Sunday, October 30, 2011

physician, heal thyself

even doctors get sick, but there is often a difference.

i was rotating through orthopaedics and was on call that night. they tended to relegate us mere general surgeons to casualties during the calls so i was quite excited to get some theater time that afternoon, even if it was for a simple wound inspection and secondary closure and even if it meant there would be a backlog of patients in casualties for me to see afterwards. once i had finished operating i rushed through the change rooms to get back to casualties. while i was changing i heard the unmistakable sounds of someone throwing up in the toilet cubicle. quite soon the door opened and out came the orthopaedic registrar who was on call that night with me. he did not look good. he glanced at me but didn't seem to see me. his face was pale, verging on grey and there were fine droplets of sweat on his brow. he was staggering slightly as he made his way to the basin to throw water over his face. i greeted him but the only reply he gave was a sort of grunt.

much later that night i had to take some x-rays to theater for the senior to see. to my surprise the registrar was still there. he hadn't swapped his call out. i assume no one wanted to help so he had no choice, he had to work. however, he had come up with a practical solution. he was scrubbed up busy operating, but i noticed two drips hanging from the drip stand next to the anaesthetist. the one drip went to the patient, but the other went under the orthopod's gown and was replacing the orthopod's fluid loss that his severe case of vomiting had caused. the anaesthetist was actually maintaining hemostasis in both the patient and the surgeon simultaneously. i was quite impressed.

a few years later when i was the senior registrar in general surgery i too came down with some or other virus and i too was on call that day. in our department no weakness was tolerated and i knew it would not be a wise move to let the prof know i was ill. i just had to suck it up and go on.

the call was busy and being a bit sick i was struggling. there were too many things happening at the same time and it was becoming increasingly difficult to get to everything, but i kept on going to the best of my abilities. quite soon i found myself in theater operating. and there i stayed, doing case after case in quick succession and rushing down to casualties between cases to sort out the continuous stream of patients that were still coming in. and thus the call grinded on.

sometime in the early morning hours standing over yet one more open abdomen in theater i started to feel light headed. with the immense workload i realised i had not taken any time at all to have anything to eat or drink. this, combined with my illness had finally caught up with me. i was on the verge of passing out. fortunately i had more or less completed the operation and my medical officer was a capable guy. i turned to him.

"ninja, i need to take a seat. do you think you can close?" as i said it i staggered back. the world seemed to be moving beneath my feet. i leaned against the wall and slumped down. the ninja was saying something but his voice was far off and incoherent to me. the next moment i was aware of the house doctor leading me to the surgery tea room where i collapsed on the bed. i looked up in a haze. she was preparing a drip. i considered refusing but the words just wouldn't come out. besides i realised that fluid was exactly what i needed.

"put glucose in that drip too!" i finally managed to say.

quite soon the drip was up and the house doctor left. i reached up opened the drip to run in as fast as possible. then sleep came.

some time later i heard the house doctor return. she seemed surprised to find the drip sack empty, but changed it anyway. as soon as she was gone, once again i opened the drip to run full speed. the first liter had made a difference and i didn't want to waste any time, just in case i was needed during the call.

the next memory i had was the ninja shaking me awake.

"bongi, there is a gunshot abdomen. i've sorted everything and he's on the table. are you ok to operate or should i call the prof?" the ninja too knew that to let the prof know i had collapsed could potentially be disastrous for me.

"no. i'm ok now. get started so long and i'll be there in ten minutes."

later when i examined the timeline of events i had only been out of action for about an hour and a half. except for the people involved in the incident, no one ever found out. and, most important of all, the prof was none the wiser.


Sub Radar (Mike) said...

Is this a true story? That's really intense.

Anonymous said...

Oh yeah, I took ophtho call with an IV strapped to me. I just took the calls and directed the various residents to send the patients to "ER room #12," which is where I was. Sad times.

kara kadife said...

aw, that reminds me the time I caught some type of pneumonia while on call and a nurse offered me a hospital cocktail' which is a 100 cc saline bag, plus 1 ampule of avil, vitamin b complex, novalgin, metoclopromid, a touch of ephedrin and 1 gram of ampicillin (question: when interns get pneumonia, does it count as hospital acquired pneumonia?) anyways, first I got a ringing in my ear, then the thing knocked me out pretty well. I couldnt tell if the professor's yelling was directed at me or the nurse but one sentence stuck: "my god, you created the idiots, why dont you do the follow up?"

Anonymous said...

My wife read this over my shoulder and freaked out. I'm a 2nd year med student and she isn't familiar with your blog so she thought this was current operating procedure in the U.S.!

Bongi said...

sub-radar-mike, it happened. the gunshot abdomen survived. parts of me survived too.

Anonymous said...

This isn't standard operating procedure in the US? I got a nasty GI virus when I was 6 months pregnant. I had 4 gallbladders, 2 hernias and several colonoscopies to do that day. Between cases I was hooking myself up to IV fluids in the call room. If anything similar happened again I might cancel that day, but it was early in practice and I was so conditioned from residency to not show any weakness that I just pressed on. No one knew until I didn't quite make it out the OR door to vomit after the last case.

Dr Guinevere said...

I just love your blogs, Bongi! Its all so true and so close to home. As a student in Pretoria, I remember a particularly green day in Paediatrics (Kalafong). Its impossible to pass through paeds without catching a gastro virus of some sorts, no matter how vigorously you scrub your hands after seeing every patient. So one morning, on the grand ward round, a number of us students were ill. We took turns running for the loos to vomit, returning to rejoin the ward round in between. That day the consultant's end-less academic bantering was cetainly not appreciated. Twenty minutes discussion per bedside was cutting it short. Don't believe any of the senior staff would say, "Gee wizz, go home, you're sick and reinfection all the patients." Uh uh. All we got was, "If any of you even think of staying home you WILL be made to come and make up the hours at night!" And that was something like three days before the final paeds exam.

Grace @ Sterilization Services said...

Incredible story! I think Dr. Guinevere makes a good point to: isn't it dangerous and more costly to the hospital to expose patients to severely sick doctors. How can you ensure sterility under those conditions? Thank you so much for sharing this.


USMLE said...

Thanks for sharing marvelous story. I really like it.