Tuesday, May 12, 2009

one shouldn't laugh, but ...

when i wrote the third principle, i was reminded of another incident. then i couldn't laugh. now i shouldn't.

i was working a casualty shift in a private hospital to make a bit of extra money (a registrar barely made enough to survive). it had been a standard night of treating the aches and pains of people who had been sick for weeks but had decided that once the sun set on friday evening they could no longer endure. maybe they just wanted to torture me.

anyway, finally a real casualty case came in. it was a young lady who had fallen and hit her head. she was fine except for an unsightly gash on her forehead just at the hairline. i prepared to clean and suture the wound. being a state doctor i had hardly sutured any face wounds on sober people, so i remember telling myself to make a point of chatting to her during the procedure to ease her fears. usually good old ethanol did all the fear easing and i was left to my own thoughts while placing the sutures.

so there i was at the head of the patient being as friendly as i could. i'd cleaned the wound and had placed the first suture. the second was going in when an ambulance pulled up. two paramedics brought a guy in on a stretcher. i had my back to them so i wasn't really watching them too closely. then the sister shouted,
"this man is not breathing!"

i left my suture just where it was and ran. as i changed my gloves the ambulance men were asking the patient to shift to the next bed. he wasn't listening to them. they seemed indignant. the sister grabbed him and dragged him over as i arrived.

there was no sign of life whatsoever. he was extremely pale. his trousers were bloodied. he had no drip. we commenced a full resus. after going through all the motions, i called it. the man was dead. i then looked over his body. he had a massive laceration in his groin. his femoral artery was visibly transected. that could be why he didn't respond when the ambulance chaps had asked him to move across to the resus bed. i asked my usual question.
"when you picked him up, was he bleeding?"
"no." they answered. that is why they didn't put up a drip, apparently.
"was there blood at the scene?"
"yes." the one man replied. "he was lying in a puddle of blood."
"was it maybe about five liters of blood?" i wondered aloud.


shadowfax said...

Lovely picture.

How did the lovely lady take to having a suture left in her scalp?

Bongi said...

shadowfax, the lady was completely awake and aware. she was therefore at least an auditory witness to a full resus which is a noisy affair with lots of shouting and screaming etc. she therefore understood and didn't fuss. i think she was actually slightly shaken up by the whole thing.

Intermediates Teaching Blog said...

Did they have vitals done on the guy? Probably thought their machines were malfunctioning... again...

anne said...

Your 'ambulance men'--they have an official name (occupational acronym) in American English. They are called 'EMT's for 'emergency medical technician'. They are often part of, or associated with, the local fire department. According to my sources, however, the real meaning of 'EMT' is 'extra man on truck'--they are useless, the world over.

Dr J said...

Bongi- Great story as always.

Anne- I can honestly say after having been on both sides of the coin as an "EMT" and then having gone to medical school afterwards that if my family member were down I would much prefer a common Paramedic to most physicians (Surgery and EM excepted).

Bongi said...

anne and afmed, i think i need to point out a few things that i sort of left out in the initial telling of the story. the ambulance guys who scooped the patient weren't fully qualified paramedics. they were basically drivers. they were sent to a scene they were not qualified to handle. unfortunately they didn't have the insight to know they couldn't handle the situation, so they took the guy's unconsciousness to mean he was drunk rather than he was as good as dead.

qualified paramedics here are pretty good as afmed implies. this story also talks about the fact that the system is overburdened, which is a post on its own. the qualified paramedics were probably responding to a gunshot chest somewhere so they sent the ambulance driver to scoop the stabwound leg. makes sense on paper.

Dizzy Dee said...

Its scary to think of it that way when you're a patient, but I guess medical staff can also make mistakes, just like me?

With the minor difference that my mistakes as a project manager may lead to loosing a few hundred dollars, leave my bosses heavily upset. Medical mistakes are a bit more tricky.

anne said...

ok let me qualify that--- where I live here, in Europe--a surprisingly high percentage of them are overwhelmed by the demands of the job, despite adequate training and extremely ample financial resources. A moonlighting anesthesiologist or a surgeon usually goes to serious cases--the trick is that the EMT has to decide what is serious enough for a doctor, which doesn't always work well. I can tell stories to buttress my point of view, but this (Bongi's blog) is not the place for it. Of course, not all EMTs are terrible, and I am sure that there are good ones, but the bad ones that I've personally seen are so spectacularly bad that I can't help but be prejudiced. Nonetheless, I am sorry for giving offense. BTW, AFmed, you are probably right that a good EMT is better than a physician who has little experience with trauma. I won't argue about that. I was thinking about a specific recent case here when I responded to the post. Often I am amazed that even though I live in one of the richest countries in the world, the things that Bongi writes about happen here too. That was where I was coming from.