Had my first CPR being performed in the ward this afternoon.
He was a 49-year-old chronic drinker, who was single, unemployed, and lived alone in Tai Wai. In short, he was essentially an abandoned middle-aged man. This emaciated man was found collasped in the Shing Mun River bank yesterday night, and admitted to this nearest hospital.
Today, 5th of March, 2009, a day I shall remember for the rest of my life, KM brought the flock of lambs into the ward, and one of them was asked to examine this gentleman. He co-operated with the lamb and the lower limb examination was finished uneventfully. The tone and power of those lathy legs were normal, with the only abnormality that the reflex was diminished. This was unlikely to be a myopathy, but a peripheral neuropathy.
KM went on to address the problem of multi-system damage due to chronic alcoholism, with loads of thamine, Vitamin B12, liver, brain and whatsoever being thrown to the lambs. Finally, KM ends his bedside teaching by once again reminding the patient to take that salty potassium chloride solution, on the other hand, reminding us not to prescribe potassium carbonate, and to appreciate chronic drinkers as well as those IVDUs, who sacrified their soul and body in teaching us how alcohol and drugs ruin one's life disastrously.
After most of the lambs had left, two of them remained in the ward, flipping through the case note of that gentleman we had just seen. At the same time, he kept on complaining abdominal discomfort. The intern was informed, whom told us the pain was just quite vague and nothing was remarkable on palpation. We then left the ward.
Only an hour later, after having a sightseeing tour at the haemodialysis centre to look for AV fistulae, I was told by the other lamb that the alcoholic was found arrested on his bed. We two hurried to the sence, only to see that the cubicle was crowded by the e-trolley, the intern, and the nurses. One of them was doing chest compression, while the other one was bagging the patient. At the same time, the intern searched hardly for a nice vein to insert a large borne catheter, and two nurses was drawing adrenaline into syringes.
Shocked by the sudden fall of the patient, one of the two young inexperience lambs, took off his white coat and got a pair of gloves in his hands. He padded the nurse who was doing the chest compression hardly, hinting he could take over in the next round. That was me, who had the hands on the chest of a dying patient for the first time.
Just cannot imagine I had a chance to perform CPR on a real patient only a week after the reinforcement assessment on the mannikin at Clinical Skills Learning Centre. The real one was definitely softer than the fake one. When two terrific pop sound slipped through my fingers during chest compression, I realised that I might have fractured one or two ribs of this unfortunate gentleman. Hesistated for few seconds, thinking about the consequences of pneumo- and haemo-thorax, I continued to deliver my thrusts with "this is the well-known complication of CPR" back in my mind.
With my eyes kept on the ECG monitor, I counted loudly "1, 2, 3, 4..." when I was compressing the chest so that the nurse could give a rescue breath at 30. Seeing the waveform moved up and down with each stroke, sometimes I misread the ECG and thought that he regain heartbeat. "Oh, still Ventricular Fibrillation." when I lifted by hands up. After 2 rounds (i.e. 300 compressions) I felt fatigue and switched position with another one. When the ICU doctor had arrived, she immediately ordered adrenaline and defibrillation to be given promptly. This was not only the first time I do a CPR, but also the first time I see a defibrillation being done in the real life. "About to strike. 360J. Oxygen Clear, All Clear!"
"Bomb!"
Unlike what I had seen in Healing Hands when I was still a primary four student, that gentleman only had a jerk but not a jump. Well the TV portrayals are always much exaggerated, otherwise there will be no dummies like me being misled into this profession. After the strike, the skin beneath became scorched, leaving a permanent mark on his upper right chest besides his American Indian native tattoo.
After two strikes of defribillation and being intubated with 100% oxygen, the patient regained a weak heartbeat. It was probably the effect of adrenaline which prolonged his life unneccessarily. His blood pressure cannot be detected by automated monitor. The nurses attempted to use a traditional sphygmomanometer, but were also pissed since his pulse was too weak to give an auscultative sound. Manual ECG was performed, only to find out that one of the limb lead was without a clip! One of the nurses immediately took out a tape of micropore and stick the electrode directly onto the patient's leg! That's why practical experience and wisdom shared by nurses should always be respected and appreciated by junior doctors...
