Bad week

I had quite a horrific week at work. My boss was in his bad mood the whole week, jumping at all of us. And my calls were terrible. Stupid referrals and patients dying on me.

My big boss refused to believe me that a trauma patient had flail chest because he could not see the flail segment. That was because patient was on positive-pressure ventilation. And because the fractures were not clearly seen on the radiographs, he said the patient did not have flail chest and asked me to change my diagnosis. And he refused to see my video captured on my handphone just because he claimed that it was not taken from an angle showing both sides of the chest symmetrically. I was so hurt with the blatant mistrust. But I didn't change my diagnosis and continued to manage him as a patient with flail chest. My colleagues saw the video and agreed with me that patient had flail chest and subsequent repeat chest radiographs showed rib fractures over my "alleged" flail segment. I'm glad I did not change my diagnosis because I know what I saw with MY OWN EYES, for goodness sake. But I just went own with my work, and I didn't show the old man the subsequent films that showed the fractures. It was enough for me to know that I was right. The worse part was that my colleagues did not stand up for me eventhough they saw the flail segment and chose to remain silent. Maybe they knew the old man's ways enough to just not be bothered with him too much.

Then there was a 72-year-old woman who was just recently discharged well from our ward after an anterior resection for colorectal cancer. She presented during my call with acute renal failure needing dialysis on the same day. She gave me a history of hematuria (blood in the urine) for one-week which lead me to a working diagnosis of urolithiasis with obstructive uropathy causing the hematuria and renal failure. So medical took over her for dialysis and she came back after a week to our surgical ward. During our grand ward round on Friday, my boss got the history of vaginal discharge with blood from the patient's daughter instead and proceeded to do a speculum examination. The patient indeed had foul-smelling vaginal discharge. He proceeded to the working diagnosis that patient had a pelvic collection causing the vaginal discharge and started scolding me for missing that history and ordered for an ultrasound scan for the patient. He gave a long lecture regarding proper history-taking. I was thinking hard how the pelvic collection became vaginal discharge and caused the renal failure. The following day, my colleague who did the ultrasound abdomen reported that he did not find any pelvic collection, but he found multiple renal stones instead! Muahahaha! The old man just glared at my colleague and proceeded to the next bed.

Then my call on Thursday was a nightmare. I was looking forward to my free weekend going into that call but the demise of a 33-year-old lady with septic shock and severe diabetic ketoacidosis will forever haunt me. She was referred to surgery for a back abscess and during admission her blood sugar was sky high and her vitals showed that she was septic. For some reason that was missed during her admission and she was left acidotic for 12hours and finally she deteriorated needing intubation. She was ventilated in the ward during my call, so my colleague passed over her case to me. She was so ill that she asystoled several hours post-intubation. I resuscitated her and did CPR for a record 1hr, but I could not save her. Her 5 young children were wailing and crying outside the curtain while we were resuscitating her. And when I finally gave up on her heart, I squatted at her bedside where her lifeless body laid, angry at the inadequate care she received, angry that I could not save her and frustrated because I did not know how to tell her husband and 5 children outside the curtain. I composed myself and pulled open the curtain slowly and looked for the husband. When we made eye contact, he just knew, and he broke down.

After that incident, I was so shaken that I could not sleep and I had several bouts of breathlessness. The following post-call working day, I felt numb and I couldn't keep my food down. And I had the worst headache in my life. And when I related the incident to my only confidant of a colleague, I was close to tears but I just had to hold it back and move on, because I had other patients depending on me. Luckily my parents called me that evening and just hearing their voices made me feel better. I went home that evening, took a quick shower and collapsed on the bed. Now the headache is gone, but the heartache is still palpable.