It’s almost 1am and I couldn’t sleep again due to the heat wave. I was tired from my hectic oncall and skipped exercising today. Instead I slept off despite the heat for about 20 minutes and woke up in a puddle of my own sweat. I feel like a “gummy bear” all the time as my neck, armpits, the elbow crease and back of my knee feels sticky. It is really an unpleasant feeling and when I am on my bed I assume a star fish position in the hopes that I could air out all those sticky regions. Taking a shower does not help either and I rarely use a towel these days as the water gets evaporated so fast.
It is definitely too late to walk to the hospital now although I have walked to the hospital at 2am before and the streets were so serene that I felt for once I am the only human alive. Last night being in the ice cold operating theatre, I wished I could snuggle my soft toys and stay in a comforter and sleep. However, I was playing with “Level-1” last night instead of getting any rest because of a horrible accident involving a young male. I would say I broke my own record of most blood product transfused during a case. The patient had a total of 14 pints of packed cell, 18 cryoprecipitate, 12 fresh frozen plasma and 4 units of platelets. We ran out of platelets so that’s all we could give him and to make things worst there was no a thromboelastogram or Rotem to guide us on our transfusions. It was just guided by serial arterial blood gas which has the haemoglobin level and calcium levels. To aggravate the whole scenario, there was difficulty in getting the person who has the expertise to secure the bleeding vessel. At one point someone even suggested to just “pack the abdomen” and I don’t see that as a solution as before the abdomen was opened up the patient was already severely hypotensive and had needed 5 pints Of packed cells.
Anyway in the end we manage to send a haemodynamically stable patient to the surgical intensive care unit after approximately 5 hours in theater. I honestly do not think he will survive as we noted his pupils were unequal mid surgery and we do not have facilities such as intraoperative CT Scan. He was so unstable from the begining that thete were no imaging available other than a portable chest x-ray. With 3 of his limbs fractured, a severe traumatic brain injury and also massive blood transfusion from the intraabdominal vascular injury, I really think his chance to survive is rather low. The injuries per say are treatable but I think time, facilities and expertise also play an important factor in reducing secondary injuries and giving the patient a better chance of survival.
I still feel there was a lot of delay in taking him to theater, it was 5 hours post trauma that he was taken to theater. I also felt like whatever I studied and what I practice does not go hand in hand due to the limitation of facilities. I also have a lot of question about the case and I wish I could discuss it with someone senior but right now everyone seems to be busy with the finals fot the senior batch. I wonder should an intracranial probe be placed to monitor the pressures in the skull or would it been better if we had en route to the CT room just for a quick CT scan after stabilizing him temporarily. How or what can we do better? (The flaw in my training is we hardly reflect on how to improve and only do so whenever there is an obvious adverse event).
I am often thinking about some of the cases I handled before and wonder if I had in my best knowledge and capacity did the right thing. Some things do haunt me and it is these thoughts that floods my mind whenever I have trouble falling asleep. I am also afraid of things like outdated practices which could bring potential short or long term harm. I wonder if whatever I learned in end of life care workshop 6 years ago is still same or have things change? Maybe I should attend one of these workshop if theres an opportunity. A lot of things are not as ideal as in first world country and I hope I will really be granted a mentor from an online application I made recently. Someone who could give me individualised guidance and feedback.
Okay it is 28 degrees now, maybe I should try taking a shower again and try to sleep or I will definitely be sleep deprived and less productive. I admit that I was really not smart in not installing an airconditioner and paying extra electricity bills (I really hate to admit this but it is an excellent example of penny wise pound foolish!)
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