As the patient was barely stabilised, the case MO agreed to take him down to the ICU. When the nurses were busy attaching those monitor, defribillator and oxygen onto the bed for transfer, two porters came. While the cluster was hurrying out to the lift, the ICU doctor and I were still in a disposable gown, i.e. the PPE. The journey from the ward to ICU, with priority switch of the lift's on, takes no more than three minutes. However, it was the most dangerous journey that happened to the patient. We rushed through the corridor crowded with visitors to make our way to ICU, whilst the ICU doctor was keeping his airway patent and I was bagging him.
When he was moved onto the ICU bed, I removed my PPE and slipped away. The next morning, I visited the ICU again, only to find out that he was not there, and I was told by the previous ICU doctor that he was not here ever after, soon after admission to her unit.
"We shouldn't admit him." She added, "He had a grave prognosis. We should let him go peacefully. However, it is the duty of ICU to get prepared as the crash call was activated."
I nodded, although I didn't expected that he could survive til the next morning, since the survival rate of CPR was less than 5%, I still could not hide my bit of sadness.
"But you had done a good job." She consoled me, "Remember, go home to revise the Adult Life Support protocol, and what are the reversible causes of cardiac arrest."
Coming close to the Final Judgment, I am no different from other lambs, being buried in piles of tasteless notes and books. Without examinations, I hope to devote myself into the ward attachment wholeheartedly, seeing the mysteries of lives and deaths, and how they are influenced by pairs of healing hands. However, life is not that simple. This is always a dilemma of the flock of third year lambs to choose between clinical and panel.
Being washed by numerous examinations, I nearly forget my original goal and dream of being a doctor. With this little incidence in the ward (Well I am sure that it is little in the eyes of many nurses or their students), having my hands on the dying patient, this is an important lesson to learn as a student, which cannot be substituted by any textbooks or lectures. I could strongly feel the sensation of gripping a life right at the gate of Death. At that moment, I remembered why I chose to be admitted as a member of the medical profession,
"I solemnly pledge myself to consecrate my life to the service of humanity." - The Declaration of Geneva.
I remembered, while I was bathing in the dormitory, a moth flied into my bathing booth. It flied across the steam and rested in front of me. It stayed there quietly. I am not a superstitionist, but at a instant I deemed that it carried his spirit, coming to inform me that he had passed away.
May God bless him and may he rest in peace.
He was a 49-year-old chronic drinker, who was single, unemployed, and lived alone in Tai Wai. In short, he was essentially an abandoned middle-aged man. This emaciated man was found collasped in the Shing Mun River bank yesterday night, and admitted to this nearest hospital.
Today, 5th of March, 2009, a day I shall remember for the rest of my life, KM brought the flock of lambs into the ward, and one of them was asked to examine this gentleman. He co-operated with the lamb and the lower limb examination was finished uneventfully. The tone and power of those lathy legs were normal, with the only abnormality that the reflex was diminished. This was unlikely to be a myopathy, but a peripheral neuropathy.
KM went on to address the problem of multi-system damage due to chronic alcoholism, with loads of thamine, Vitamin B12, liver, brain and whatsoever being thrown to the lambs. Finally, KM ends his bedside teaching by once again reminding the patient to take that salty potassium chloride solution, on the other hand, reminding us not to prescribe potassium carbonate, and to appreciate chronic drinkers as well as those IVDUs, who sacrified their soul and body in teaching us how alcohol and drugs ruin one's life disastrously.
After most of the lambs had left, two of them remained in the ward, flipping through the case note of that gentleman we had just seen. At the same time, he kept on complaining abdominal discomfort. The intern was informed, whom told us the pain was just quite vague and nothing was remarkable on palpation. We then left the ward.
Only an hour later, after having a sightseeing tour at the haemodialysis centre to look for AV fistulae, I was told by the other lamb that the alcoholic was found arrested on his bed. We two hurried to the sence, only to see that the cubicle was crowded by the e-trolley, the intern, and the nurses. One of them was doing chest compression, while the other one was bagging the patient. At the same time, the intern searched hardly for a nice vein to insert a large borne catheter, and two nurses was drawing adrenaline into syringes.
Shocked by the sudden fall of the patient, one of the two young inexperience lambs, took off his white coat and got a pair of gloves in his hands. He padded the nurse who was doing the chest compression hardly, hinting he could take over in the next round. That was me, who had the hands on the chest of a dying patient for the first time.
