Mr. F
Wednesday, July 21 - 2010 was the day I had double shift. I arrived at the hospital at 6.45 am and waited for my shift-partner in the HQ. I couldn't start the morning visit without her and so I used the waiting time for reading textbook. Not long, my partner came. After readied our stethoscope, penlight, reflex hammer, notebook, and pen, we started our visit to the wards.
There were 6 wards in the hospital, starting from ward A to F. We had received notice from our friends on yesterday' shift said that there were 6 patients to take care of. 3 in ward B, 1 in ward C, and 2 in ward F. Those were the same patients since Monday that me and my partner already knew, and so we thought "Ah, it'll be just another routine check up, let's do it fast." Then, we decided to start our visit from ward B.
My partner checked the patients-list board and found 4th patient consulted to neurologist in ward B. Huh, we thought there were only 3 patients as stated from our friends. If there was a new patient, my friends should've informed us 'bout it, but when I asked them, they said they didn't know about that additional patient. Then I asked the nurse and she said that patient, Mr. F was referred to neurologist from ER at 4 am, and apparently the ER staff nor ward B' staff informed neurology' young doctors (my group) about that patient (;=.=).. Then we started examining the patient in nearest bed. It was a man with low back pain, hospitalized since Monday and he was suspected to have HNP. His condition was getting better since yesterday, so me and my partner didn't do anything much. Then, we decided to move to the next patient, and the one who got the bed nearest to our spot at that time was the 4th patient, Mr. F, so we moved to him.
I saw a middle aged man, lying unconscious on the bed with oxygen mask attached. I could hear his breathing, it was quiet loud, and fast. "Hyperventilation" I said in my mind, then I turned to the young man sitting next to the patient. He was Mr. F's younger brother. I asked what happened to Mr. F, and the young man said it was a motorcycle accident. Last night, Mr. F was riding his motorcycle alone when a man suddenly crossed the street that led Mr. F avoiding him and accidentally hit the sidewalk, fell, hit his head, and then loss consciousness right on the spot. Then Mr. F was taken to nearby hospital, but the brother said Mr. F was ignored during the stay in that hospital, and then he was moved to Marine's hospital in expectation to get better treatment.
I heard the history, next me and my friend started with physical examination of Mr. F. I called his name and asked him to open his eyes several times to check his consciousness level = no answer, he was still hyperventilating. I tried with pain stimulus = no answer, no movement at all from his limbs. I checked the blood pressure and got a very amazing number: 190/110 mmHg O_O!!!!!!!!!! I was shocked-honestly! I turned to my partner who took notes on my findings, and her expression turned O___O! But it was in front of the patient's family, so we tried to be calm as we could. I moved to next examination, I took of the sphygmomanometer' wrap off from the Mr. F's arm, and at that time I felt a bit warmness on my hand. Quickly I checked him with a thermometer and it gave me a very amazing number too: 39.2 C!
"Bad, bad, bad, this is bad, this is bad..*repeated* " in my mind.
He has history of motor accident, probably high impact because of his low level of consciousness. But I found no bruises on his body, no bone fractures, no swelling, so I suspected an intracranial hemorrhage(bleeding inside the skull). The blood pressure scared me, and more to it the temperature! O_O High temperature can fasten the degree of brain damage in intracranial bleeding and it's nothing but SERIOUSLY BAD!!!!!
I asked the male nurse-trainee (because the other nurses were gone I didn't know where) of what medication had Mr. F got since he got to this hospital. The trainee guy quickly checked Mr. F's status and nice... he only got hydration therapy and oxygen, nothing else! O_O I couldn't believe it... The trainee nurse guy saw that me and my friend found something serious and he stayed there.
I took my penlight and checked the eyes and I found another AMAZING result: anisocoria! The right pupil is in normal size, but the left pupil is dilated! ...uh oh... that was BAD!!!!! O_O!!!!!!
