Holiday dilemma

Its the first day of the Chinese Lunar calendar - the year of the boar promises good outcome for those who work for it. To my chinese friends ; a very happy new year and may the year brings you prosperity !!!

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Obviously , I am on call today. It'll be my last call for the month as I've requested to finish it by this week. It had been a busy 2 and a half week. My mind is a bit tired ; drained by "thinking" while doing my ICU call. Wifey is 37++ weeks now which means that the baby may come out any time now. Dzaeff was delivered spontaneously at 38 weeks therefore I;m predicting my second to be around in the very near future. We haven't decided on any name for her as yet - thanks to wifey's "fickle"ness - not to be helped by her busy working hours and on call. Her department is not as kind as mine - She's still doing calls till term and if she takes the whole 2 months maternity leave ; she would be extended for another year !! A bit cruel i reckon considering us doctors having to work like a dog day by day.

My ICU is still full - I'm stuck with certain patients who are not going anywhere.True enough we are giving full support to ascertain stabilization ; unfortunately things have to move fast as sepsis with multiresistant bugs are just waiting to strike. Tracheostomy for few patients are delayed due to the long holiday. We don't do percutaneous traceheostomy here in UMMC - which certainly slows down all plans and further management.

Managing ICU during a public holiday alone is a challenge. I am sure my colleagues all over the country would agree with the statement. If things are Ok it is OK - but when "drama"s happen all at the same time - it is very frightening as one has to make decisions swiftly. No matter how one calls for help , but life is at stake. Decisions made at that split second will determine whether the patients continue living or die. Sometimes , we wonder , are we just prolonging death or saving lives ?

Talking to patient's relatives is a big challenge. It is not an easy job and I have to do it everyday. Keeping them updated is one thing - informing deterioration is another. Helping families to cope with such critical illness at times can be disheartening. Discussing with families who cannot accept their family member dying is a skill which I am certainly hoping to gain. When things go wrong - denial is difficult to encounter. I believe that strong communication will help to ease the acceptance - but I mean if you are in their shoes - would you be rational as you think you might be ?

Waahh.. philosophical ! I'm thinking too much eih ? Well , its time for my maghrib prayers and night rounds will continue..

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Bed 1 : Day 32 - iatrogenic perforated CBD. abdomen still distended - ileus . Unable to wean off to CPAP because of diaphragm splinting !! Now having gross haematuria !!!

Bed 2 : Day 5 - form 2 boy MVA - hit and run with subdural and subarachnoid bleed with conservative management. splenectomy done and i just extubated him this morning.Not really awake.

Bed 3 : Day 6 - fit foreigner paralysed neck downwards ; C5-C6 fracture corrected. Trachy delayed till Wednesday - no relatives around. very depressed.

Bed 4 : Day 22 - young lady with stage 4 SLE. Needs continous dialysis - lungs not looking good. Just spoke to the family regarding tracheostomy.

Bed 5 : Day 7 - an elderly who recuperated from Perforated Gastric ulcer but now in spesis - nosocomial pneumonia in a chronic COAD patient.

Bed 6 : Day 1 - readmitted to ICU for BIPAP. An elderly lady with a chronic urology problem - pain causes her tachypnoea ; currently comfortable on BIPAP but if the main problem is not adressed - we are not going anywhere.

Bed 7 : Day 38 - a middle aged lady who underwent a simple operation which went wrong .. MAJOR ! Not doing well in every department.

Bed 8 : Day 14 - A middle aged man with ESRF on continuous dialysis , IHD recurrent APO - not doing well at all. reintubated x3 last night.

Bed 9 : Day 10 - an elderly lady whose primary teams were fighting over the proper diagnosis. Still in sepsis with acidosis - not looking good. CVVHD stopped because not going anywhere.

Bed 10 : Day 5 - a referred case from a private setting. Bad pneumonia on a chronic restrictive lung disease - Post tracheostomy looks convincing as She's more awake now. Unfortunately , all breaths are mandatory and none of her own effort despite full GCS !!

Bed 11 : Day 2 - a depressed mother who just lost her child two weeks ago - went overdose with her medication. Not awake yet.

Fuiyooo.. mcm buat round online pulak...