Just cannot imagine I had a chance to perform CPR on a real patient only a week after the reinforcement assessment on the mannikin at Clinical Skills Learning Centre. The real one was definitely softer than the fake one. When two terrific pop sound slipped through my fingers during chest compression, I realised that I might have fractured one or two ribs of this unfortunate gentleman. Hesistated for few seconds, thinking about the consequences of pneumo- and haemo-thorax, I continued to deliver my thrusts with "this is the well-known complication of CPR" back in my mind.
With my eyes kept on the ECG monitor, I counted loudly "1, 2, 3, 4..." when I was compressing the chest so that the nurse could give a rescue breath at 30. Seeing the waveform moved up and down with each stroke, sometimes I misread the ECG and thought that he regain heartbeat. "Oh, still Ventricular Fibrillation." when I lifted by hands up. After 2 rounds (i.e. 300 compressions) I felt fatigue and switched position with another one. When the ICU doctor had arrived, she immediately ordered adrenaline and defibrillation to be given promptly. This was not only the first time I do a CPR, but also the first time I see a defibrillation being done in the real life. "About to strike. 360J. Oxygen Clear, All Clear!"
"Bomb!"
Unlike what I had seen in Healing Hands when I was still a primary four student, that gentleman only had a jerk but not a jump. Well the TV portrayals are always much exaggerated, otherwise there will be no dummies like me being misled into this profession. After the strike, the skin beneath became scorched, leaving a permanent mark on his upper right chest besides his American Indian native tattoo.
After two strikes of defribillation and being intubated with 100% oxygen, the patient regained a weak heartbeat. It was probably the effect of adrenaline which prolonged his life unneccessarily. His blood pressure cannot be detected by automated monitor. The nurses attempted to use a traditional sphygmomanometer, but were also pissed since his pulse was too weak to give an auscultative sound. Manual ECG was performed, only to find out that one of the limb lead was without a clip! One of the nurses immediately took out a tape of micropore and stick the electrode directly onto the patient's leg! That's why practical experience and wisdom shared by nurses should always be respected and appreciated by junior doctors...
As the patient was barely stabilised, the case MO agreed to take him down to the ICU. When the nurses were busy attaching those monitor, defribillator and oxygen onto the bed for transfer, two porters came. While the cluster was hurrying out to the lift, the ICU doctor and I were still in a disposable gown, i.e. the PPE. The journey from the ward to ICU, with priority switch of the lift's on, takes no more than three minutes. However, it was the most dangerous journey that happened to the patient. We rushed through the corridor crowded with visitors to make our way to ICU, whilst the ICU doctor was keeping his airway patent and I was bagging him.
When he was moved onto the ICU bed, I removed my PPE and slipped away. The next morning, I visited the ICU again, only to find out that he was not there, and I was told by the previous ICU doctor that he was not here ever after, soon after admission to her unit.
"We shouldn't admit him." She added, "He had a grave prognosis. We should let him go peacefully. However, it is the duty of ICU to get prepared as the crash call was activated."
I nodded, although I didn't expected that he could survive til the next morning, since the survival rate of CPR was less than 5%, I still could not hide my bit of sadness.
"But you had done a good job." She consoled me, "Remember, go home to revise the Adult Life Support protocol, and what are the reversible causes of cardiac arrest."
Coming close to the Final Judgment, I am no different from other lambs, being buried in piles of tasteless notes and books. Without examinations, I hope to devote myself into the ward attachment wholeheartedly, seeing the mysteries of lives and deaths, and how they are influenced by pairs of healing hands. However, life is not that simple. This is always a dilemma of the flock of third year lambs to choose between clinical and panel.
Being washed by numerous examinations, I nearly forget my original goal and dream of being a doctor. With this little incidence in the ward (Well I am sure that it is little in the eyes of many nurses or their students), having my hands on the dying patient, this is an important lesson to learn as a student, which cannot be substituted by any textbooks or lectures. I could strongly feel the sensation of gripping a life right at the gate of Death. At that moment, I remembered why I chose to be admitted as a member of the medical profession,
"I solemnly pledge myself to consecrate my life to the service of humanity." - The Declaration of Geneva.
I remembered, while I was bathing in the dormitory, a moth flied into my bathing booth. It flied across the steam and rested in front of me. It stayed there quietly. I am not a superstitionist, but at a instant I deemed that it carried his spirit, coming to inform me that he had passed away.
May God bless him and may he rest in peace.
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