Before I realized it, my pace on examining Mr. F became faster and faster, I checked the heart- there was murmur, the lungs- there were rhonchi. The pulse: >200 x/min, respiratory rate: > 60 x/min. My partner who aided my examination said the pathologic reflex is positive, and physiologic reflex is increased in all four limbs. I went "Oh my Gooooooddd!!!" in my mind. And when my partner asked for GCS score (it's a score we use to measure one's consciousness level, contained 3 variables, Eye, Verbal, and Movement. The lowest score is 3, indicating coma, and Mr. F was...4!!!!!!!) I realized what I had missed since the first inspection-the posture of Mr. F. His body stiffened, legs straight and rigid, both arms extended outward and rigid too, then I remembered that that was the perfect image for decerebration!!! Means massive brain damage!!!!! O____O!!!!!!!!!!!!!!!!!!
"WHY IS THIS KIND OF PATIENT STILL IN THE WARD?!!!!!!!!!!!!!! ICU ICU ICU ICUUUUU!!!!!!!!!!!" I screamed inside my mind.
I turned to my partner, though we got our 'calm face', we could both read our eyes saying "this is baaaaad..."
Mr. F's younger brother became aware of our pace and voice tone, and he asked if something bad was happening to his brother. Oooh, it's not bad, but VERY VERY BAD!!!! O_O! Hmh, of course I didn't tell him that...( =_=) Me and my partner was thinking what we should do. As a young doctor, we are only allowed to observe and examine. We can not give treatment or advices to patients and their families without our consultant's permission. At that time, our consultant hasn't arrived yet (he hadn't even met the patient) so our choice was the attending doctor. Quickly we excused ourselves from the patient and reported our findings to the attending doctor. When we met the attending doctor, honestly we didn't know how to start reporting about Mr. F's condition because everything was BAD and we didn't know that attending doctor-a new face to us.
"Eerr...doc..." I called,
"Yes?" She put off her phone and turned to me and my partner.
"We are neurology' young doctors.. Errr, about Mr. F.."
"Humm? What about him?"
"Eerr..his body temperature is 39.2, and blood pressure is 190/110."
"Eh? Really~ Lemme see his status..." *read the status slowly* "Hmm... accident... hmm... how's his GCS?"
"It's 4. E1, V1, M2."
"Oh, that's bad, hmm... ... ..." *slowly read the status again, flipping pages after pages.
At that time, my mind was filled with question... Mr. F had been brought to the ward since morning, his condition was no better, but how come no one wasn't aware of his condition? His breathing was hyperventilated and was loud enough for everyone to hear, but none came to take a look, even the attending doctor said "REALLY?" and she didn't know anything about Mr. F when we reported to her...
After some times (I hoped that attending doctor could act more faster because we're facing a critical condition here) reading the status, that attending doctor phoned the neurologist-our consultant. And phew... we could feel at ease a little because our consultant said that Mr. F should be brought to ICU. But... when we explained about ICU to Mr. F's brother, he said to wait for a while because he didn't have the fee and needed to wait for other relatives to come.
We can't do anything without patient's(or patient's family in case of the patient is unconscious) approval, so... me and my partner just hoped that the relatives could come sooner.
-- 2 pm
My consultant arrived at the hospital. He started the visit round with my group, and we went to Ward B and we found Mr. F was still there!! O_O! And his condition deteriorated! And that was my first time to see the Cheyne-Stokes respiratory pattern. It was typical massive brain damage... ... he could die soon if he didn't get into ICU, I thought...
There were a lot of his relatives that afternoon, and my consultant explained Mr. F's condition and that he needed ICU. I could see the family members were all not quiet agree to get Mr. F to the ICU because of the fee, and the asked if there were another option, but as we all knew, there was none.
-- 9 pm
Me and my partner started our night visit to ICU. Mr. F was finally moved there! But... even though he had been moved to ICU, honestly, I didn't think he would get better... When we're talking about brain damage, we are talking about every second means life. But Mr. F had been too long neglected with no treatment... It was too late, I thought...
