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It was tiresome day…. Ong had gone back for his routine escape , I had a rest of 17 hrs before I returned to desk of ED. I did not had a good rest after the 30hrs shift: the shift was considered moderate with a sleep of 3 hrs. However I had to prepared for a talk in the school. It was not mine actually. Ving had planned for sharing experience regarding the hunger 30 activity organized by the worldvision with the children in the school. Initially the talk was limited to Xian and Yun class. Yun had invited the supervisor of the local worldvision office to present some film and talk to the children. My only part was to edit a short clip of DVD for them to present(extracted from the 2009 hunger 30 special). However Ving told me that she made a mistake and she was supposed to attend the “Rainbow mother education class” in another school. She was unable to make it to the morning session…..so I had to replace her for the talk.
I had to say yes as everyone was prepared for it….
6 hrs before I went off on Tuesday. Ving told me that the talk had expanded from 1 class/talk x 2…The whole second grade is coming …I was only 1/2 prepared….it was hell night as I had gone to sleep as 2:30 am and wake up by 6:am…
The talk was a success but I was over stressed…
I was hoping for a easy call…
The patient came in about 7pm – terminal stage esophagus cancer patient , complaining of shortness of breath and coughing blood. Cachetic and hypoxic, a taxi driver brought him in. No family around. I decided to tuck him into the ICU. I ordered some blood for transfusion and after a 20min trial, the nurses finally gave up and asked me to insert a central line. He was quite dyspneic but I was reluctant to intubate him. I inserted the internal jugular line at a sitting position(yeah, with me standing on a stoll!!!).
He seems ok when I sent him off, but 5 mins later, the ICU informed me that he had gone into arrest.
I rushed to the ICU and took over the resuscitation scene. The ABG was readied when I resumed the intubation position – darn, a mix respiratory and metabolic acidosis. I ordered a large dose of sodium bicarbonate. The intubation was smooth until I tried to pass the tube. There was a big clot of blood over the opening of larynx and I had a real bad feeling about it – blood clot or tumor????? I got the answer seconds later. I failed to push the tube through.
I hesitated for 2 seconds before I told the nurses to prepare a suture set and a scalpel. One of the nurse asked me , “?why ?”… the respiratory therapist answered for me- “we are going to do a tracheostomy”…yeap... did not want to do a cricothyroidectomy…there would be no one to sign a tracheostomy and the patient would stuck with the supposed temporary cricothyroidectomy for the rest of his time, if he is “unlucky” to make it….
It was another 2 minutes(seems for ever to me…it is my no 6….) before someone had scrubbed the patient and I placed my incision…the tracheostomy tube was inserted in less than 10 seconds….he was hooked onto the ventilator – within minutes, we got a pulse.
This is the first time, my tracheostomy patient survive through the CPR...
I saw him today – laying on the bed breathing smoothly…..
it was a milestone for me.....
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