Wednesday, November 30, 2005

OUR PRECARIOUS LIFE


It was 1.45pm yesterday. I was taking a respite after settling a number of cases, in and outpatients. Shidah, the staff-nurse called for me albeit in a casual way and I assumed it was a non-urgent case. Thus I approached the patient who was lying on the bed and asked the male attendent for any info about her. In a relaxed manner he said, "alaa, perempuan ni, dia orang jumpa pengsan tepi jalan.." I took a quick glance at her and immediately I percieved that she was gasping and her breathing was markedly erratic. "My goodness! She's gasping!" Grabbing the torch-lite, I checked for her pupillary response: Right side fixed and dilated (full-moon) and the left side was 4 mm and sluggish. "Call for code-blue!" I shouted. Calling for code blue means that staffs(code blue team) who are trained to handle emergency/ resuscitation from other floors and departments are to come straight away/stat to the A and E.

In an instant everyone started moving frantically. I demanded the ambu-bag and ordered that the patient be masked and bagged (oxygen 10 litres/min). As the patient was still breathing on her own although erratically, I ordered the nurse to synchronize the bagging with the patient's breathing or the effort will be futile. I managed to set an I/V line in her right arm and started running a pint of Hartman's. At the same time, another I/V line was installed in the other arm for drug infusions.

A swift examination revealed a hematoma and laceration on the occipital region. There were also two small hematomas on the forehead.

The patient was still unconscious. I took over the bagging and demanded the nurses to prepare equipments for intubation and check the ECG leads. The ECG rythm was tachycardic but still in sinus rythm. Her blood-pressure was 90/60. There was blood coming from her mouth.

"Call the surgeon and anaesthetist stat!" I ordered . Meantime, we prepared the patient for an urgent brain-scan and group-cross-matched 4 pints of whole blood. In between resuscitation, I managed to retrieve history regarding the patient. Apparently, patient was brought in by a passer-by who found her sprawled, unconscious on a back alley, surrounded by onlookers. The good samaritan carried the lady into her car and drove her straight to the A and E.

Each time when we face such a case in the A and E, with unknown cause of unconsciousness relating to head injury, we have to consider the possibility of cervical spine fracture. Thus stabilization of the neck is crucial. In this case we used a cervical collar. Another important diagnosis to be looked into is fracture of the base of skull which if not properly handled will worsen the condition especially during forced intubation.


The patient was transfered to the ICU, intubated and on ventilator. The brain-scan showed fracture of the occipital bone extending to base of skull. There was a huge subdural hematoma causing a midline shift. Her BP crashed and she was supported with adrenaline and dopamine infusions. She continually bled from her mouth and the endotracheal tube and continuous suction had to be done. Blood was transfused.

This is a sad story of someone whom just 24 hrs ago was living her life unassumingly. As her husband had died a year ago of leukemia, she had to make ends meet to support her 2 children (8 and 9 yrs old) and an elderly mother. To top it all, she was diagnosed with SLE.

On that fated afternoon, she had just withdrew money from the ATM machine and was walking towards her car in the small alley when a theif on motorbike snatched her bag. Whilst struggling she lost balance and fell, hitting the hard cemented pavement. She never regained consciousness.

I took her photo in sadness. She is fighting for her life which the visiting Neurosurgeon postulated only 40% chance of survival rate even if surgery is attempted in view of the massive hemorrhage. I can't bear watching her two small kids cry over her. It's truly heart-wrenching.

Maybe this can be a lesson for us to be extra, extra careful. Avoid lonely alleys. Withdraw money from ATMs with friends and not alone. It's probably better not to struggle with a snatcher and avoid head-injuries. After all what's a few hundred ringgits compared to dear life. And to all snatch-thieves out there: stealing is one thing but to take another person's life? Is it worth it?

13 comments:

easylady said...

All this shows how bad is this generation now.Something that we see happening in the west is happening here right in front of our eyes.What is coming to our society.Who is at fault.Is it the system or the basic of our nucleus family?

On a lighter note to Dr roza,yes I am from that badge.Both of them are in KL.Julie is in PUSRAWI while Mahanum has her own private practice.

bergen said...

Dr: I am shaking with anger reading this entry thinking of the thieves who did this to her. I don't want think of her children for it will only make my eyes cloudy trying to hold back my tears. I think of Aunt, a single mother who raised me.

pycnogenol said...

Read in the papers today that the lady had passed away.
Wonder who's gonna take care of the children now.
To the snatch thieves - I hope you can live with your conscience....

Queen Of The House said...

As always with cases like this, it makes one want to strangle the perpetrators with one's bare hands if given the chance. Sadly she is only one of many snatch-theft victims. My own niece had to wear a neck-brace and undergo therapy because of a snatching incident.

One thing that made me wonder --- does it take a doctor to recognise the seriousness of the case? It is troubling to read of how casually your staff acted before you called for the code blue.

dr in the house said...
This comment has been removed by a blog administrator.
ikelah said...

easylady:
the system and basic lack of nucleus family are both influenced by 'our policy'. this is the price of becoming a developed nation in a haste, unprepared, unproper planning, greediness, selfishness leading to unbalanced development.

bergen
her son is 9 yrs and daughter 8.

pycnogenol
she died the next day not regaining consciousness. she was declared brain dead on the same evening she got admitted.

QOTH
Many a times we had 'cry wolf' episodes where patients had feign illness thus at times my staff can get caught unguard! But dont worry we dont refuse patient especially those in life and death situations! No downpayment needed!

P5 said...

so many things i'd like to comment.. but it'll take too much time to compose my violent thoughts and reaction at the moment.

simply said, any snatch thief that crosses my path will be most unfortunate.

we need to beef-up public awareness on basic first aid, eg call 999 rather than stand gawking like bunch of idiots.

pre-hospital care has lots of room for improvement. first in attitude. second in materials.

been there, done that in emergency response. which could do the same in malaysia. i'll write about that one of these days...

crimsonskye said...

remember how there was this one time where news abt the snatch thieves and heartbreaking stories on their victims were everywhere? it was really a serious issue and then.. it died down. just like that...

Has said...

Ikelah, i feel rather uncomfortable seeing the face of the lady, shouldn't her face at least be blurred.

hiyoshi said...

I got a sudden shiver imagining that I'll be facing the same scenario one day....

Anonymous said...

I think it's very rude and unethical to take photos of the woman like that, since she was in no shape or form to protest.

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