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Thursday, September 21, 2006

An Emerg To Remember

Wednesday's are supposed to be light.
The OPD was light. We finished by 11.30 took rounds and settled in. I had the day shift for the casualty and it started.
Some corporator decided he knew whats best for one of the patients and sent him to the hosp with R hemiplegia (R side paralysis) Uncontrolled Diabetes and a nasty yellow dripping foot abscess/cellulitis with great toe gangrene. I have seen this yellow colour once before in my life and I was willing to bet this was Madura Mycosis / Actinomycosis. Since I knew my seniors would never allow a debridement with an uncontrolled blood sugar level, I advised him to go in for hyperbaric O2 therapy but the AMO intervened and had him admitted into the Medical Ward.
Well, this guy was bad and he died today with counts of 37,500 (too high). The clincher - When I gave the patient the option of hyperbaric he was only too willing to go and get it done at Kasturba (we don't have a hyperbaric chamber) but the AMO forced him to get admitted because he had a corporators letter and couldn't be turned away....never mind the well being of the patient.

The other thing was a perforation that came in in the evening. His timing was so great that just at that time Dr. Big Boss Man's patient collapsed in the ward and her relative panicked and called him directly. He lost it, I mean LOST it. He called Dr. Shanky and let him have it. I was sitting some 6 feet away and I could see Dr. Shanky replying but couldn't hear a word he said...After the call he was in a state of shock! To top it off he had also told him that he was sending another patient, active tuberculosis with a ? Perforation. Now everyone started to panic cause no one wants to see the Boss Man in a bad mood. He's viscious. We were all tracking progress, getting Xrays and putting tubes whereever possible.
When the X ray of the TB patient came we all almost fell over. He had lesions all over and we had to find his lung in there. We knew at that instant that this was trouble since no one would induce him there so we couldn't operate. We were told to sit on him and the other fellow.

Today morning we finally got the go ahead for the normal fellow and he was taken up in the afternoon. As soon as we finished him we get a call that the TB fellow is bad and getting worse. We tried reasoning with the anaesthetist but there was no way he was getting induced so we had to transfer him to Maike!(higher centre)
So, we've actually finished yesterday's emerg tonight at 10 and I'm exhausted beyond words...

Oh and somewhere in between all this we got another of the Boss' cases with a Hb of 3.3 Normal being 12 so he's weak beyond repair....sheesh and I have a double weekend coming up


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