I haven’t posted about Bara in a while, but I
assure you the nights are still wild. Here’s a play-by-play of yesterday’s
crazy call:
0705: Stab wound #1 of the day rolls in.
Eviscerated bowel injury with loops adorning the stretcher. Up goes two
large-bore IVs, bloods, blood gas, Foley, and he's off to the operating
theater.
0900: Our lone ultrasound unit breaks. No more
E-FAST exams. So much for ATLS protocol for the remainder of today's
thorax/abdominal injuries.
1400: Back-to-back surgeries with another
exploratory laporatomy.
1930: Complications during surgery. Liters of cardiac
output literally pour into the thoracic cavity. Ever seen a heart physically beat in ventricular fibrillation?
0130: I wheel a vented patient to radiology for
a CT angiogram with the following instructions: “The patient is starting to
wake up and buck the vent. Here is 2x20ml of morphine, push as much as you
need. Sorry we don't know where the ambu-bag is.”
0500: Are we up to stab wound #12 now? Who
knows? There were a few gunshot wounds mixed in there. Resus bay is jampacked
spilling out into the hallway but thankfully everyone is stable.
0700: One (of two) interns out sick and no
replacement until 5pm. All 8 beds in resus bay full. It's going to be a LONG
day.
0815: Chest xray confirms a pneumothorax I
called on ultrasound for a stabbed chest!
 |
| The bird lands. |
0930: Helicopter arrives with multiple MVA
motorbike vs. taxibus.
1200: First-assisting in the operating theater
on a stabbed abdomen with pleural violation.
 |
| Radiology waiting area already packed by 10am. |
1700: Covering intern is here! Yay, hopefully
will decompress some of the workload.
1815: Covering intern gets splash exposure and is out of commission.
1830: Stabbed heart that rolled in earlier
today with ? pericardial effusion develops tombstoning ST elevations. We're off
to the operating theater.
 |
| Throwing stitches on a beating heart (not my hands!) |
2030: Have not eaten food since 6am this
morning. Sneak a quick trip to KFC in Soweto while I wait for the blood blank
to crossmatch some emergency units for four unstable patients in the resus bay.
Now I know why I was warned to stay out of Soweto after sunset. Ever seen a KFC
with barred windows?
2100: One bite into the chicken wing and I'm
called back into the OR. Stabbed neck with vascular compromise.
0030: Out of the OR, the resus bay is backed up
four stretchers into the hallway. Like a assembly line, I pull ABGs in succession,
with a chest tube at the end of the rainbow.
0045: Just got irradiated again by
xray tech two beds down as I’m putting in the chest tube. Again no warning.
This is probably the 20th time this month. My poor unborn children.
0145: Waiting in radiology while receptionist
sleeps and radiologist is nowhere to be found. BP cuff doesn't work, swinging
wildly by 30 points – the usual. Did manage to grab one of two pulse oximeters
we have. Vital signs – I’ll take what I can get.
0230: Back in the resus bay, I get an axe kick
to the head from a drunk patient. Surprisingly flexible for his size. He gets
intubated.
0300: The patient I wheeled off to CT earlier
is on a downward spiral. He is made comfort measures only.
0330: Second wind arrives! :)
0430: Second wind gone :(
 |
| The morning light beckoning. |
0530: A medical house officer starts asking me
about hyponatremia on a blood gas for a polytrauma patient.....some things are
the same everywhere.
0600: I am in full-on zombie mode. The intern,
who is about to collapse from exhaustion, asks me to suture a complex
head lac. I turn her down as I make it a point to not suture anything after 6am
for safety reasons – especially since we often use hand Colt needles here
instead of needle drivers. Reinforcements are coming in one hour so I’m just
staying the course, tidying up paperwork and readying presentations.
0700: I’m a survivor.
