Job Satisfaction

circle of life 

Job satisfaction is something ideal which is difficult to achieve especially during the early years. We try to do our job properly but not everybody are enjoying what they do. At the end of the day , it's the pay-cheque that counts. Its about what produces the magic papers that guarantees life. Especially nowadays when money is everything.

I am not quite sure whether i achieved this nirvana on Sunday morning , but i felt good , really good keeping my patient alive. In the midst of chaos , he pulled through but the prognosis.. It did not look good. He is still on the ventilator in ICU ; fighting it so much that we had to sedate him .

This pakcik underwent a laparotomy early Sunday morning , at 2 am. He was my last case for the night. A 65 year old Pakcik , with Diabetes and Hypertension ; history of abdominal pain with sign and symptoms of intestinal obstruction for 3 days. His sugar control was haywire ; most likely due to peritonitis with an unknown cause.

We saw him in the recovery area before hte surgey to assess him . He looked troubled , difficulty in taking long breathes due to his distended abdomen. His SPO2 was at its best 82%. Otherwise , he was very alert and calm ; reciting quranic verses. A short history taking revealed he was a very active person ; moving around like either yours or my grandparents.

The laparotomy went well early in the operation. His airway was easy so i gave Halina to intubate him. His saturation picked up to 98% after pre oxygenation but it quicky went back down after artificial ventilation is given.Haemodynamically he was stable ; after fluid resuscitation he was fairly stable. Unfortunately , the surgeons were unable to find the source of 800ml of pus collected ; the whole bowel was out but his oxygenation is still poor. His PEEP was already 10 but his oxygenation remained 78 - 82%.

2 hours into the Op his BP started to decrease. Called my Consultant to inform him about the likelihood of this patient not to be extubated post Op. His BP went crashing all of a sudden , with his heart rate following suite. I tried to do something but i didn't know what was wrong with the patient ! I panicked !! Gave him Atropine , but it did not help at all. I was in the midst of preparing Noradrenaline when my Consultant came in ; and i saw the panic look in his eyes !!

His heart rate was going down.. 65... 50... 43... 35... Shit !! Bp was low.. 50 / 30 mmHg. Dr HAshim gave adrenaline , but he did not respond. Surgeons stopped the Op . A moment of standstill beckoned. I was preparing for the worse.. the patient was going !I told the nurses to prepare adrenaline and atropine for CPR .Syringes and needles were flying around with drug ampoules all over the floor. Another bout of adrenaline was given... and his heart rate picked up. Adrenaline and Noradrenaline inotropes were started .. and his BP picked up. He was a fighter. Maybe it was not his time to go as yet. Boss quickly inserted the triple lumen and the surgeons managed to complete the Op. Unfortunately, his bowels were markedly distended so they did not really close his abdomen.

I was glad that we manage to save his life then. I felt really good but seeing his poor saturation with a distended abdomen ; it did not look good at all. But somehow , i felt satisfied because somehow i know that he is not ready to go yet.