Saturday, September 20, 2008

Triage: Prioritising Lives

(0% fiction,100%realty)



“Life was created…or perhaps it sprouted up from nowhere all of a sudden. I was born. I needed air to live. I breathe in and out at least 16 times in a minute. I never care if what I expire can choke my neighbour. I have power. I can create life but not at the same pace at which I take it. “



The stethoscope that adorns my neck was once an ornament that made me ‘look’ a doctor. It set me apart from a nursing student who too wore a white coat. With the passage of time, it let me hear the non-stop machine that panted ‘lubb dupp’ and now I was using it to detect life.

The heart still beats”, shouted Neha. We were rushing to the SICU (Surgical I.C.U). I was holding the Ambu bag. I felt thrilled. I was pumping life into him…oxygen.




I knew he was breathing. I didn’t care if it were the last puffs that he got to gasp. A multitude of thoughts flashed through my mind. I didn’t exactly know why the M.O (Medical Officer) chose us to accompany the patient; did he overestimate the fourth year students who were posted at the emergency room?
(The patient was brought 15 minutes back, drenched in blood; an old man in his sixties; a case of road traffic accident. He had sustained severe head injury)

I could see his abdomen rise and fall…rise and fall…yes he was alive. I kept on pumping, a puff every 5 seconds.

I wished the elevator would ascent faster.

Neha once again checked if the tiny organ was still panting. Yes, it was.

Lubb dupp…lubb dupp




The attendant who pulled the trolley seemed to carry a ‘mask like face’…the kind of face that one gives when suffering Parkinsonism. He was sweating just like us.

The poor old man who lay in the trolley knew nothing; he was helpless and not even his pupils could move in response to light, the energy that keeps life alive.

People who flooded the corridor gave way for the sprinting trolley.




Someone else was panting too…running at the same pace as we were. It could been his son or brother or a relative. I was damn sure the guy was not a stranger filled with compassion.

Finally we reached the SICU (Surgical Intensive Care Unit). Our job was over, the patient was ‘delivered’. Now all that I cared was to get the Ambu-bag back (the surgery casualty was short of supply and SICU had its own Ambu-bags).

“Hey do a CPCR!” yelled a house surgeon.





Why me? I have never done this before. I checked if Neha was puzzled just like me…no…she was about to jump over the patient to break his ribs and give the lifesaving resuscitation.

Well in that case why should I miss my chance?

“Sir…errr…I need a demonstration…or in plain terms…I am short of confidence”, I spoke, and waited for the house surgeon to shout.

But he was cool and calm and taught me how to do it.

1-2-3-4-NOW…’I said and Neha pumped the bag.

After a couple of tries, I turned to Neha, “Want to try?”

It was Neha’s ‘chance’ now and I took the Ambu-bag from her.

‘Okay, that will do’. The house surgeon checked for a carotid pulse. With his fingers still on the patient’s neck, he turned to the fellow resident and asked if the patient ‘really’ required to be put into a ventilator.

I didn’t understand why these guys were damn so cool. What the hell where they waiting for? This was why ‘we’ soaked our coats…drenched ourselves in sweat?

It took me a couple of seconds to get a grip on what was going on. The poor old man was almost dead…perhaps the brain was already off when we rushed him out of the emergency room.
The Medical Officer had done all that he could do within the four walls of the room. So he sent us with this patient. He was correct. By this time at least five new emergency cases would’ve got attended by the senior residents, who were back at the casualty, seeing to patients who had better chance to ‘survive’.



The stethoscope was not fabricating sounds. The beats were kept alive by the injected Adrenaline. They receded once the action of the drug exhausted. The abdomen did not move once I stopped pumping oxygen. A ventilator…the ultimate and the last hope to rejuvenate life…must be reserved for a ‘better’ case…someone who had a 0.1% better chance to survive and not a ‘dead’ patient.

We had ‘lost’ him on the way to the SICU.

Neha and I walked out of the SICU. The guy who was running with us was waiting there…I didn’t know what to say.

‘Sir, please…I can stand anything…please say…is there a hope?’

“Well…we are trying all that we can do…” before I could complete, Neha interrupted, “The chances are too low”.

I felt a bit frustrated…felt offended.

Who cares…? It was 8.00pm and our shift was over.

I returned home…having learnt something new.


‘TRIAGE’… Prioritising ‘Lives’.

Someone was dead and tomorrow his body will go through the post-mortem examination…torn open, and then sutured back…samples will be sent to various laboratories…final reports will be written.
Someone will shed tears; some others might smile; weeks or perhaps months may pass and all will be back normal.