We met and talked with the family to fill our information about Mr. F. The brother said Mr. F was a healthy person, except for his hypertension, but none other, he was strong and healthy. He was going home last night from his friend's house when that accident happened. And since that, Mr. F had never open his eyes, not even once.
Also, I spotted a monetary problem in the family, they signed for DNR order (Do Not Resucitate: do not give treatment or rescucitation to the patient when he is stop breathing.. a.k.a, let the patient to die.) because they couldn't afford the hospital fee.
-- 4 am
Me and my partner got a call from ward C about our stroke patient, the nurse said her condition worsen. After taking care of that patient, my friend asked if we could visit Mr. F again. I agreed and we went to the ICU. Opened the door, we saw empty beds inside. It was very quiet there, with only one male-nurse in the counter, playing laptop while giggling on something we didn't bother to know.
"Excuse me, where is Mr. F?" my partner asked.
"Huh? What? Mr. F? He's already "plus"." the male nurse answered with his eyes locked to his laptop. ('plus' or '+' is common word among medical practices which has the same meaning as deceased)
"...When?" I asked.
"2 am~" once again he answered without looking at us-still giggling on something in his laptop.
"How did he die? Was it because aspiration or the progression of his disease?"
"Naah, not aspiration. He was hopeless, anyway~"
"Can I see the medical record?"
"Sure~"
After reading the medical record, we returned to HQ. I returned to my sleeping bag, and so did my partner.
"The first dying patient during my shift." she said.
"So am I." I said.
"We got one, now."
"You know his condition won't get any better."
"I know...and I'm glad I wasn't there when he died. I couldn't think of seeing people die right in front of me..I don't want it."
"I've never seen people die in front of me, too. " I said.
"...What would it feel like?...Oh God, I don't want it! it would be a nightmare." she pulled the sleeping bag's covering to her face.
"But we can't avoid it, y'know... dying people... " I said. "Not even once I thought that I could save all of my patients... no matter how skillful I am, no matter how smart I am, I'm not god... I know, we don't want our patient to die, but we're not the one deciding they're going to live or to die."
"Errr...you're rrright, but... Aaah, I still don't want it!"
"As long as the patient die not by our mistakes, I think that's fine.. "
"Yeah... not because of our mistakes."
"Yeah... we do the best as we can."
"But I'm afraid..."
"Me too. " I replied. "Hey... ... do you realize it?"
"What?"
"Mr. F had been in that condition since last night, with no medications."
"Yeah, so?"
"You see... human bodies... how our body struggle for survival, even in most severe condition, even when we loss consciousness, our body never stop trying to live. Struggling through compensation- the hyperventilation, high body temperatures... Mr. F got severe brain stem compression and brain hemorrhage, yet he could survive for more than 24 hours- without any medication. Isn't it awesome, our body?"
"Yeah... awesome... it's unpredicted."
"God is super genius to design this complex mechanism of our body, ne?"
"Yeah.."
That was the first time I had closer contact with dying patient. Me and my partner examined Mr. F since morning, we had communications with the family members, and we knew it was a great loss.
Mr. F was one healthy man before, but one sudden event changed his-and his family's life.
One day we talked and laughed with our beloved one, but the next minute he or she was gone forever. No messages, no farewells, leaving nothing but regrets.
Human's life is unpredicted, no one knows when one will die.
Seeing Mr. F, I want to cherish this life more. I had been wasting my time with useless stuff all this time.. Oh Jesus, forgive me.. So many people died before knowing your truth. That is what I regretted the most...
I wonder if Mr. F had ever heard about Jesus? Had he heard about the truth?
Now that he's gone, nothing left can be done.
Life is short.
Life is precious.
Life is purposeful.
Thanks God for giving me life.
