital signs of Patient A, I was informed by the husband of Patient B that his wife feeling Short of Breath.
I went to check the Oxygen concentration level of the oxygen tank which delivered to her through nasal cannula, i had been increase to an optimal concentration but the patient still suffering from short of Breath. Immediately, i went to inform nurse and doctor, after checking on that patient, the doctor asked me to go and rest.
When i was just about entering the dream of fantasy, awaken by the nurse and she said the patient was fever and asked me to check for her vital sign ( pulse, blood pressure, respiratory rate and temperature ) , with the eyes hardly opened, I tried to feel the patient's pulse, was weak, and I was trying to get her blood pressure reading... hardly heard any sound via the stethoscope, my heart start pounding rapily, felt some imminent bad things would happen.
As soon as i thought, the patient husband shout , "Doctor, look...the chest stop moving !" 1st thing come to mind, " Oh my gosh..." after checking the pupil reflex and heart sound, i faster ran to get the doctor .
When I came with the doctor, I saw nurse came along with the ECG monitoring machine and the resuscitation Bag. Doctor asked me to fit the ECG on the patient and check for her heart rhythm. At first it still had some residual rhythm of heart beat, but soon followed by the high-pitched sound "dee----------" After observation of 5 minutes, the doctors declared the patient had passed away.
The husband looked calm, he just said "she been struggling for over 35 years, she said she was tired and wanna go to heaven very soon and asked me to take out the ring from the ring finger. It happens now...... " Soon, he kissed his beloved wife forehead, nose, and mouth... and their children cried devastating....
------------------------------------Not going to elaborate much as i still have tons of book awaiting me to read them. Phew~~ seriously don't have time to study, every day just busy with hospital work and during back home, i had thoroughly exhausted, I could still directly fall into sleep right after a cup of coffee, or I should try 2/3 cups instead ?
Still have alot to catch up... and I still stuck in Physical Examination of Neuro ONLY. =.="""
28.04.2010
Sharing my 1st experience of facing a dying patient in the ward of neurology with you guyz...
I was ALONE with NO seniors and doctors ,observing all the patients under that ward. ( around 20 patients. ) ohya, with nurses of course... but most of the nurse went to sleep , left 1 nurse who was alert.
Around 1.00am, when i was checking the vital signs of Patient A, I was informed by the husband of Patient B that his wife feeling Short of Breath.
I went to check the Oxygen concentration level of the oxygen tank which delivered to her through nasal cannula, i had been increase to an optimal concentration but the patient still suffering from short of Breath. Immediately, i went to inform nurse and doctor, after checking on that patient, the doctor asked me to go and rest.
When i was just about entering the dream of fantasy, awaken by the nurse and she said the patient was fever and asked me to check for her vital sign ( pulse, blood pressure, respiratory rate and temperature ) , with the eyes hardly opened, I tried to feel the patient's pulse, was weak, and I was trying to get her blood pressure reading... hardly heard any sound via the stethoscope, my heart start pounding rapily, felt some imminent bad things would happen.
As soon as i thought, the patient husband shout , "Doctor, look...the chest stop moving !" 1st thing come to mind, " Oh my gosh..." after checking the pupil reflex and heart sound, i faster ran to get the doctor .
When I came with the doctor, I saw nurse came along with the ECG monitoring machine and the resuscitation Bag. Doctor asked me to fit the ECG on the patient and check for her heart rhythm. At first it still had some residual rhythm of heart beat, but soon followed by the high-pitched sound "dee----------" After observation of 5 minutes, the doctors declared the patient had passed away.
The husband looked calm, he just said "she been struggling for over 35 years, she said she was tired and wanna go to heaven very soon and asked me to take out the ring from the ring finger. It happens now...... " Soon, he kissed his beloved wife forehead, nose, and mouth... and their children cried devastating....
When i think about that incident, I felt guilty as I didn't do any resuscitation procedure like CPR. I think I should do it although the doctor didn't instruct me to do so. I understand that even If I do the CPR , it might not help the patient though but still at least i had tried my best, right ? At least we do something optimally before the patient died. That's why I felt so guilty, this feeling still haunting in my heart although it happened few days ago...
Morning when the senior came, I told them, and most of them said, " nevermind... 1st time what... just take it as experience, 2nd time would be better... "
Yupe, 2nd time would be better...!!!!
