oncall…..
when i was oncall on 30/4/2006, i had an unstable patient in the ward…patient had upper GI bleed and presented with massive fresh malena…Hb was 7 so, we put her on 2 pints of packed cells….anyway, we (registrar, MO and me) planned for the patient to have her OGDS in the afternoon…so the oncall specialist was informed…to my surprise he refused to do scope on this patient….the reason being, she’s not her patient and the respected specialist (who is in terengganu) should come to do the scope for this patient….
well…we already sent the patient down to scope room….patient seems ok…but then at 10.30pm i was called by the nurses….patient’s BP unrecordable…!!!!!i rushed to the ward, found out the nurses was bagging the patient….sorry to say, the nurses in the surgery wards are not quite good with CPR…no cardiac monitoring was put on, patient was already pulseless but yet no CPR started….!when we put her on cardiac monitoring she was actually already asystole….my MO intubated her…
anyway, we started doing CPR on the patient…BP was still unrecordable…when the registrar came, he decided to give inotropes accordingly until maximum….we continuosly resuscitated the patient until about 1 hour…goshhhhh!!!!i was so damn tired…!it’s not that i didnt want to save the patient but just look at the patient herself…she’s old, 80+…had a huge bedsore, necrotic and foul smelling…with massive upper GI bleed…and sepsis….after 20 minutes resuscitated her BP was still unrecordable…later on BP was picked up due to inotropes effects…and we had to DC shock her twice coz she had 2 episodes of VT..!in conclusion, this patient had a bad prognosis…..what are we trying to achieve in this patient if we try to revive her..?
well, it’s a very hard decision to make….what will happen to her if we scope her in the beginning..?will her fate be different..?
today, i have another patient upper GI bleed…again had massive fresh malena…due to multipel angiodysplasia….we planned for emergency operation today..extended hemicolectomy…family members were called…it took them 3 hours to decide….in the end, they decided not to operate on the mother…they said, they dont want their mother to suffer due to operation…let Allah take her peacefully….her cahnces are 50-50…if operated, she might die on table…if not she might die too…when i left at about 5.30, patient looked nazak…gasping and drowsy…i pray, may Allah decide what is best for her and that we all of us made the correct decision…