Oh my, *scrolls up up up* This entry is LONG!!? O_O The longest entry I guess. Ha ha, never thought I could write something this long and it's not a fic. XD But I'm too lazy to put an LJ-cut to spare your monitor. Ah well, it's fine! Have a nice day, everybody! XD *runs*
There were 6 wards in the hospital, starting from ward A to F. We had received notice from our friends on yesterday' shift said that there were 6 patients to take care of. 3 in ward B, 1 in ward C, and 2 in ward F. Those were the same patients since Monday that me and my partner already knew, and so we thought "Ah, it'll be just another routine check up, let's do it fast." Then, we decided to start our visit from ward B.
My partner checked the patients-list board and found 4th patient consulted to neurologist in ward B. Huh, we thought there were only 3 patients as stated from our friends. If there was a new patient, my friends should've informed us 'bout it, but when I asked them, they said they didn't know about that additional patient. Then I asked the nurse and she said that patient, Mr. F was referred to neurologist from ER at 4 am, and apparently the ER staff nor ward B' staff informed neurology' young doctors (my group) about that patient (;=.=).. Then we started examining the patient in nearest bed. It was a man with low back pain, hospitalized since Monday and he was suspected to have HNP. His condition was getting better since yesterday, so me and my partner didn't do anything much. Then, we decided to move to the next patient, and the one who got the bed nearest to our spot at that time was the 4th patient, Mr. F, so we moved to him.
I saw a middle aged man, lying unconscious on the bed with oxygen mask attached. I could hear his breathing, it was quiet loud, and fast. "Hyperventilation" I said in my mind, then I turned to the young man sitting next to the patient. He was Mr. F's younger brother. I asked what happened to Mr. F, and the young man said it was a motorcycle accident. Last night, Mr. F was riding his motorcycle alone when a man suddenly crossed the street that led Mr. F avoiding him and accidentally hit the sidewalk, fell, hit his head, and then loss consciousness right on the spot. Then Mr. F was taken to nearby hospital, but the brother said Mr. F was ignored during the stay in that hospital, and then he was moved to Marine's hospital in expectation to get better treatment.
I heard the history, next me and my friend started with physical examination of Mr. F. I called his name and asked him to open his eyes several times to check his consciousness level = no answer, he was still hyperventilating. I tried with pain stimulus = no answer, no movement at all from his limbs. I checked the blood pressure and got a very amazing number: 190/110 mmHg O_O!!!!!!!!!! I was shocked-honestly! I turned to my partner who took notes on my findings, and her expression turned O___O! But it was in front of the patient's family, so we tried to be calm as we could. I moved to next examination, I took of the sphygmomanometer' wrap off from the Mr. F's arm, and at that time I felt a bit warmness on my hand. Quickly I checked him with a thermometer and it gave me a very amazing number too: 39.2 C!
"Bad, bad, bad, this is bad, this is bad..*repeated* " in my mind.
He has history of motor accident, probably high impact because of his low level of consciousness. But I found no bruises on his body, no bone fractures, no swelling, so I suspected an intracranial hemorrhage(bleeding inside the skull). The blood pressure scared me, and more to it the temperature! O_O High temperature can fasten the degree of brain damage in intracranial bleeding and it's nothing but SERIOUSLY BAD!!!!!
I asked the male nurse-trainee (because the other nurses were gone I didn't know where) of what medication had Mr. F got since he got to this hospital. The trainee guy quickly checked Mr. F's status and nice... he only got hydration therapy and oxygen, nothing else! O_O I couldn't believe it... The trainee nurse guy saw that me and my friend found something serious and he stayed there.
I took my penlight and checked the eyes and I found another AMAZING result: anisocoria! The right pupil is in normal size, but the left pupil is dilated! ...uh oh... that was BAD!!!!! O_O!!!!!!
