CNY call , D-4

CNY is a nightmare for the ED staff. All the outpatient departments are close and everyone rush to the ED. You would see a lot of GI upset, flu and trauma. The ED would be crowded and patients and family staring at you hoping that you would speed up and see them ASAP.

I have to do 4 consecutive night shifts starting from CNY eve as I would be leaving from homeland for 10 days. The ED roster is always you gain some and lose some basis; most of us will comply to others request if there is no other event.

Well, the ED was packed as expected when I walk passed the triage desk. At 10+pm, a 21y/o lady had presented to ED complaining of abdominal pain since morning. She claimed that she was pregnant. She confirmed her pregnancy with a pregnancy kits. She was wearing a tight jean with plumy look. It was difficult to tell if she is truly pregnant. I had bad feeling when I saw her. I took her to the bedside and did a bed side sono. Fetal heart beat was noted and I was unable to locate the head…bad sign, should be in labour and the station was definitely low.

I rushed her into the resus area and asked the nurses to alert boss (I saw him wandering around earlier). A quick VE confirmed my fear; fully open os and fetal station is +2… I “interrogated” her further and found out that she was G1 and unable to recall her last menstruation cycle. She claimed that she had only one pre-natal follow up and unable to recall the due date. The contraction was not prominent as she was plumy. I had 2 choice at that moment, one to deliver the baby and two to transferred the lady. Option two was applicable as she was G1; but it might also jeopardize the fetal as it might be premature and might be complicated with prolong labor. I made a decision to deliver her as boss had agreed to come. It was risky but worth the effort to save the baby as boss was well trained in neonatology (his record was 800g premature in our hospital ).

Boss arrived about 10 mins later and he joined the team. We had a hard time as she was a primigravida. The baby was delivered after 30mins of effort. The baby was well taken care by boss and was in good condition. I had a hard time repairing the vagina tear but was able to manage it with the aid of surgical assistant.

Well, my nurse had later asked the girl that who was the father…. Her answer was not surprise –“ex-boy friend”. She said that she don’t want to kill her baby. My nurses pointed out to her that the way she managed her prenatal was incorrect and might hurt her baby.

I came out from the scenario with more than 10 patients waiting for consultation and I managed to clear them. 2 of the local regional grade hospital and denied my referral as the gestation age was uncertain even though the Apgar score was satisfactory.

I finally got a referral up north at a medical center. 2 hours later, the EMT who escorted the duo called me up stating that the lady had given a false identity during the consultation…. She was actually 17 instead of 21. I sigh and surprisingly I did not curse even though I need to re-enter the “#%#@#” medical note again. Truly an unforgettable CNY eve….