in the old days at kalafong (hell), the sentence 'the patient is gasping' was euphemistic for the patient is stone dead, rigor mortis has set in and we accidentally found the body when someone noticed a strange smell emanating from his bed. fortunately, occasionally one is pleasantly surprised. one such time was in my first year as a registrar.
he was a young man. with a bit of dutch courage on board he had not maintained a good following distance behind a car while driving home late at night on his scooter. in other words he drove full speed into a parked car on an otherwise deserted road. when i saw him for the first time he was in trouble. his abdomen was distended and painful. his blood pressure was down and his heart was racing. he needed surgery and fast.
just as i was pushing the patient into theater his mother called me aside to ask about his chances etc. i gave my honest assessment with emphasis on the fact that we needed to get going as soon as possible to optimise his chances. then, as if i wasn't nervous enough being such a junior registrar with the prospect of trying to pull this guy through , the mother gave me a small piece of information that pushed my heart rate up to about the same as the patient's.
"he is dr w's cousin." dr w was the most senior registrar in our department.
"good!" i said. but 'oh f#@k' is what i thought. and then i went in to operate.
the operation was a major challenge. in the end i resected segments six and seven of the liver. actually i just scooped them out. the impact had done all the actual dissecting. i just needed to control the bleeding, which in itself was not all that easy. finally we got him off the table in a fair to good condition. after tucking him into bed in the ward i got on with the rest of the call. finally i got to sleep at about two thirty in the morning.
at four in the morning, the phone in the call room rang.
"doctor, the patient is gasping!" my blood went cold. i confess i had images of dr w taking me apart for letting his cousin die. i paniced a bit. i phoned my house doctor and told her to meet me in the ward. then i ran.
i walked in to see something i think i am the only person ever to see in kalafong, an actual attempt at a resus by the nursing staff. the patient wasn't dead, only dying. i was so relieved. then i realised if i let him die dr w would still eat me alive. i jumped to it.
after a bit of the old pounding on the chest, a tube down the wind pipe and much intravenous fluid. we pulled the guy back from the brink and put him in icu (intensive scare as we called it).
and so a near disaster was averted and for once at least 'the patient is gasping' actually meant the patient is gasping.