Yestersay I was on-duty at the front-line again, most of the patients came with critical condition with the risk of impending death... so scary... It seem like that's a RULE that everyday there must be at least 1 patient died in the neurology department and sadly, i felt some of the doctors already take it as a norm as they won't have too much emotion when facing a dying patient.
After the whole night of "jaga" in the front line, It was tiring and thank God i switched to "jaga" at the ward of stroke of the hospital when the dawn announced. Duty in the ward is easier and less hectic, most of my work is just observing the patient condition, injecting some drugs, do some physical examination on them.
This is the photo which i taken this morning when i met a lady and her husband who contracted from stroke. When i was doing physical examination on her husband, the lady took out her video cam and record , feeling nervous at that moment actually.. and after that, she requested to take photo with us.
In the stroke center of this hospital, we are required to wear the not-really-sterile blue coat and sandals before entering the ward...
and tomorrow, sunday, jaga again at night shift.... how to squeeze out the time to study while i always need to go hospital all the while from monday to saturday????? and Even sunday???? God knows..... =((((
Morning when the senior came, I told them, and most of them said, " nevermind... 1st time what... just take it as experience, 2nd time would be better... "
Yupe, 2nd time would be better...!!!!
Yestersay I was on-duty at the front-line again, most of the patients came with critical condition with the risk of impending death... so scary... It seem like that's a RULE that everyday there must be at least 1 patient died in the neurology department and sadly, i felt some of the doctors already take it as a norm as they won't have too much emotion when facing a dying patient.
After the whole night of "jaga" in the front line, It was tiring and thank God i switched to "jaga" at the ward of stroke of the hospital when the dawn announced. Duty in the ward is easier and less hectic, most of my work is just observing the patient condition, injecting some drugs, do some physical examination on them.
This is the photo which i taken this morning when i met a lady and her husband who contracted from stroke. When i was doing physical examination on her husband, the lady took out her video cam and record , feeling nervous at that moment actually.. and after that, she requested to take photo with us.
In the stroke center of this hospital, we are required to wear the not-really-sterile blue coat and sandals before entering the ward...
and tomorrow, sunday, jaga again at night shift.... how to squeeze out the time to study while i always need to go hospital all the while from monday to saturday????? and Even sunday???? God knows..... =((((
Sounds like you are bullied by the intern in the ward.
ReplyDeleteLife could be hectic, but good for you, because you can have a glimpse of what medicine is apart from reading books.
Studying medicine is easy, but practicing medicine is complicated.
There are many factors that govern your decision making.
For instance, the aunty that you mention in your post, who passed away without being resuscitated, you felt guilty for not doing anything.
I’m not sure what she was suffering from, but perhaps some chronic incurable illness that she had for the past 35 years.
At the moment when she succumbed, decision whether to resuscitate should be discussed with the family members.
If they refused for any active intervention, it is best to let the aunty go in peace, and not after repeated chest compression, manual bagging, intubation, tons of inotropic medications….
Letting go life is difficult, but is something you have to learn in this field……
Medicboyz ,
ReplyDeleteI like your quotes,
Studying medicine is easy, but practicing medicine is complicated.
I not really know how malaysia sys working, but for tat case, whn the aunty was succumbed, the doctor never instructed to me to do anthing and just asked me to fix ECG and declared her death. Luckily the family dint sue us for doing nothing b4 she died. And actually the patient had complained SOB since 6pm.. i informed nurse, informed the resident doctor there... but no one bother me... i thk because tat patient is a 3rd class patient ( low economic status patient ), so thy didnt do anything jz bcuz save the cost ??? a SOB patient shud be close monitoring in ICU,rite ? but thy jz let her stay in a common ward wic was damn Smelly and bad ventilation.
and as i remembered, the doctors dint asked whether the family wanna accept the recuscitation intervention or not.
After the incident, her husband still came forward and thank me... realy felt shamed of myself... i dint do anything... so pity of thm who don hv much knowlege. Thy donno anything but still appreciate you alot.
Medicboyz ,
ReplyDeleteI like your quotes,
Studying medicine is easy, but practicing medicine is complicated.
