Tuesday, July 24, 2007


I am a resident in orthopaedics in a center owned best institute of India.—two + years down, 9 months to go. I'm not allowed to make excuses. If a patient needs something done, I can't say, "But my shift is over," or, "I'm too tired." With 100-hour workweeks and many nights without sleep, I'm also trying to learn to be an orthoapedician..

This weekend I was on duty, which means start work at 8 a.m. on Saturday and not going home until Sunday 11:00 am. I have to attend OPD. See few of the patients till 12:00 and go to emergency.

7:30 I was about to leave my room. Got a beep. contact emergency 4706 urgent. Oh god. Its not even 8 and started getting calls. Reached ER. Two days old fracture pelvis managed outside came for definitive management. Patient not stable. Though not on support of any kind. Primary evaluation and investigation ordered. X rays –open book fracture pelvis. Fracture neck of femur right. Monoparesis right lower limb ? sciatic nerve injury. Ultrasound showed no visceral injury. Wrote for admission.

8:30 started OPD. The as usual crowd and never listening patients. Very tough to convince them esp. patients from bihar. For every tom dick and harry ailment. they come just to add more crowd. Bloody this is referral centre. Not the centre for back pain treatment. Get lost.

I was late to come to ER. Got several beep. I was hurried to finish my OPd card. Finished and rushed to ER at 12:15. no breakfast, now time to have lunch too. On top of that there will be many patients waiting in the emergency.

Good job done by my plaster technician. He had collected all the papers and arranged the patients in queue. 10 patients . 7 fracture and 2 ankle sprain and one soft tissue injury of hand.
Called one by one. Reduced 7 fractures and applied pop. My helper applied pop for ankle sprain and gave slab for soft tissue injury hand. So what? If there is no fracture any one can apply pop. And my technician sometime feels me low by putting a good looking cast. Any way took lunch or breakfast whatever at 3pm. While waiting for lunch wrote the papers for all ten patients.

While having food beep beep in pager. Contact ER urgent. Bleeding from brachial artery and fracture humerus,open wound. F**k these ER doc are the assholes they should try to stabilize the patient and give a call.. I added their work. Two units of blood, Doppler upper limb, x ray and vascular surgery opinion. wash the wound and give a compression bandage till I reach.

Informed my senior. God ! compound communited frature with brachial artery injury. Grossly contaminated. Asked for urgent admission. But no bed is vacant. Trial of salvage can be done if bed is vacant. Talked to vascular surgeon if they have bed . no bed vacant their side too. Patient send back to other hospital. Don’t know what happened to that poor guy. Must have been amputated I guess.

Started seeing the piled up cases. By the time I was free it was 7 pm. Ohh have to arrange for emergency operation. Few pending cases from ward were suppose to be operated tonight. Called the anaesthist. Bloody they are always busy. Don’t know what they does. The most no of people in duty is anaesthesia and they never give time to any of the department. every body thinks that they are busy somewhere and these bastards are sleeping or watching tv in duty room. Bloody enjoy your life till you are in institute.

Sighhhhh ..8:00.pm I feel like comiting suicide after 8. they will start calling from ward. You have to cover ward and ER. Both the places night time is busy. Called my junior how the ward is . he told patients are stable. Noting to worry. Ohh god saved me.

But who will save those bastards who will enjoy the booze weekend and fall or suffers RTA. The big headache in the night is such type of injury.
At last got call from anaesthesist. Shift the case. Hummmm whether to go for dinner or shift the case to theatre. .........Shifted the case to theatre.

Two cases one after another. My senior operated one and I assisted. For another one I called my junior and i did it. Thank god anaesthesist did not get call from other place and I got chance to operate. Otherwise they cancel next case and walk away.

2 am- went for so called dinner let me say treat. Whoever operates in night should give treat to assistant. Sounds good. I started this tradition. What u can get in the mid night except Maggie and cup of tea. Had it and went to attend call from ward and ER as well.

One patient could not sleep because of pain in the ward. Others are sleeping like hell. I sometimes feel greedy seeing people sleeping in the night for 8 hours. Its been years sleeping for 8 hours since I came here. Gave pethidine and phenargan for old man. God night! you will sleep even somebody lets u not.

Got call from ER .urgent. where to go and where not sometimes feels u like mad.. This time must be alcoholics and road traffic accidents.

Few head injury few limb injury. few needs admission. But I have no vacant bed list. Quickly disposed off few patients. Problem was with one of the head injury patient who need orthopaedic intervention also. Neurosurgery resident was expecting me to write for admission. But why me? why not him. Wrote in the paper – neurosurg to evaluate regarding admission and ortho will start intervension only after admission. No vacant bed with ortho E/M. This is enough for them. And enough to save my ass during round.

By the time I finished disposing patient it was 6 am. Now has to prepare for morning round at 8 am. Wrote progress notes for my bed patient. Prepared trauma register. Arranged x rays to trauma conference on Monday. It was 7:30 . now could not decide; breakfast or only tea/ coffee. Had tea and went for round. Emergency free from ortho patients.

My service, for acute trauma comprises 80 % of the surgical emergency patients.

The last time I was on weekend duty, I hardly got time to had lunch and dinner. and it was far busier, more like usual. 50 pager calls a day. Four sick patients post op recovery in needing to be checked every hours. Midnight Saturday. I need to go to the bathroom. My pager goes off. “Reach ER”. I figure that can’t wait. I get paged again. No other option than to wait myself going to bathroom . Ohhh god he died in the emergency before I reached there. sorry we are no one to save life. Its god who decides. Even we have to go……. I fill out the inevitable paperwork.

I reached the ER. The fat man is angry I took so long. I smiled at him and gave in indirect threat. If you were at my place you would not be smiling like me. I finally went to the bathroom.

Round started at 8 took two hours time to finish. I was dragging myself throughout the round. Slept standing many times like a horse. But I don’t mind it. whole night I had no sleep. No proper sleep and food. how can I sustain fresh in the round . after all I am a normal human. Sometimes I doubt I was normal before coming here but don’t know the current status..

Went to check the ER for pending patient though I did not get the beep. Finished the work, marched towards my favorite spot. Canteen and my onion parantha and curd. That’s what my dinner or breakfast or todays lunch. Once I sleep I will wake up at 6 pm….while eating I was remembering the article in NEJM “A frightening study, recently reported in the New England Journal of Medicine, found that long-haul truck drivers frequently nod off on the road. An accompanying NEJM editorial forcefully emphasized the safety importance of adequate sleep. Yet, somehow medicine's premier journal ignored physician training, in which residents work even longer hours without any sleep at all. If driving a truck on five hours of sleep is dangerous, surely taking care of deathly ill patients on no sleep is too.

Sucks after 6 again have to go to hospital….

No comments: