Talk of the Town

Talk of the Town

Thank God ! We Were Saved .

 (Violence against Doctors in the ER)

–       Dr. Mitali Gupta,

 Intern,

 KMC Manipal.

 

Beep. Beep. Click. Ring.  A  shout here. A wail there.

“Are you done with the admission forms?”, asked the resident on call.

“ Yes, sir. I only have to fill in the drug chart ,” I replied.

“Okay, good.  After that, accompany the trolley to CT, get it done and then escort him to the ICU. Make sure you give a proper handover and ask the ICU PG to give me an hourly report of his hemoglobin without fail. “

“I will make sure of that, sir.” came my reply.

“I am going to check the other 4 ER patients we admitted today. We are getting an OT in about an hour. I will be busy there. Make sure you check in on the patients in Post –op ICU and then those two semi-emergency patients from your ward who might need to be operated tomorrow. Make sure their sugars and BP is under control. Then make sure that patient on TPN is fine. We will meet up early in the morning to go over the new admissions once again along with all investigations before rounds.”

“ Yes, sir.” I said simply as I made a mental list of things to do.

“Try to get some food and rest while you can. I shall grab a quick nap before the OT. I still haven’t started on the Morbidity and Mortality Meet presentation. Today has been unbelievable!” mumbled the resident as he ambled out of the ER, stretching. It was 9 PM and his 61st hour on call straight.

After handing the patient over dutifully, I habitually looked at my phone. 9 missed calls! Oh my mother is going to be so angry. I had turned it to silent during ICU rounds and forgotten about it.  I quickly dialed her number and talked to her as I gobbled down some insipid brew from the hospital canteen.

Then I went to the ward, finished off my work and was walking towards the duty room when I crossed paths with my resident going frantic. The hemoglobin of the ER patient had dropped drastically in just over 2 hours and he needed emergency operation. He had to call in the whole unit. There was no way three people could handle 2 operations and an ER.

He looked up, exhausted. I followed his gaze. 1:00 am, smirked the clock in our faces. The Saturday night had not even begun.

Just then, my phone rang mercilessly. I pulled it out. “Trauma Triage” it mocked us. I was informed there was a “seriously serious case” in the ER by the trauma nurse who on further questioning could only offer that all the doctors are still examining him and one of them has asked for a surgery consult.

“One can’t even think about a break, huh?” laughed my resident at our situation. “Go see what this enchanting night has in store for us now, while I wake up everyone and get yelled at some more.”

So, again I went to the ER. It was not difficult to locate the patient. There was an army of doctors and nurses surrounding a trolley. Both his feet were twisted in a bizarre fashion – tied up in an old cloth that was so red and entwined with the legs bent at 7 different places, it was hard to tell where the cloth ended and the flesh began. One doctor was trying to make sense of how best to straighten and splint them or if he should even venture to do so on his own; or whether the legs would even be salvageable. One nurse was standing and manually pressing the blood bag. Another was trying to secure one more IV line in the mess.  One doctor was putting in a chest tube which had already started draining blood. Another was checking his pupils.

“Surgery ?” inquired a voice.  “Yes.” “ Well what are you waiting for?” I quickly examined the patient. His abdomen had some bruises but it was soft to touch. His perineum had some tears but nothing of immediate attention. I ordered an emergency USG scan and inquired about the amount of blood and fluids transfused. I opined there is a possibility of abdominal bleed and extricated myself from the mess to take a history from the relatives.

I found them. 4 of them. Big burly youth of the nation stinking of vomit and…..it took me a minute to place the smell – alcohol. Blood shot and barely conscious themselves, all they could tell me was that the patient had had an RTA about 3.5 hours ago. They had gone to a private hospital and some scans had been done there but no films were available. “How long will it take to revive him?”, they demanded impatiently. “We have been waiting for half an hour!”

Being an intern I had neither the authority nor the experience to speak of such matters. “He is very serious. There are doctors from 5 different departments examining him and treating him right now. I too, have to get back.  Someone will be in touch with you as soon as possible”

I reported the case to my exasperated resident.

Suddenly there was a commotion. The patient had become unresponsive. His BP was fine, breath sounds were fine, pulse was fine. “B/L dilated and sluggishly responsive. Intubate.” said the doctor at the head end.

Brain bleed! I face-palmed in my mind. “His GCS was 10!, “ I exclaimed.

“It is 5 now,” he said with a sigh looking at the tangled mass of flesh, blood and tubes, “I had better document this and talk to the patient party”

Suddenly the monitors began to beep wildly. He was arresting. The rehearsed CPR cycle began. It was at this point the “patient party” walked into the ER as one. They found the neurosurgeon at the counter and within minutes we could hear shouting. “For the past 45 minutes you people have been wasting our time and no one has even bothered to tell us a thing! He was talking after the accident and now you have killed him! You think you are such big men that you have no value of anyone’s time or life! Someone is dying and you are calmly writing some ‘Kathas’ here!….” All four of them yelling at the poor resident and wringing their fists in the air and thumping the counter top as the doctors thumped the patient’s chest.

It was at this moment my resident entered with the attending and other members of our unit.

He immediately called for security and the unit as a whole came to the counter. The attending doctor talked to them for almost half an hour in a language I barely understood – their native dialect. He was able to counsel them and cool them down enough to be taken in a separate room to be brought back to their senses – literally and figuratively. As they left, I noticed silence in the ER. The thumping had stopped.

 

We were fortunate to have had ample security, the attending and a number of doctors in the ER at the time of this fiasco. Things were prevented from going out of hand and a disaster averted.

But all of us are not that lucky.

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