I not really know how malaysia sys working, but for tat case, whn the aunty was succumbed, the doctor never instructed to me to do anthing and just asked me to fix ECG and declared her death. Luckily the family dint sue us for doing nothing b4 she died. And actually the patient had complained SOB since 6pm.. i informed nurse, informed the resident doctor there... but no one bother me... i thk because tat patient is a 3rd class patient ( low economic status patient ), so thy didnt do anything jz bcuz save the cost ??? a SOB patient shud be close monitoring in ICU,rite ? but thy jz let her stay in a common ward wic was damn Smelly and bad ventilation.
and as i remembered, the doctors dint asked whether the family wanna accept the recuscitation intervention or not.
After the incident, her husband still came forward and thank me... realy felt shamed of myself... i dint do anything... so pity of thm who don hv much knowlege. Thy donno anything but still appreciate you alot.
Medicboyz ,
ReplyDeleteI like your quotes,
Studying medicine is easy, but practicing medicine is complicated.
I not really know how malaysia sys working, but for tat case, whn the aunty was succumbed, the doctor never instructed to me to do anthing and just asked me to fix ECG and declared her death. Luckily the family dint sue us for doing nothing b4 she died. And actually the patient had complained SOB since 6pm.. i informed nurse, informed the resident doctor there... but no one bother me... i thk because tat patient is a 3rd class patient ( low economic status patient ), so thy didnt do anything jz bcuz save the cost ??? a SOB patient shud be close monitoring in ICU,rite ? but thy jz let her stay in a common ward wic was damn Smelly and bad ventilation.
and as i remembered, the doctors dint asked whether the family wanna accept the recuscitation intervention or not.
After the incident, her husband still came forward and thank me... realy felt shamed of myself... i dint do anything... so pity of thm who don hv much knowlege. Thy donno anything but still appreciate you alot.
Medicboyz ,
ReplyDeleteI like your quotes,
Studying medicine is easy, but practicing medicine is complicated.
I not really know how malaysia sys working, but for tat case, whn the aunty was succumbed, the doctor never instructed to me to do anthing and just asked me to fix ECG and declared her death. Luckily the family dint sue us for doing nothing b4 she died. And actually the patient had complained SOB since 6pm.. i informed nurse, informed the resident doctor there... but no one bother me... i thk because tat patient is a 3rd class patient ( low economic status patient ), so thy didnt do anything jz bcuz save the cost ??? a SOB patient shud be close monitoring in ICU,rite ? but thy jz let her stay in a common ward wic was damn Smelly and bad ventilation.
and as i remembered, the doctors dint asked whether the family wanna accept the recuscitation intervention or not.
After the incident, her husband still came forward and thank me... realy felt shamed of myself... i dint do anything... so pity of thm who don hv much knowlege. Thy donno anything but still appreciate you alot.
seems like ur life in hospital is full of challenge and dramatic..gambateh ya future pretty doctor..anyway..looking forward for ur future interesting post in hospital incident!
ReplyDeletecarina , thanks ya.... I'm glad to share with you all about my story.... tat's why i create a blog... =)
ReplyDeleteU gambate for ur journey too !!!!!
Aeris,
ReplyDeleteWhat we read from books could not always put into practice.
About that patient, probably before the night, doctor in charge have discussed with family regarding their expectation.
That is the reason they kept the lady there and not in ICU.
Imagine you only have 1 empty bed in ICU and the last bed is occupied by this lady, who had 35 years of chronic incurable disease with poor prognosis.
Suddenly, one 14 year old boy with severe head injury came in, and required the ICU back-up, what should you do?
You can’t be probably pushed the lady out to empty the bed for that boy, right?
That is why sometimes we have to be selective in treating patient, choose those who has better survival chance.
Sounds cold-blooded, but this is life.
Practising medicine is never easy….
medicboyz,
ReplyDeletei got wat u mean....sometime bec to the reality, is brutal but ter's only way out..
thanks alot... ur opinion is really highly appreciated =)
gambatte in ur journey of medicine too~
Aeris,
ReplyDeleteLife is tough sometimes.Just do the best you are or if too emotional, you totally cant continue your career in future cause you just will continue to haunt by the dilemma issue like this.
That why I always will respect those friends who study medic,ready to face to the tough time in study,after that more tough in practical moment..Jia you !