Thursday, December 1, 2011

The Rush Continues . . .

(Kindly note that the picture in this blog is a bit gruesome for non-healthcare readers)

The last 3 days of November were relatively manageable at NJH. So, most of us were comforting ourselves that we would slowly be moving into a season of rest and celebration. And, from the second week of December till almost the first week of January, we would not be more than 2 doctors at a time in NJH. So, we would have preferred to remain a bit quiet - enough patients to just keep ourselves financially stable.

So were my thoughts as I walked out of office for the Unit Management Committee meeting yesterday, the 30th November.

However, as I came back, I knew that at least we would not be starting December the same way.

There were 2 patients in labour room. One of them had come in sometime early morning. A teacher in a school in the adjacent district. She had been leaking since the previous day. She was screaming for a Cesarian section. Ultimately to satisfy her, I had to do a examination which was not really warranted - and was almost sure that if she could hold on for another 4 hours, she could deliver.

Then, we had PD, who had been with us for the last week - leaking at 32 weeks. Ultrasound had shown that her baby was just around 1500 gms. We tried our best to refer her but to no positive response from the relatives. Sometime in the morning, we had done an ultrasound which revealed hardly any liquer. In addition, I wondered if she was running a mild fever. Total counts were elevated. We had to induce her, which is what we did sometime in the evening.

As I left the labour room to check on MY, there was one more patient being rolled in.

I reached ACU to find out that there has been a road traffic accident and couple of people who were quite serious has turned up. I met Dr Shishir who was on duty who updated me that one of them had a very bad degloving injury of the foot and he had called Dr. Nandamani to review. The second person appeared to have a blunt injury foot.

Then, there was one more case of poisoning which had turned up - this time, it was organophosphorus poisoning. AK was doing fine so was MY. I wrote for repeat liver enzymes for MY and returned home. As I passed through Labour Room, I enquired about the new patient. I was informed that SD has come in with most probably a dead baby and Dr Shishir was on his way to examine her.

Today early morning as I made to office, I was informed that SD turned out to have a rupture uterus. Her story was so painful. I hope to post it sometime later. She continues to remain sick after undergoing a hysterectomy in the night.

Then, there was PK, a young man - an alcoholic on regular pain medication for non-specific body pain who had come in with quite a bad duodenal perforation.

The theatre team was in hospital overnight. They had arrived at 8 PM the previous night and had returned at 5 AM in the morning. In addition to the two laparotomies, there was the young man with the degloved injury of the leg. Nandu informed me that the unfortunate soul would need a tendon transplant later.

However, I was glad to know that both the other labour patients had delivered normally. The teacher delivered a 2.25 kg girl sometime before midnight and the 32 weeker with leaking delivered a 1.5 kg boy.

Later, there were 4 more deliveries over the day including KD, a G5 with abruptio placenta.

The previous night would have been busier had a primigravida in frank pre-eclampsia with a horrifying blood pressure of 170/130 and a Urine Albumin of 3+ not decide to go home inspite of all our pleadings... It was so unnerving.

However, to compensate for her, today afternoon, we had another primigravida who has come with severe eclampsia at around 7 months pregnancy. By ultrasound, the baby weighs about 1400 gms. We had decided to give the baby a chance by with steroids acting for 24 hours.

SD who had the laparotomy continues to be sick. We request your prayers. Meanwhile, we thank the Lord that MY has survived. His liver enzymes are within normal limits. I plan to discharge him tomorrow.

And to top it all, all this rush on a day when the whole nation is on strike . . . If this continues, we would find it difficult to manage from next week with only 2 doctors . . .

No comments:

Post a Comment