Casualties

Three blind mice

Sometimes casualty work takes grit. It takes fighting for people who have given up on themselves. 

This was especially applicable to Willy. It was his second day in casualties since he was too unstable to send to the wards and the physician in the referral hospital did not yet approve his acceptance. 

He was bleeding from everywhere- his urine the color of coke-a-cola. His buttock was purple with blood seeping into the gluteal muscle after an injection was made by a private doctor. His constant diarrhea was bright pink- blood-stained. His Hb kept dropping, from 8 to 7.6 to 5.6...

Unstable as he was, he wanted to eat. I was just turning around to attend to, yet another, malnourished toddler- when I heard a commotion behind me. The monitor caught my attention first- Saturation of 48%. As my custom, I called my team to prepare for resuscitation and requested a nasogastric tube. I was afraid he might have aspirated and wanted to prevent any further risk. 

After a few seconds, the saturation improved to an acceptable level and my team was ready with a nasogastric tube. The uncomfortable process began with pushing the tube through his nose and into his throat while combatting his semi-conscious resistance. Suddenly he awakes from his slumber and starts pulling on the coiled tube that was still in the back of his mouth.

If someone told me a few years back I would have slapped a male patient multiple times on his forehead, to prevent him from amputating his nose with a nasogastric tube, I would have laughed aloud. 

It took 3 sisters trying to loosen his grip, me at the other end playing tug of war, and another sister bringing a razor to cut my end for us to be able to save his nose...a near miss. 

The mundane tasks continue with his management including clotting factor studies (INR and PTT). The normal person INR studies are 1-2. People using warfarin usually maintain an INR of 2-3... his was 15!!! (later that week I had to pull out the result sheet for my colleague for her to believe me)

Another attempt at discussing him with the referral hospitals led me to a professor who asked a specific question: Could he have ingested rat poison?

After a translated inquiry and a bit of persuasion, he finally reveals that ten days earlier he tried to commit suicide with rat poison. This was missed by 3 doctors (including me). Three blind mice. 

After an emergency blood transfusion, a unit of FDPs, and a dose of vitamin K, he left my casualties alive. He arrived in the referral hospital alive. I received a video of him from the professor to show evidence that he was still alive the next day. 

A few days later I was asked his name by one of my staff members- after they confirmed that it was indeed him, they informed me of his demise. 

Later that day I contemplated if there was something we could have done that would have changed the futility of the situation. Did my efforts make any difference?

Maybe if someone fought for him earlier in his life he would have known he was worth fighting for. If that was all my actions would have brought across to him in the last moments, then the battle was worth it.