A CALL WITH A FANTASTIC MO

*Disclaimer: Cerita ini cuma rekaan semata-mata, tidak berkaitan sama ada dengan yang hidup ataupun yang mati* This is a fiction story, not related to anyone dead, or alive.*

I remembered I used to read Darren’s blog on how miserable calls can get when you get ‘certain’ HO who calls you for many reasons. Sometimes, things can be the otherway round.

DARREN’s :

Most of the time, your call's quality largely depends on whom you're working with, in the particular night. A good and reliable helper would definitely lighten your work, whereas the opposite can cause you a sleepless night. Just some examples of the calls that MO received from a HO during an on-call night... (click to continue reading)

QUOTE:

Most of the time, your call’s quality largely depends on whom you’re working with, in the particular night. A good and reliable boss (who makes good and quick decisions) would definitely lighten your work, whereas the opposite can cause you a sleepless night. Just some examples of calls that HO received during an on-call night…

*phone ring* HO#1 pick up phone @ 2:37am:

HO#1: hello??

HO#2: Hello, I need your help with a branula.

HO#1: Okay

HO#2:  I was trying with MO for a very long time already but still cannot get venous access. Can 

you come to HDW to set a neck line?

HO#1: What? You are with an MO and can’t get a line? What case is it? How is the patient?

HO#2 briefly present the case.

HO#1: Okay, I am coming.

Upon arrival, patient was a C5-C6 compression fracture patient with C5 cord injury, ventilating on trachy. BP falling. Has one IV access. MO miserably trying to set another peripheral line.

MO: Good, you are here. This patient very hard to get line. You need to set a neck line.

HO#1: Isn’t he on inotropes, shouldn’t we insert a triple lumen?? (central line)

MO: You can insert a triple lumen?? I mean, can you insert? If not, we can call GA MO to insert.

HO#1: Okay, I’ll try.

Coagulation profile normal, in view to keep the neck in neutral position and not flex the neck, HO#1 decided for a subclavian approach.

HO#1 attempt failed.

HO#1: I think someone else should try. (Hoping that the MO will take over)

MO: Hmm… let’s call the GA MO to help. I'm not very good with lines.

HO#1: Okay. Please do then.

MO: Ermm… could you talk to the GA MO?

Apparently, the GA MO on-call was well known to be very ‘fierce’ and the MO had some unpleasant previous history with the GA MO.

SN took a peep next door: The GA MO is very busy in ICU, attending to a collapse patient.

Having no choice, HO#1 kept her fingers crossed and said: Very well, I’ll try again

*Thank God, Left Subclavian Central line inserted successfully, anchored at 15cm, no acute complication, good flow. Placement confirmed with VBG and CXR. Bloods sent for investigation. Patient resuscitated with fluids and inotropes, BP picked up and patient stabilized.

After documentation, the SN asked: Siapa HO#1? Specialist ke??MO ke?

.....silence....

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CASE II, later that morning,

* phone ring* HO#1 pick up phone @ 6:45am:

HO#1: Hello? I am reviewing patient, anything?

HO#3: Hello, there is a patient in wardXXX who collapsed. Asystole. I informed MO already, she asked me to ‘buat apa-apa yang patut’ and ask you to come stat. I tengah CPR now.

*Upon arrival stat, HO#3 was performing CPR, SN bagging, MO holding mask.

MO looked at HO#1 with an anxious face and said: HO#1, you boleh intubate patient, kan?

*HO#1 almost fainted when heard that. ^^|||

HO#1: SN, cepat prepare intubation set. ETT size 7 and 6.5. Prepare blade, suction. Prepare Midazolam 5ml.  

SN: Kena buka DDA ni …. (FAINT~!)

HO#1: Student nurse, tau bagging?

Student nurse 1: YA

HO#1: pakai gloves, ambil alih tempat SN. SN prepare for intubation.

SN kelam-kabut, busy preparing the equipment and drug.

HO#1: How’s the patient? What happened? (HO#1 asked while putting on gloves and mask)

MO: I tak sempat access lagi

HO#3: Patient asystole, pupils dilated, BP unrecordable,..

HO#1 quickly accessing the patient and asked: How long CPR?

HO#3: about 15 minutes

HO#1: What was given? How many atrophin , adrenaline?

MO quiet (…)

HO#3: None given.

HO#1: SN2, syringe out adrenaline and atropine, give 1 atrophic, 3 adrenaline.

Apparently, SN2 was so slow… HO#1 started breaking the ampules and syringed out herself and gave the drug while the SN prepare intubation set. HO#1 took over MO position and intubated the patient. Condition was bad. More Adrenaline and atrophin given, still no response.

HO#1: Ada siapa-siapa call medical? call relative?

SN: No.

HO#1: Make sure panggil. Suruh SN3 yang tengah serve ubat kat tu call.

After 45mins CPR still no response.

HO#3: MO, do you still one to proceed?

MO: Huh? Kita dah buat semua kan? Ada ape-ape lagi?

HO#3: MO, do you think we should pronounce death?

MO: Erm…

(pause…)

MO: Okaylah

*documentation done*

HO#1: What’s the cause of death?

MO: Kena bagi cause of death ke?

HO#3: I think it is APO secondary to CCF and CRF. Maybe it’s time to call the medical team and our specialist to discuss.

MO: Okay.


After discussion: Cause of death: Acute Pulmonary Edema secondary to CCF

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MORAL OF THE STORY: Dear HO colleagues, HO life is not all fun and relax. Sure, we will always be covered by MO, but remember, we will become MO (or even specialist) one day. It is very important to learn the most from your housemanship days. Otherwise, it will be regrettable. 


And NEVER EVER GIVE INSTRUCTIONS: buat apa-apa yang patut.
Do ask what has been done, and give further plans of what else can be done while you are on your way to see the patient.
When  a HO calls his MO, means he needs help. (or he needs to be covered)
Imagine documenting : 
S/T DR XXX, case and progress and Investigation noted. Plan: To carry out all necessary procedures. (apa-apa yang patut?) 


Please, be a safe doctor.