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Wednesday, May 11, 2011

Ambo ride

Semalam punye la busy kat ED. Initially tak le busy mana, and I had to see one of the DEMTs (Director of Emergency Medicine Training) about my coming exam. That already took almost an hour, which was fine coz it means less time on the floor. Hahahaha.. bunyi agak pemalas kan? Memang sangat-sangat demoralized lately (... erk.. slalu pon gini).

First patient I took was a stroke patient. Symptoms was dysphasia. Mid-age lady in her 60s. Admitted under neurology.
2nd one was another stroke. Wah, back to back stroke cases aku dapat.
Youngish man 50yrs old, came in with total right hemiparesis, aphasic, poor comprehension, projectile vomiting. Hantar straight to CT scan of the brain + perfusion scan (circle of Willis), but he only got the plain CT brain. Kureng betul radiographer tak buat perfusion scan. Turned out to be dia ada haemorrhagic stroke: large left subcortical bleed injecting into the ventricle.. in another word, bad bleed that causes irreversible damage.. needs to be evacuated.

The wife was present, kesian, diorang takde sapa kat bumi Aussie ni coz both r frm the UK.
Anyway, he was stable all through out ED stay. We had to transfer him to St. Vincent's hospital coz kat spital aku takde neurosurgery specialty. First time aku ikut as an escort in a patient transfer. Dok dalam ambulance.

Seriously kagum & excited, even though seram jugak coz takut patient to crash on me while on the way. I guess the only things yg aku mampu buat as a junior doc at that point ialah airway management & aku boleh intubate (Alhamdulillah). Sebelum bertolak tu aku dah sediakan all the resuscitation drugs in my hand + the resus bag (yg berat nak mampos) dah sedia ada to come with me for the journey. The bosses kasi aku taklimat & nasihat sebelum pergi coz aku tak pernah pegi ikut inter-hospital transfer ni. The deputy of ED puan prof cam ragu2 nak kasi aku pegi coz aku sangat junior in my training. Tapi the bosses yg suruh aku pegi tu relax je ckp this is a perfect opportunity for me to learn. Thanks bosses for believing in me (at the time when I really needed the support).
Sepanjang perjalanan gi St. Vincent's aku sentiasa check his blood pressure. Despite him doesnt have blood pressure issues, he was hypertensive on presentation up to 220/115, which is quite a common complication of a haemorrhagic stroke. We gave him hydralazine, GTN patch, those brought down the BP to a stable 170/100, even though we alwiz like the BP to be below 160 systolic & 90 diastolic. Tapi at the same time tak nak drop the BP too quickly too much coz tak nak other unwanted complications to the already injured brain.
Oh ye, one nurse yg looked afta the patient kat ED kata I deserve a pat on the shoulder coz berjaya masukkan a large bore cannula 16G kat patient tu masa sumer org failed to get another access. Bangga la jugak :P Selalunye case yg critical like this we like to have 2 secure IV access, 1 has to be a large one of minimum size 18G.

St. Vincent's hospital is in the city, sampai-sampai je aku sangat kagum dgn hospital besar banyak tingkat tu. The neurosurgery registrar sambut kami dgn baiknye, he was nice on the phone. Naik terus ke tingkat 10. Cantiknyeeeee ward kat spital ni. Nice view of Melbourne city. Rasa cam nak tukar specialty training supaya dapat dok kat tingkat atas2 of the hospital to have this kind of beautiful view. Terlupa kejap pasal patient haemorrhagic stroke aku ni. Hehehe.

Anyway, it was a short trip from Box Hill Hospital ED to St. Vincent's Hospital. ~15-20minutes je, despite the ambo was running at the speed limit coz hujan lebat. And my hospital kasi aku taxi voucher to come back to ED, and my au$40 worth of trip back was free. =) Seram gak tunggu sorang-sorang kat luar ED St. Vincent's tu for the cab. St. Vincent's terkenal sebagai catchment hospital for psych + substance abuse people. Habis baju aku bau asap rokok coz masa tunggu kat luar tu ramai sungguh org kuar masuk hisap rokok kat pintu luar despite kat situ besar gila sign takleh merokok.
The whole trip pegi-transfer-balik took only ~1 hour. Boleh dikatakan my only exciting case on yesterday shift. Sampai ED Box Hill dlm kol 11pm. 1 jam je lagi until my shift nak abis.

The whole case is kinda a sad one, but very satisfying personally & professionally, and aku bersyukur aku involved in this. I cannot imagine if that happens to my family, let alone my partner. Na'udzubillah. Sedih jugak aku memikirkan how that wife nak look afta her husband yg dah non-verbal & sebelah badan lumpuh, with no family support around. Kalau orang tanya aku sekarang sanggup tak aku jaga a family member kalau jadi cam ni, of course, aku sanggup. It will be difficult, no doubt. But for love, I'll do it, and semoga Allah swt bagi aku & my family kekuatan if this ever happend.

Aku doakan semoga all of us diberi kesihatan yg baik, keimanan yg kuat supaya kami tak lupa kepadaNya, and diberi kesedaran jaga diri baik2 for now. Amin.

Now kena get ready to work.

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