Monday, July 9, 2012

Stories From Internship Part 05: "Doc, Kaya Niyo Ba Siya Buhayin?"


Two fifteen in the morning and I'm settling in for some moments of peace in the triage area.  The initial evening surge of patients starting 7 PM has let up and the breeze is slowly making itself felt, finally.  I can finally disinfect my stethoscope, BP app, and pen.  In fifteen minutes' time, my triage duties are ending and the Rehab intern is hopefully coming to relieve the post.  Before I finish the first swig of the now lukewarm soda I bought hours prior, a taxi drives up followed by a tricycle, both crammed with anxious looking relatives.

Here we go again.

"Doc, doc, tulungan niyo po kami, tulungan niyo po kami!"

I ask them to lay down the patient in the benches immediately beside me and ask the relatives to find a stretcher ASAP.  They refuse to remove themselves from the patient whom I have yet to see, and commence the "TV Patrol" scene in front of me.  No one seems to be listening as my voice rises, "Humanap na po kayo ng stretcher, ako po ang bahala sa pasyente ninyo."

"Kuya, kuya, gumising ka na!"  The relatives keep wailing into their Good Morning towels, crowding around the patient that I still can't get to him.

"ATE, PLEASE, KUMUHA KAYO NG STRETCHER!"

One of them proceeds to disentagle himself from the clump of relatives clinging like barnacles on the patient.  A crowd gathers to watch as I frantically wrench away relatives to get the initial vital signs of the patient.  The relatives wail louder, stomp their feet, push each other, and try to rip each other's clothes in their frenzy.  TV Patrol levels, in the words of Eugene Domingo.  The crowd of bantays and kibitzers grows and moves closer, anticipating their entertainment for the night.  I yell at the guard for crowd control.

After almost five minutes of wrestling with the relatives, I get the first glimpse of the patient.

HOLY BILLY BOB BATMAN, WHAT THE HELL.  WHAT THE FREAKING HELL IS THIS?

The patient is obviously dead, very very dead, at least more than 24 hours dead.

Do I even call a code for this one?  He obviously is starting to decompose.

I try to feel for a heartbeat and obviously there is none.

"Kailan pa po nangyari ito?"

"Doc, kahapon kasi, di namin siya magising para mag-hapunan, ginigising namin di naman sumasagot."

"Wala po siyang ibang sakit? Di po siya nahulog o na-aksidente? Wala pong mga gamot o bote na nakakalat sa paligid niya? Wala pong sinabing nararamdaman sa inyo bago nangyari ito?  Ano pong ginawa ninyo kahapon?  Dinala niyo po sa ospital?"

"Wala naman nangyari bago ito, malusog naman siya!"

"Masakit lang minsan ang ulo!"

"Dati, nakulam na yan!"

"Di naman nadulas, di sementado ang bahay namin!"

"Walang iniinom yan, liban sa gin gabi-gabi!!"

"Doc, dinala namin sa clinic, sabi po patay na kaya inuwi namin, kasi parang natutulog lang naman!"

"Bakit niyo po siya naisipan dalhin dito?"

"Eh doc, nung inuwi namin siya, matigas at malamig na siya.  Naghahanap na kami ng funeraria.  Tapos kaninang umaga lumambot po yung katawan niya tapos medyo uminit nang kaunti.  Akala po namin, nabuhay ulit.  Doc, kaya niyo ba siya buhayin?"  

One relative starts massaging the dead man's muscles, probably in an attempt to get his circulation going.  I try not to wince at the sight of the dead boy being manhandled, and stop the relative.

Lord, I don't have the heart to tell them that You're the only one who raised the dead.

"Ma'am, patay na po talaga si Sir. Di na namin siya kayang buhayin, mahigit 24 hours na rin po kasi siyang namatay.  Sa katotohanan po, nagsisimula na nga pong ma-agnas yung katawan niya.  Sandali lang po at tatawagin ko po yung kasamahan ko para maipaliwanag sa inyo."