(Triage means the assessment of the seriousness of wounds or illnesses to decide the order in which a large number of patients should be treated. CPCR stands for Cardio Pulmonary Resuscitation. A ventilator is an equipment that maintain a flow of air into and out of the lungs of a patient who is unable to breathe normally)

(Thanks 2 diva nawale, de title sprouted up during a chat session, and Amooma...i broke her sleep just 2 read out de entire post !!! and Azgar)

(entrant for Get your story published in The Chicken Soup for the Indian Soul – Indian Doctors at BlogAdda‘)

51 comments:

ANWESA said...

a very intense description.i was ngrossed in it.watevr happens,all bcoms normal(same) after a certain period of tym.coz tym a gr8 healer.

firebird said...

now thats some story... i liked it very much... felt like reading robin cook... ;)

and "he palpated neck VEIN for a pulse"...he he...typing error... ;)

[some dark secrets of med school]
we actually did cpcr on a dead patient...when the house surgeon gave up and told us..go get some practice and when ur done tell me... in paed surgery lecturer was saying to us..practice intubation on dead patients..coz if ur doing it for the first time during an emergency,u r sure to fail..

k.ø.c.h.ü said...

@anwesa; true mate..no addons!!! thnxs 4 dat comment...

@firebird: robin cook...!!! man u've made my day..i didnt know if i would succeed in describing the scene exactly as i saw...

de 'vein'..oops..ive corrected it yupp!!!

de dark secrets..!!!

in this case: once v wer sure de patient is no more...

de house surgeon asked ma'am 4 a favour, "ma'am shall i learn putting a central venous line in dis body??
"

Smriti Srivastava said...

I cant imagine how it must be like...I dunno...for the first time I feel so wierd. Just tugged my heart... I really dont know what to say...Its just left me speechless...

Pooja said...

dat was ngrossin'...u docs hav a tough job 2 do...

tym heals everythng...

k.ø.c.h.ü said...

@smriti: :) n im ouuta words...

@pooja: yeah mate...!!! thx 4 de comment

*~*{Sameera}*~* said...

I used to always wonder how the profs could be so cool even as they are losing a patient.Only later did I realize it's their experience which makes them know well before hand and that there is only a limit to which we can try.As much as it is heart wrenching,one needs to make a choice between the viable and the dispensable.

Brought back memories of ICU postings when we had our "chances" for CPR & DC.

Well written buddy!May the patient RIP.

Btw in case you are wondering,I took up Cardio Pulmonary Sciences in PG :)

Diva said...

Life is precious they say.. We all get shaken up when we lose a loved one... but then, the world doesnt stop..the Sun/moon rise and set as they always have, and slowly we all tend to forget what we had...
It all fades away.. Thank God it does!!!!

I appreciate doctors and nurses because they see great happiness in saving a life and I have always seen them try for the best of their patients...
They truly are like angels...
And am sure they do feel sad to triage and prioritize lives.. After all, each life is precious...
and one cannot be sure of wats gonna happen in most medical cases!!!
But I guess this is how the world works... Everything cannot be done at once... Its always, one after the othr ;) ;)(You'll get wat i mean)
But am sure You are doing a great Job buddy.... You gonna be the angel in many ppl's lives soon... Kudos to you :) :)

Divya said...

my brother is doing mbbs too.. he talks of patients, dead bodies etc like i talk of resistors and capacitors.. i've always wondered how him and the likes of him can talk so.. guess you guys have seen so many similar cases, it becomes routine for you.. although, mighty responsibilities you guys have to take-that of someone's life! one of the primary reasons why i knew i didn't wanna do medicine.

k.ø.c.h.ü said...

@sameera
indeed, u made me wonder! :-)
n thanks mate, u got my point!
I think now i've succeeded! Yippie

k.ø.c.h.ü said...

@diva
oh mate! That was so sweat! Angel ha! :-) yeah...seems de next time i write something i'll have 2 show u first 4 modifications!(hi hi no way! De busy diva would keep my blog waiting 4 too long im damn sure)
n de 'one by one' concept got accepted right? So i get a point in de war :-)

k.ø.c.h.ü said...

@divya
:-) so u didn't wanna take responsibilities ha! Hmmm...i heard short circuits can take away lives! Wrong resistances n capacitors can cost much!de wrong voltages can kill someone!
:-)

Priya Joyce said...

death is tragic!
and seeing death is much more tragic but what is much much more sad and tragic is seeing someone struggling for life.
hey I should say it was a..... i don't hav words actually to express it.
I can only say that I went cold and got haunting memories of 1 feb 2006 wen my mom wasn't well.
My hands r shivering while typing this i got into the post too much.
I won't get sleep tonight and that's not a lie.

k.ø.c.h.ü said...

