Thursday, March 17, 2005
Stressed By My Definition
How would you describe something which happened beyond stressed, so stressed that you wished everybody in the theatre spontaneously combust and the patient’s oesophageal cancer cured a-surgically. No surgery indicated, no anaesthetics needed. I wish.
This chap, had electively been scheduled for an oesophagectomy (gullet operation) yesterday, which didn’t happen funny enough, after all that ICU bed booked for him, the whole morning session allocated for him and me psyched up for this big big anaesthetic salsa for him. Why?
Naturally, you would think he’d be sensible enough to understand that nil by mouth means, nothing per oral, zero through mouth, yillek itu mulut juga makan, and various other ways of understanding it.
His operation was in half an hour’s time and he had a flipping apple. A whole gargantuan apple! (on my scale of things), because this not only meant he’d get cancelled, it meant ICU bed getting cancelled, and possibly other sessions cancelled to fit him in the next day.
"Oh I thought a snack is ok", I could only smile, whatelse can I do.
So tomorrow arrived which is today. If I were to ask now, on what it means to deal with a ‘difficult’ patient, I’d say it’s him. His body was as if saying just let me go, it’s my time, and so every step we made was a struggle through and through. At least it felt so.
Chronologically, I first put the cannula for iv drip, the vein was so wriggly I had to retract the skin and play chase the snake. Once I nailed the snake, it popped as if I asked it to.
What????
Next the arterial line. Got it in but a swelling followed not long after the transducer was connected. A haematoma? How did that happen? What??
Next, putting him to sleep. The standard size double lumen tube just wouldn’t pass the larynx and didn’t that just trash my confidence. Eventually had to put in a size down, compromising a good seal, risking a leak.
The NG tube had to play the part as well so it coiled and coiled at the back of his throat like it’s a lion dance show. By that time I was losing my patience.
The thoracic epidural was a nightmare. Multiple attempt is by definition 3 goes or more at putting it in. Is there such thing as multiple attempt squared? Yes, let’s have that. Got it in the end and I thought my armpits felt a bit damp.
The subclavian cannulation was proven to be an epitome of impossibility if there is such a phrase. 2 goes and each time the guide wire just bounced off. I wished I had an isobestic power of a cross between x-ray vision and ultrasonic touch to know exactly what was going on underneath that skin of his.
Dr.G saved the day and put in a subclavian. Felt useless as usual while he was doing it.
So that’s why you’re a consultant eh Dr.G?
I am sure I gave him that look, because he later said, it comes with practise Naj and smiled.
At least my existence and failure had made somebody felt good about somebodyself.
I could probably do something with all these sour grape thoughts I am collecting. Pickle them or something and bury it somewhere.
And, oh my god. After all that palaver and hurdles and obstructions as if his body is resisting against anything at all to do with the removal of the cancer, the most nerve wrecking thing happened.
The surgeon turned the patient to left lateral and started going through the right lung to get to the oeasophagus. They started the routine deflating of the lung.
The oxygen saturation dropped steadily.
We all like 100%. Mine is 98%-100%. If you smoke it’s lower. Maybe 95%.
This chap’s dropped more but still steadily passed the 90 mark. I was alarmed.
It dropped more to 85 and suspended for a while. My heart beat jumped to a triple figure but I kept composed. I did the drill and at the same time Dr G was summoned.
The hiatus broke, glided down to 75 very fast and the patient was blue. I felt an impending doom, imminent catastrophe. What’s wrong? Think think think.
My throat felt dry my voice felt weak. I backed off and Dr G took over. It dropped further and by then we’ve gone through all possibilities but nothing was obvious.
It went down to the 50s figures. How is this compatible with life?
I felt giddy with my own pounding palpitations. My heart beat was so loud, the repercussion kneaded it’s way as far as my ears, and my chest felt funny. It was so hard to not breath so heavily ….Ya Tuhan tolonglah….
This chap, had electively been scheduled for an oesophagectomy (gullet operation) yesterday, which didn’t happen funny enough, after all that ICU bed booked for him, the whole morning session allocated for him and me psyched up for this big big anaesthetic salsa for him. Why?
Naturally, you would think he’d be sensible enough to understand that nil by mouth means, nothing per oral, zero through mouth, yillek itu mulut juga makan, and various other ways of understanding it.
His operation was in half an hour’s time and he had a flipping apple. A whole gargantuan apple! (on my scale of things), because this not only meant he’d get cancelled, it meant ICU bed getting cancelled, and possibly other sessions cancelled to fit him in the next day.
"Oh I thought a snack is ok", I could only smile, whatelse can I do.
So tomorrow arrived which is today. If I were to ask now, on what it means to deal with a ‘difficult’ patient, I’d say it’s him. His body was as if saying just let me go, it’s my time, and so every step we made was a struggle through and through. At least it felt so.
Chronologically, I first put the cannula for iv drip, the vein was so wriggly I had to retract the skin and play chase the snake. Once I nailed the snake, it popped as if I asked it to.
What????
Next the arterial line. Got it in but a swelling followed not long after the transducer was connected. A haematoma? How did that happen? What??
Next, putting him to sleep. The standard size double lumen tube just wouldn’t pass the larynx and didn’t that just trash my confidence. Eventually had to put in a size down, compromising a good seal, risking a leak.
The NG tube had to play the part as well so it coiled and coiled at the back of his throat like it’s a lion dance show. By that time I was losing my patience.
The thoracic epidural was a nightmare. Multiple attempt is by definition 3 goes or more at putting it in. Is there such thing as multiple attempt squared? Yes, let’s have that. Got it in the end and I thought my armpits felt a bit damp.
The subclavian cannulation was proven to be an epitome of impossibility if there is such a phrase. 2 goes and each time the guide wire just bounced off. I wished I had an isobestic power of a cross between x-ray vision and ultrasonic touch to know exactly what was going on underneath that skin of his.
Dr.G saved the day and put in a subclavian. Felt useless as usual while he was doing it.
So that’s why you’re a consultant eh Dr.G?
I am sure I gave him that look, because he later said, it comes with practise Naj and smiled.
At least my existence and failure had made somebody felt good about somebodyself.
I could probably do something with all these sour grape thoughts I am collecting. Pickle them or something and bury it somewhere.
And, oh my god. After all that palaver and hurdles and obstructions as if his body is resisting against anything at all to do with the removal of the cancer, the most nerve wrecking thing happened.
The surgeon turned the patient to left lateral and started going through the right lung to get to the oeasophagus. They started the routine deflating of the lung.
The oxygen saturation dropped steadily.
We all like 100%. Mine is 98%-100%. If you smoke it’s lower. Maybe 95%.
This chap’s dropped more but still steadily passed the 90 mark. I was alarmed.
It dropped more to 85 and suspended for a while. My heart beat jumped to a triple figure but I kept composed. I did the drill and at the same time Dr G was summoned.
The hiatus broke, glided down to 75 very fast and the patient was blue. I felt an impending doom, imminent catastrophe. What’s wrong? Think think think.
My throat felt dry my voice felt weak. I backed off and Dr G took over. It dropped further and by then we’ve gone through all possibilities but nothing was obvious.
It went down to the 50s figures. How is this compatible with life?
I felt giddy with my own pounding palpitations. My heart beat was so loud, the repercussion kneaded it’s way as far as my ears, and my chest felt funny. It was so hard to not breath so heavily ….Ya Tuhan tolonglah….