I call the resident and look at my watch, it's almost two thirty.  My reliever is coming in soon.  It's a crazy end to my triage duties.

Monday, July 2, 2012

Stories From Internship Part 04: One Hour in ACU


07:00 PM
"Kelly, maraming patients, so ganito hatian...si patient A, di pa na-send yung labs kasi wala talagang pera, si patient B, paki-follow-up daw yung trop I stat, si patient C baka i-akyat sa dialysis so standby, si patient D mukhang titignan muna ng MICU senior, tapos si patient E, paki-dress daw yung paa...tapos ito yung decking based dun sa time kung kailan tayo dumating dito...so ikaw first monitoring, last on deck"

"Uy, ang toxic mo talaga! Sige, bye!"

07:01 PM - 07:10 PM
100/70...100/60...90/60...130/80...120/70...140/90...150/80 (adjust dose)...ad infinitum
Opo, normal po. Maayos po. Di po yun anemic. Ito po ang normal niya. Opo, 120/70. Mataas na. Mataas pa rin po...ad infinitum

07:10 PM
"Kelly, i-follow up mo raw labs ng patient mo kung na-send na"

Hay na-ipit na naman ang monitoring ko. Asan na ba yung pasyenteng yun?

*lalapit sa bantay*

Ate, may pampadala na po kayo sa dugo niya?
"Eh wala eh."
(She turns back to playing whatever game on the PSP dangling from her neck and resumes kicking her right foot to and fro.)
(Wow, may pang-PSP siya pero walang pambayad ng 250?)

07:10 PM - 07:15 PM
100/70...100/60...90/60...130/80...120/70...140/90...150/80 (adjust dose)...ad infinitum
Opo, normal po. Maayos po. Di po yun anemic. Ito po ang normal niya. Opo, 120/70. Mataas na. Mataas pa rin po...ad infinitum

*looking for patient X. NAWC since 4 PM*

07:15 PM
*may kumakalabit na bantay*
(Bantay who seems slightly drunk [at 07:15 PM!] in a most condescending tone) "Nurse, kunin mo BP ko."
Kuya, mga pasyente po muna uunahin ko, may 25 pa ako kailangan ikutin...
 "Bakit hindi pwede kami ngayon? Ha, diba nurse ka? Ano bang pangalan mo?"
*Trying to evade the spittle from said bantay's mouth*
Kuya, kung gusto niyo po, pumunta muna po kayo sa AMBU, di ko talaga kaya kayo asikasuhin sa dami ng pasyente. At doktor po ako, di po ako nurse. Pasensya na po.

 07:20 PM - 07:23 PM
*Psych resident* "Ma'am, paki-BP naman to."
Sir, 70/40 po.
"Ay, dalhin to agad sa resus!"
*wheels patient to resus area and proceeds to have a paramedical give me a stink-eye because I wheeled a patient in*
"Bakit yan dinala dito?!!"
Sir, 70/40 siya. Psych patient.
"Bakit dito sa resus? Eh bakit ngayon lang dinala dito?"
(Hay naku kuya, rhetorical questions ba raw ang peg? Dadalhin ko ba yan dito kung gising to at maayos ang BP?)

07:23 PM
"Miss, di pa ba kami dadaanan ng doktor?"
Ano po apelyido ng pasyente?
 *checks list, patient's name not there, and belatedly realizes patient is decked to another service, makeshift sling and all*
Nay, paki-tanong po sa loob sa may Ortho, di po kasi namin siya pasyente
 "Eh, bakit nga wala pa yung doktor?"
Di po namin kilala yung doktor ninyo, sorry po. 

07:24 PM
*may kumakalabit na isa pang bantay*

"Nurse, wala nang dikstros"
(Ah, the all-powerful panacea, IV fluid.)
Sige po, pakisabi na lang po sa nurse ninyo na naka-violet sa loob.
"Sa loob?"
(Hay, ate.) Opo sa loob.