I remember that post of yours mate...i still remember de shock that it gave

peter said...

well tht sounds horrible :(
I wanted to be a doctor in skool lyf until I choose biotech ...!

but when u have so many responsibilities related wid lyfs and deaths u gotta be perfect at it ...I hope u are !!

very well narrated there !

happy blogging !

--xh-- said...

lively narrative of hard reality... i could feel the emotions running through you during the entire event...

k.ø.c.h.ü said...

@peter
perfection is mandatory dude! But man has his restrictions!right?

k.ø.c.h.ü said...

@xh
i was not sure if i would succeed in penning de events just as it occured! :-)

Hemanth Potluri said...

u had a tough job..and i loved to be a doctor but became a engg ...but i have so many doc frnds..:)..

urs..hemu..

Vaisakh P S said...

"I felt a bit frustrated…felt offended..."
why do u feel so??

Cinderella. said...

This was engulfing ! YOu described the little details so well !!!

And time is indeed a healer. Loved your concluding para.

Good work Nithin !

peter said...

hey btw join this orkut community made by me for blogger frnds :

jus copy the link in the browser and open !

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peter said...

hey btw join this orkut community made by me for blogger frnds :

jus copy the link in the browser and open !

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k.ø.c.h.ü said...

@hemu
n live's gettin tougher dude...gettin lesser time 2 blog :-(

k.ø.c.h.ü said...

@vaishak
neha offended me by interrupting me.this is kinda violation of a general protocol (strictly speaking)

k.ø.c.h.ü said...

@cind
:-) so happy 2 know that.

k.ø.c.h.ü said...

@peter
will do that when i reach home mate.browsin from mobile now.

Sadia Hussain said...

Triage .... i wonder if the stranger running alongside the stretcher would agree?

k.ø.c.h.ü said...

@sadia
no way...! Selfishness is unique 2 man! U can't blame him... :-)
(n 'hi' since this seems 2 b yer first visit...keep in touch)

¢яŷştąŁ said...

I am speechless.
Everything gets the same after a certain time..and as they say "life goes on!"

Prashant Sree said...

Hi da,

How ya doing.,. I have been unable to comment on other blogs for sometime,as Blogs have been blocked in my company. Had read 'Triage' but commenting on it now only.,.

So we have Doctors view on saving lives.,. Frankly enough i really admire a Doctor's coolness at the heat of the moment.,. Wonder you get used to it.,. I can only wish that being the only people apart from God to have the capability to save people, the doctors continue to make a difference. :)

Vinay said...

very intense and engrossing post...
as anwesa says, korachu divasangal kazhinjal ellam pazhe maadiri aagum...

ps: blogrollin yu...!!

k.ø.c.h.ü said...

@crystal

yeah mate...time's de healer!!!

k.ø.c.h.ü said...

@prashant

hey..wow...simply luvd dat comment da...yeah...i missed thee..!! n yupp...im out too...too busy these days...!!! very little blogging!!!

k.ø.c.h.ü said...

@vinay...

welcum 2 de party dude...!!!cheers

Vinay said...

umm... thanks for d lovely comments on my CK blog dude...!! :)

welcome to my blog too...!!

Pooja said...

visit me at http://smilestearslife.blogspot.com/

new blog!!

Diana said...

What a job n what life u docs hav....My BF is a doc..all that he speaks is patients, blood, surgeries.....I mean its so tough to a doctor.

¢яŷştąŁ said...

Do drop down at my plc,sometime!

joiedevivre said...

yeah...d post of urs!!

V. Archana said...

you doctors must really have a strong heart if the patients life is not even in ur hands na?

this posting has really left me speechless.
All the best to you,future doc :)
Regards,
Archana

nikhil said...

no words :P

Amooma said...

wooo. too long. i am remembering the intense phone session we had that day, u readin to me. didnt read this post til now. so, got the full effect now.
id like to say 'i understand', but i dont think i would, since im not on the other side of the healing process.

Netha Hussain said...

Nicely written..I could feel the whole incident..When we were taught CPCR in community medicine classes, I was taking a nap..I think I should learn it soon or I'll be in trouble..
Read most of your posts, brother..Summing up, I'd say..GREAT!!
Keep on smiling:)

k.ø.c.h.ü said...

@pooja ;)

k.ø.c.h.ü said...

@diana

ahem ahem

k.ø.c.h.ü said...

@zhwadaveewateva

;)

k.ø.c.h.ü said...

@archana


speechless hmmm !! cool...de couchwarmer wid her mouth shut means world peace 4 a while;) lol

k.ø.c.h.ü said...

@nikhil

;)

k.ø.c.h.ü said...

@amoomma

entha satyasanthatha ;)

k.ø.c.h.ü said...

@netha

cheers ;)