Tuesday, August 19, 2008


Eventually, the 12 hrs night shift for 7 days in a row ended yesterday. Another 4 weeks before i have another one. Now, I have a week off work...well not really, I have to go back for 1 morning shift on Friday after swopping with Samuel, the other AE sho.

The whole week last week was an interesting week. Few interesting cases I had to deal with, each one with different level of difficulties. One of them was a case involving an elderly man with multiple medical problems, came in by an ambulance with acute onset severe abdominal pain. The pain was initially located centrally, and it was very severe that I had to give him a small dose of morphine, which relieved the pain partially. He was sweating profusely, looked clammy with drowsiness. Vital signs were stable at arrival. Immediately I moved him to the resus unit, a special room to deal with a very sick patient. At first I thought he had bowel obstruction because the abdomen was distended and he had colostomy bag for rectal removal few years ago. During further assessment, he complained that the pain now was more severe on his back. The blood pressure dropped below normal value. At this stage I knew that he had an abdominal aortic aneurism (also known as AAA, triple A) which may had been leaking. I expressed my concern immediately to my senior colleague, who organised an urgent CT scan of abdomen, which later showed as expected, a leaking AAA. Subsequently, he was tranferred to another hospital, 1 hour away for emergency surgery. Everyone congratulated me for the quick action.

Working in emergency medicine can be daunting sometimes. It is a stressfull job with so many things to do at the same time. Time is the essence, and as a medical officer in AE you are working against it. Anyhow, with a case like the one mentioned above, it is all worth it. I know I make a difference, and it is, of course, fulfilling.

Most of the cases I dealt with in Drogheda during last week were traumatic injuries, particularly after midnight. I don't know how many I saw with a head injury and most of them were drunk. I just don't understand this drinking behaviour in Ireland. It is their culture alright, but why on earth they go out drinking until they can't stand up on their feet. Some of them become very abusive and aggressive when they are drunk. I had several cases like that last week. One of them was assaulted with a hammer. He was so drunk that he couldn't remember what exactly had happened. He sustained mutilple lacerations on his bald head, and on one of his ears. He was quite abusive against us while we were trying to clean the wound. After calming him down, we continued to clean the wound. Unfortunately we found he was bleeding profusely from the injured ear, and we could not locate the site of bleeding source. Ct brain was arranged, and luckily it was normal. We planned to admit him for neuroobservation and for ENT review because the ear was still bleeding. Frustratingly, once he was more sober, he walked out from the department with a bleeding ear. In a case like this, we only could watch him walked away as he was an adult......stupid adult! This only one example of the many....and we have just to put up with it.

Another case was an anorexic lady, fell in her house, complaining of very severe back pain. She was given high dose morphine, later difene per rectal but the pain persisted. The initial xray show no broken vertebrae nor pelvis. I was puzzled initially. I suspected it was psychogenic pain as the pain was inconsitent to the injury. She looked so thin, like a ghost. She came in with full make-up on her face and this was 4 am. I couldn't take proper history from her because she was shouting, roaring and crying. She kept calling, like a child, for her mother, who was beside her. She was in her 40's but looked much older than her own mother who was also dressed immaculately. I decided to keep her in AE for further review by my senior colleague. The next day, I was told she created a drama in AE after MRI scan showed normal results. The orthopaedic team didn't want to do anything with her because there was no broken bone. Eventually my consultant organised physiotherapy for her. Initially she was resistance to the intervention. After much persuasion she was discharged home the next day.

The saddest case or most tragic case was a case involving an elderly lady who fell from stairs in her home. She was found by her husband. On arrival, she was already on intubation, still breathing on her own but both eyes widely opened with non-reactive, dilated pupils. At this stage I knew she had a brain injury- more specifically brain death. On arrival the trauma team had already been contacted. During the assessment she stopped breathing and resuscitation was initiated and she was brought back to breathing on her own again. Eventually my consultant decided, with consent from her understandably distraught family to end her misery by stopping the life support.....she died in the department surrounded by her large family. I cried a little later during my break, thinking about my mother who also died tragically 10 years ago.

Life is so short and yet it is so precious. Appreciate what you have in life no matter how little it is because you never know when you are going to lose it. Appreciate the love you have from your family, your friends and of course your partner. Live to the fullest, and that is what I am going to do.....

(ps: for confidentiality purposes, I deliberately omitted the name of patients, their exact age, and the exact nature of injury including the exact site)