07:24 PM - 07:33 PM
100/70...100/60...90/60...130/80...120/70...140/90...150/80 (adjust dose)...ad infinitum
Opo, normal po. Maayos po. Di po yun anemic. Ito po ang normal niya. Opo, 120/70. Mataas na. Mataas pa rin po...ad infinitum

07:34 PM
*sees a patient eating a Chickenjoy meal happily amidst the horrid smell of his DM foot*

07:34 PM-07:37 PM
"Kelly, si patient D daw, paki-extract ng bagong labs. May bagong orders galing sa MICU"

*prepares supply list for patient D*

Tatay, punta po kayo sa pharmacy, pakibili po ng gamit, kailangan po natin kunan ng dugo si Kuya.
 "Saan ang pharmacy? Kailangan na ba ngayon? Masakit na kasi yung paa ko."
Sige tatay, yung isang bantay na lang muna. Kayo muna mag-bomba kay Kuya.
"Hindi ako marunong."
Tatay, susundan lang po natin yung paghinga ni Kuya. Sige po, pisil tapos 1-2-3, pisil tapos 1-2-3. Sabihin niyo na lang po sa kasama ninyo dalian na lang.
*bantay proceeds to pump the bag with all his might, completely out of sync with patient's breathing pattern*
Tatay, dahan dahan lang po, pisil, 1, 2, 3...

07:37 - 07:44 PM
100/70...100/60...90/60...130/80...120/70...140/90...150/80 (adjust dose)...ad infinitum
Opo, normal po. Maayos po. Di po yun anemic. Ito po ang normal niya. Opo, 120/70. Mataas na. Mataas pa rin po...ad infinitum

07:44 PM
*checks ACU logbook and realizes patient X was already brought to the ward at 4 PM, hence "NAWC" and erases name from monitoring list*

07:45 PM
*uupo saglit*
Siomai na hilaw naman, patapos pa lang ako ng monitoring, magsisimula na ako ulit. Teka may trop I pa si patient B (sana may kumuha na ng labs), tapos si patient C baka kailangan ko makipag-switch para ma-i-akyat sa dialysis.

07:45 - 07:56 PM
(At the labs counter)
Ma'am, sa ACU po
Pangalan?
Intern de Guzman po
*handed a stack of labs that unfortunately does not have patient B's result and checks with lab inside*

Ma'am may trop I na ba sa ACU patients?
"Tignan mo diyan sa listahan"
Andito po, kanina pa pong 5:30 PM ma'am
"Tignan mo yung number diyan"
62 po.
"Tignan mo dito sa screen. Mamaya pa yung print-out niyan ha."
*writes down result*
Thank you po.

Ma'am, yung trop I ni patient B, 0.1 po.
"Ah, okay. Sige, mamayang 11, extract ka ulit. Tapos bigyan mo nitong bagong reseta yung bantay"
Yes ma'am.

07:57 PM - 07:59 PM
"Kelly, pakitignan mo raw yung dressing ng DM foot, dumudugo raw. Baka kailangan ng re-dressing. Tapos may FBS siya dapat kanina, pero di nagawa. Habulin na lang daw kung di pa kumakain yung patient."
(Shucks, lumalamon na ng Jollibee yun kanina nung dumaan ako.)

"Pakidagdag daw sa monitoring yung intubated dun sa Bed 9 sabi ng Neuro. With NVS and pupils daw."

"Yung patient mo na isa, iaakyat na raw sa dialysis maya maya. Sabihin daw sa relatives, i-handa na lahat ng gamit at meds. Sabi ng fellow, wag na wag kang aakyat kung walang diazepam, nag-seizure kasi yan."

"Si patient A daw pakikulit yung labs na bayaran na. Hinihintay na kasi kanina pang morning.  Malamang hemolyzed na yung iba so extract na lang din ng bago."

08:00 PM
Here we go again...