Before I realized it, my pace on examining Mr. F became faster and faster, I checked the heart- there was murmur, the lungs- there were rhonchi. The pulse: >200 x/min, respiratory rate: > 60 x/min. My partner who aided my examination said the pathologic reflex is positive, and physiologic reflex is increased in all four limbs. I went "Oh my Gooooooddd!!!" in my mind. And when my partner asked for GCS score (it's a score we use to measure one's consciousness level, contained 3 variables, Eye, Verbal, and Movement. The lowest score is 3, indicating coma, and Mr. F was...4!!!!!!!) I realized what I had missed since the first inspection-the posture of Mr. F. His body stiffened, legs straight and rigid, both arms extended outward and rigid too, then I remembered that that was the perfect image for decerebration!!! Means massive brain damage!!!!! O____O!!!!!!!!!!!!!!!!!!
"WHY IS THIS KIND OF PATIENT STILL IN THE WARD?!!!!!!!!!!!!!! ICU ICU ICU ICUUUUU!!!!!!!!!!!" I screamed inside my mind.
I turned to my partner, though we got our 'calm face', we could both read our eyes saying "this is baaaaad..."
Mr. F's younger brother became aware of our pace and voice tone, and he asked if something bad was happening to his brother. Oooh, it's not bad, but VERY VERY BAD!!!! O_O! Hmh, of course I didn't tell him that...( =_=) Me and my partner was thinking what we should do. As a young doctor, we are only allowed to observe and examine. We can not give treatment or advices to patients and their families without our consultant's permission. At that time, our consultant hasn't arrived yet (he hadn't even met the patient) so our choice was the attending doctor. Quickly we excused ourselves from the patient and reported our findings to the attending doctor. When we met the attending doctor, honestly we didn't know how to start reporting about Mr. F's condition because everything was BAD and we didn't know that attending doctor-a new face to us.
"Eerr...doc..." I called,
"Yes?" She put off her phone and turned to me and my partner.
"We are neurology' young doctors.. Errr, about Mr. F.."
"Humm? What about him?"
"Eerr..his body temperature is 39.2, and blood pressure is 190/110."
"Eh? Really~ Lemme see his status..." *read the status slowly* "Hmm... accident... hmm... how's his GCS?"
"It's 4. E1, V1, M2."
"Oh, that's bad, hmm... ... ..." *slowly read the status again, flipping pages after pages.
At that time, my mind was filled with question... Mr. F had been brought to the ward since morning, his condition was no better, but how come no one wasn't aware of his condition? His breathing was hyperventilated and was loud enough for everyone to hear, but none came to take a look, even the attending doctor said "REALLY?" and she didn't know anything about Mr. F when we reported to her...
After some times (I hoped that attending doctor could act more faster because we're facing a critical condition here) reading the status, that attending doctor phoned the neurologist-our consultant. And phew... we could feel at ease a little because our consultant said that Mr. F should be brought to ICU. But... when we explained about ICU to Mr. F's brother, he said to wait for a while because he didn't have the fee and needed to wait for other relatives to come.
We can't do anything without patient's(or patient's family in case of the patient is unconscious) approval, so... me and my partner just hoped that the relatives could come sooner.
-- 2 pm
My consultant arrived at the hospital. He started the visit round with my group, and we went to Ward B and we found Mr. F was still there!! O_O! And his condition deteriorated! And that was my first time to see the Cheyne-Stokes respiratory pattern. It was typical massive brain damage... ... he could die soon if he didn't get into ICU, I thought...
There were a lot of his relatives that afternoon, and my consultant explained Mr. F's condition and that he needed ICU. I could see the family members were all not quiet agree to get Mr. F to the ICU because of the fee, and the asked if there were another option, but as we all knew, there was none.
-- 9 pm
Me and my partner started our night visit to ICU. Mr. F was finally moved there! But... even though he had been moved to ICU, honestly, I didn't think he would get better... When we're talking about brain damage, we are talking about every second means life. But Mr. F had been too long neglected with no treatment... It was too late, I thought...
