I was dragging my tired leg from the car park toward the hospital and met one of the ICU nurse leader. I waved at her and she returned me with a bitter look,” I am the first from the day shift to go off..” . What the FXXX, day shift ends at 3pm and it was 5:40pm. She added, “we where busy with big brother SE…”… In our hospital, nurses would tend to add the title of big brother to any of the paramedics (lab technician, radiographer, surgical aide) as a respect. SE is one of the ambulance drivers cum EMT. He had joined our service 10 yrs ago, just after I left for my service for MOH. He was a known case of alcoholic liver cirrhosis, with multiple episode of Esophageal varices bleeding. He had been intubated in the past for hepatic encephalopathy and yet he still drink from time to time.
We were chatting 34 hrs ago before I pass over my shift. Although expected but still I was still shock to hear the news. I quicken my step and rush to ICU. CH, our gastroenterologist , and CM was there. I took a glance at what he had, 2 peripheral lines, 2 central lines was in placed. Blood was dripping in but not fast in enough. CH saw me and pass over to me. 16 units of packed had gone in and 6 were left. I ordered another 12 while squeezing the blood. He was hypotensive and tachycardic. Semicomatose and intubated. Still he managed to struggle a bit. A good sign but not enough. Blood was rushing out from his nostril like spring water and from time to time, he would expulsed a big gulp full of blood from his mouth despite the nasogastric tube decompression. Darn bad sign…
He was admitted the day before with multiple episode of coffee ground vomitus. CH had done a ligation through endoscope and bleeding had seemed to stop. However he was noted with vague abdominal pain after drinking a large amount of water (supposed to be sip only ….). CH had then ordered a computer tomography of abdomen and he was sent to the examination room. During the transfer, he had noted with heavy bloody vomitus and passed out. He was rushed back to ICU and intubated. That happened 5 hrs before I came to work.
Well, I then proceeded to ED and did a pass over with Lem…Lem told me that ZE is not going to make it through the night. I tend to deny it and wish I could do the best….
It was a bad night…. I had an acute myocardial infarction(inferior wall) – transfer for tPA, a perforated peptic ulcer – sent for ops, an ulna artery occlusion (yes… show the picture later…), incomplete abortion – transfer for DnC, chronic respiratory failure case who extubated himself…. Well, ZE had gone into arrest during the process and I managed to get him back after a trial round of antihyperkalemic regimen. I was right, the potassium was 7 something. Well, we had poured in too much blood and he was acidotic(pH 6.9).
I managed to pass him over to Lem by 12 noon when I go off after 1 more round of arrest-resuscitation (due to hyperkalemia off coz). Well, he was comatose after the first round of resuscitation.
I told the nurses to call me up if he is certified later as I am the sports club chairman (the actual name supposed to be employee welfare committee). I had to pay tribute to the family and arrange the needed (flower etc.)
It was 22:15 when I received the call….
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