Saved my patient! :)

Today's a great day. I was kept busy from the start till the end - very rare in my current post unless I'm on call.

I felt really satisfied at the end of the day, but even more happy because I saved a patient of mine who is dying, alone.

This patient hasn't been well over the weekend, and when I was on my ward round with my seniors this morning, he looked terrible. From his look, u can tell that the end is nearing. Everyone in the ward knew that he might be going off very very soon, but weren't very panicky about it because the "golden ticket" (as we term it in the hospital...is a form that says "Do Not Resuscitate") was right on top of his notes.

Honestly, there is good and bad to this ticket. The good is we prevent a patient from going through all the defibrillation, CPR and whatever aggressive resuscitation methods we have, when before touching the patient, we know for sure that he/she will not make it after considering his/her general state and comorbidities. Also, in some ways, it saves the relatives agony and mental torture if they are urgently called to rush down to the hospital to have a last look at their loved one, having to witness the doctors and nurses doing various things (most of which are not nice) to the patient (sometimes, u might even find them raising their voice at each other during times of conflict. yup, unprofessional, but it happens!). The medical staff will not have to be on their toes, and running down the corridor to the room when the cardiac arrest alarm goes off too (everyone gets on with their life basically..)

The bad is that everyone tends to lax once the "golden ticket" is signed by the doctor. Even if the observations go way off, the nurses would just bleep u but show no signs of panic or insist on immediate attention.

Apparently, this "golden ticket" is so important that whenever a patient doesn't look well or too troublesome to handle when ill, the nurses will come after your neck to ask u to sign the ticket (which u can so kindly reject if u feel that the patient should be resuscitated, and be prepared to be "cursed" by the nursing staff abt it). But overall, I must say that the doctors I know don't just issue "golden tickets" without valid reasons, which is good. The only thing I don't feel too pleased about is the lax attitude some tend to give later when they know that the ticket is done. I think if possible (after considering if the management might change the situation), every patient has the right to be given attention when appropriate and needed and be given the best treatment possible.

Isn't that what doctors are there for? We're not gods, and we are no position to determine if a patient should live or die, but at least, I think we should not give the patient a death penalty on the spot.

I was bleeped during lunchtime to review this ill patient of mine. While rushing to the ward, thoughts of what possibilities there are for his observations to go haywire continuously streamed through my mind.

In the situation I was given, there wasn't time to take a thorough history. I had to rely on all the information I have from his medical notes, and my clinical examination to come up with a diagnosis and differentials.

I drafted all the investigations and management, did them, and then informed my Registrar about the situation. It was pleasing to know that my Registrar agreed with my plan, came up to the ward to have a quick look at the patient and told me to continue with all my proposed plans while he rushes off for clinic.

I was left to do everything from scratch alone, from taking bloods, to blood gases, to oxygen, to venflons to catheters to sending bloods off to the lab myself. The only thing which I need not do was to sit the patient up and administer the medication. Pathetic eh? But that's how it is if the "golden ticket" has been signed. U won't get anyone around u to give u assistance, and there were times before, I had to shout so that nurses will run over to see what's going on.

The number of things I had to do on this patient isn't drastically huge, but still, it took me hours to get everything done and compiling all the results.

The struggle wasn't all for nothing though. Observations were repeated after I've completed everything, and I let a sigh of relief immediately when the nurses told me that the observations are stabilised and my patient's feeling better.

My Registrar came up soon after, and was really pleased. "What magic did u do? U've saved your patient. Well done!" he said.

That made my day. The satisfaction I got from today's experience is just wonderful. Definitely a confidence boosting experience and one which tested my ability to keep cool-headed and calm.