We met and talked with the family to fill our information about Mr. F. The brother said Mr. F was a healthy person, except for his hypertension, but none other, he was strong and healthy. He was going home last night from his friend's house when that accident happened. And since that, Mr. F had never open his eyes, not even once.
Also, I spotted a monetary problem in the family, they signed for DNR order (Do Not Resucitate: do not give treatment or rescucitation to the patient when he is stop breathing.. a.k.a, let the patient to die.) because they couldn't afford the hospital fee.
-- 4 am
Me and my partner got a call from ward C about our stroke patient, the nurse said her condition worsen. After taking care of that patient, my friend asked if we could visit Mr. F again. I agreed and we went to the ICU. Opened the door, we saw empty beds inside. It was very quiet there, with only one male-nurse in the counter, playing laptop while giggling on something we didn't bother to know.
"Excuse me, where is Mr. F?" my partner asked.
"Huh? What? Mr. F? He's already "plus"." the male nurse answered with his eyes locked to his laptop. ('plus' or '+' is common word among medical practices which has the same meaning as deceased)
"...When?" I asked.
"2 am~" once again he answered without looking at us-still giggling on something in his laptop.
"How did he die? Was it because aspiration or the progression of his disease?"
"Naah, not aspiration. He was hopeless, anyway~"
"Can I see the medical record?"
"Sure~"
After reading the medical record, we returned to HQ. I returned to my sleeping bag, and so did my partner.
"The first dying patient during my shift." she said.
"So am I." I said.
"We got one, now."
"You know his condition won't get any better."
"I know...and I'm glad I wasn't there when he died. I couldn't think of seeing people die right in front of me..I don't want it."
"I've never seen people die in front of me, too. " I said.
"...What would it feel like?...Oh God, I don't want it! it would be a nightmare." she pulled the sleeping bag's covering to her face.
"But we can't avoid it, y'know... dying people... " I said. "Not even once I thought that I could save all of my patients... no matter how skillful I am, no matter how smart I am, I'm not god... I know, we don't want our patient to die, but we're not the one deciding they're going to live or to die."
"Errr...you're rrright, but... Aaah, I still don't want it!"
"As long as the patient die not by our mistakes, I think that's fine.. "
"Yeah... not because of our mistakes."
"Yeah... we do the best as we can."
"But I'm afraid..."
"Me too. " I replied. "Hey... ... do you realize it?"
"What?"
"Mr. F had been in that condition since last night, with no medications."
"Yeah, so?"
"You see... human bodies... how our body struggle for survival, even in most severe condition, even when we loss consciousness, our body never stop trying to live. Struggling through compensation- the hyperventilation, high body temperatures... Mr. F got severe brain stem compression and brain hemorrhage, yet he could survive for more than 24 hours- without any medication. Isn't it awesome, our body?"
"Yeah... awesome... it's unpredicted."
"God is super genius to design this complex mechanism of our body, ne?"
"Yeah.."
That was the first time I had closer contact with dying patient. Me and my partner examined Mr. F since morning, we had communications with the family members, and we knew it was a great loss.
Mr. F was one healthy man before, but one sudden event changed his-and his family's life.
One day we talked and laughed with our beloved one, but the next minute he or she was gone forever. No messages, no farewells, leaving nothing but regrets.
Human's life is unpredicted, no one knows when one will die.
Seeing Mr. F, I want to cherish this life more. I had been wasting my time with useless stuff all this time.. Oh Jesus, forgive me.. So many people died before knowing your truth. That is what I regretted the most...
I wonder if Mr. F had ever heard about Jesus? Had he heard about the truth?
Now that he's gone, nothing left can be done.
Life is short.
Life is precious.
Life is purposeful.
Thanks God for giving me life.
Oh my, *scrolls up up up* This entry is LONG!!? O_O The longest entry I guess. Ha ha, never thought I could write something this long and it's not a fic. XD But I'm too lazy to put an LJ-cut to spare your monitor. Ah well, it's fine! Have a nice day, everybody! XD *runs*