Thursday, August 27, 2009

Life can be cruel but we have to be thankful..

The orthopods posted a case; a 17 year old girl with advanced osteosarcoma which needed AKA. They needed to do it on a Sunday because it was oozing slowly; she had a histroy when at an acute stage her Hb was 3 !!!
I was very surprised when she arrived; an anaeroxic girl with a football ( literally) below her right knee. I wa surprised to see her in such look that my initial thought that she had some syndrome to start of with. Upon questioning her father, she was a normal child until about a year ago. They even had a biopsy done when it was very mild; just a small growth below the knee.
Father was not keen for any operation then and resorted to various traditional treatment. It was painful that she was bed bound and i guess , they let it grow and i don't know how they ignored it; the smelly and bloody growth! It grew and grew until one day , she was unconscious at home. The family brought her to the closest hospital, and yes..she needed at least 10 pints of blood before she was ok.
Doing the amputation was a big risk itself, she was merely 12kg in weight and i cannot afford to let her loose blood more than 500ml! That is nearly half her blood volume!! To see her in such a stage was sad; because she is still young but she was having bad contractures all over with bad bed sores! I have a feeling she was neglected because her hygiene was really bad and i felt so sad for her. Her prognosis was poor from her current condition.
" Doktor.. kalau kaki dia potong sikit je boleh tak?"
I was left speechless.. I don't know what to say.

I was just lying on the bed; waiting for Subuh after my sahur when i received a phone call. Apparently an obstetric emergency! A patient who'd just delivered from another centre with Post Partum Haemorrhage was on her way to ou centre and needed blood urgently. I enquired where was my Obs Anaes oncall as I was the registrar that night ; and the obs staff mentioned they can't get through her.. OK i said.. but then i received a second call almost immediately.. saying that the lady had collapsed in the ambulance! I was telling them to divert and send the lady to our A@E..
i got a 3rd phone call.. the lady was already here and in labour room ! Arrrgghhh!! Why labour room? The most inadequate place for resuscitation ! I quickly dashed to the labour room which was situated miles away from the general OT..
True enough when i arrived, Rusnaini was leading the resuscitation ; them telling me she was cold and blue, pulseless on arrival. I had the defibrillator on and the ECG did show VF.. We CPRd and shocked her 5 times !!! It was bad , the young mother who'd just delivered their first baby could not have expected this to happen! We tried our best to revive her but it was futile from the start. We resuscitated her for 1 hour before calling it off.
The emotions of her family members upon receiving the news was bad.. and understandable. She was ok 4 hours before but now she was dead. Everybody was shocked!
Of course, there were a lot of questions on how it became this way but i don't think i can comment as I'm sure it'll be inquired soon enough.
I was very thirsty.. and it was just 7am.. what a day to start in Ramadhan... :) but i prevailed :)

1 comment:

Dr Zek said...

sad story...really. I'm sure that it is not easy resuscitate pt in labour sure. its shouldnt.