Post Call Post Mortem

Future MOs at district hospitals sekalian.......bahawasanya, kes-kes APO dan yang sewaktu dgnnya will almost always turn up in the wee hours of the morning. Seriously.

APO (acute pulmonary oedema) is a condition when there is a sudden onset of chest pains associated with shortness of breath due to fluids in the lungs. Your patient will definitely not be able to lie flat - if he/she is forced to do so, he/she will complain of feeling 'lemas'. They get very restless and to a fresh MO on her first on call at the district hospital, can be very scary. Ye lah, previously, masa korang housemen, most likely case APO nie MO korang yang settle kat casualty. By the time korang tgk kat wad, makcik or pakcik tu dah stable.

My on call last night (speaking of which, on calls on back to back weekends are sgt meletihkan la. Hari tu on call raya haji-the following weekend, on call lagi..) wasn't too bad in terms of patients coming to the casualty. Well, not in the first half of the day anyway. Patients were basically non existant apart from a barrage of jaundiced babies which, most, thankfully could be discharged. However, the previous night a male patient with fever and low blood pressure was admitted. His BP only picked up after commencement of dopamine. The staff nurse in ward kept calling me with one problem after another. I think, though, it's just a ploy to get me to refer him so that they won't have to be bothered with his once every 15-minutes BP monitoring...hahaha.

First his BP was shooting up and down. Adjust dopamine pun payah nak stabilise. Then he developed vomiting and abdominal discomfort with some difficulty in breathing. Finally, he stopped producing urine after 12 noon. Waaa, manyak tension oo. Then I had the unfortunate luck of having the most annoying night staff who kept pestering me to refer the patient. Weh, aku doctor ke mu doctor....that was what I wished I could say to her.

On top of that, the casualty started to become busy. There was a PV bleeding, two MVAs (motor vehicle accidents) - one of which claimed and cried when he was unable to move his legs, tapi tetiba kecoh and menjerit mintak seluar jeans dia balik. One kid got knocked down by a motorbike, NOT by the aforementioned though, hahaha. A stroke case got in and an acute abdomen who had come several times the night before. and ON TOP OF ALL THAT, my male ward has become full. Aiyo, where to put patients lah?

Luckily, a former colleague in Machang was also on call. I gave him a quick call and asked if I could 'borrow' a bed or two if needed. Nasib baik boleh. So one of the MVAs was shipped to Machang, his friend was referred to HRPZ II and the stroke to Pasir Mas. The PV bleeding got admitted, as with the child with the closed fracture. The acute abdomen was a clear cut case of intestinal obstruction but refused to be referred. Letih la. If I keep him, his condition might deteriorate. Honestly, ikut hati memang tak nak simpan la cases like these. Tapi what to do, if patients refuse to go, there is nothing you can do.

Labour room kept receiving cases, thankfully, nothing serious that needs urgent attention.

About midnight, just when I thought I could finally go and clerk my labour room cases, masuk la this 88-year-old lady. TYPICAL presentation of APO. Tambah2 lagi, already has a history of previous admission for APO. According to son, though premorbidly quite active, very difficult to persuade to take medications.

I started the initial medication, put her on bladder catheterisation and called the medical MO on call. Suara macam letih aje. Nasib baik dia tak ckp banyak, terima terus kes tu.

By now, it's already past 1 am. Makcik looked increasingly distressed. My second on call was away somewhere else which would take an hour to get here. What to do, what to do?

Future doctors, if you're on passive call, please la don't be so irresponsible as to be so far away from the hospital. It beats the purpose of putting you on passive call in the first place.

Makcik's oxygen level dropped to 80. She looked near collapse. I contemplated intubating her. Tapi karang takde ventilator, susah plak aku. I gave her another shot of frusemide, put her on high flow oxygen and decided to escort the case myself. A quick call to my senior MO who lives nearby and I was off.

Surprisingly, makcik survived the 45 min journey. Siap bleh sengih2 kat aku lagi. "Mujur selamak sa-pa, deh? (Mujur selamat sampai, kan?)" Ye makcik, mujur..... Her condition made a complete turnaround. Must be that roller coaster-like ride on the ambulance.

Balik ke HTM at three, sembahyang isya and collapsed. Slept till 5 am and trudged to casualty to look at this IHD case. He came in at half two tapi apparently was stable. He was sleeping soundly on the stretcher. Kalau aku tau, aku tidur sikit lagi. Hehehe.

Penutup of my oncall was a BID (brought in dead) case. 57 years old, background history of heart problem and had earlier complained of shortness of breath. Apparently, became still about 10 mins away from the hospital. Sedih la tgk anak dia. Tak sangka la mak dia dah meninggal. Apa nak buat.

and BTW, the guy with hypotension and no urine? Referred him at 8 am. My morning nurses must have been jumping for joy as he left.