RESUS!!!


Today I moved to Ward 18 at Helen Joseph Hospital. Usually its a pretty relaxed ward, but today it was utter drama!

Because it was a new ward and I have never worked there, the sister (who is male, and thus I call him Mister Sister 😀 ) orientated me to the ward layout, however it usually takes a few days to understand where everything is at. One of the nurses then rushed me, saying we have to get beds done before breakfast arrives – Fine.

While we were doing this one cubicle, the one lady there was sleeping in her bed, snoring. As we fixed the bed, she didn’t wake up. I asked the staff nurse that whisked me away from my orientation if she is on morphine, because morphine represses your respiratory center and can cause you to snore (shows that you are having breathing difficulties) and may even cause you to stop breathing altogether. I have been taught that you NEVER allow a patient to snore in the ward. The staff nurse said no, and that we must hurry. I noted that she had a nappy on, and asked if we need to change it (because you usually do on routine) and she was all like “No, they changed it at 5:30am” and didn’t even want me to check. And so I didn’t.

Little did I know, that this patient (Mrs Alice Radebe) was actually in a diabetic coma. Her sugar had dropped to 0.6 (4 – 7 are the round about normal ranges, although sometimes even 10 is acceptable depending on the patient). I am totally saddened at myself, for not speaking up. I am frustrated and angry at myself, for not having the guts to stand up to justify something I knew should not happen in the ward, and allow myself to be manipulated by someone you take for granted knows better than you because they have what they call “experience”. Excuse my French, but fuck experience. Honestly, I could have got her help a lot faster than waiting for the doctors to find her in a comatose state during their ward rounds.

I walked in on two of the doctors attempting to wake her up. Fortunately she was still breathing by herself, but she was very ill. Firstly I was asked to place oxygen on her, and so because it was my first day, I struggled to find where the masks were, but I did, and attached her to a polymask flowing at 10liters. The drs had already put a drip up and put her on 5% dextrose. I assisted them in getting a blood pressure cuff on her, and took her sugar levels. It was slowly improving. The dr was trying to get her out of her nightdress and was struggling as she is rather fat, and he looks at me to ask what he should do. “Rip it” I said. And so he tore the whole thing down the middle. I know that culturally black people are so attached to their clothes, possibly because they have so few of them, but you know what – when you are dying, material worth means nothing. I am saying this also because the rest of the patients in the cubicle were looking at me like I had grown 3 extra heads.

The dr was showing the intern how to insert a central line. We started off at the subclavian (shoulder), then moved onto the neck, where the dr then displayed what a corotid arterial bleed looks like, and then to the femoral (by the pubis symphisis), and eventually we got it in the neck. Wow, it looks so painful the way they jab the needle in like that, and go fishing. But she was so out of it that she didn’t feel anything. Again, checking BP, and it kept rising – what a great feeling from usually hearing the “error” sound(no blood pressure as heart not beating)!

Unfortunately she was struggling to breathe, and it was decided to intubate her. We suctioned her first, and a whole lot of bloody mucus was swept up from her throat into her tube. The dr then attempted to insert the laryngoscope after giving scoline, and I am not quite sure what exactly happened when he inserted quite a big size in, but suddenly he put his fingers in her mouth and tore her tooth out from her gums. Blood erupted from her gums, and spewed everywhere. Suction again. I swear I nearly passed out. It didn’t even cross my mind that something like that would happen! Worse still, once he took the tooth out, he handed it to Mister Sister and said “Here is a present for you”. *WTF*. And this tooth was about 3 cms long. My face drained of blood. *Wonder how much the tooth fairy gives for this one!*

I then went running for a ventilator and also ran earlier to do a blood gas check. The machine for that is very cool! You insert the syringe (full of arterial blood) into it and it reads it!

I arrived back into the ward after failing to get a ventilator, and meanwhile they had started bagging the patient. I took over for about 10mins doing 1 breath every 6 seconds, until a ventilator arrived. It is very tiring.

Meanwhile Alice had stabilized, and eventually began to become very restless, usually as a result of pain.
Mister Sister gave her some dormicum, and she calmed down.

Just before I left, a person from ICU came to assess her, and I really hope they will be able to take her through to ICU.

Okay, so this is where the problem comes in: IT WAS CHAOS. Usually the resus itself is chaotic, but I am talking about the staff. Mister Sister didnt bring the emergency trolley, he didn’t know what he should have brought and done in advance for the resus, and thus the dr was getting very irritated with him, none of the nurses were arriving to asist at all with the resus, and the one bitch (the one who was fixing beds with me) said to me after I asked if anyone can help us as the drs need more help: “There doesn’t need to be twenty of us in there”. “No,” I retorted. “There doesn’t need to be TWENTY of us there, but just TWO of us there is not enough as the dr needs more help, and it is in your job description to assist with a resus so stop standing there and wasting my time, and come assist”.

Fine – maybe I was rude, but I am not working at a hospital to make friends. I am advocating for a patient, and advocating for her life. Silly cow. It made me so mad.

Afterwards I went to the one dr who is in charge, and asked if he can organise me a debriefing on what exactly should be done in a resus so that I can become more skilled at it, and not faff around. I was so angry, and disappointed at this nursing staff as well as at myself for said earlier reason.

This resus lasted for about 2 and a half hours, and she is breathing on a ventilator. It was such a weird feeling when I was bagging her to know that me pushing the bag down and thus air into her lungs meant that I was holding her life in my hands. Had I stopped, she would die – simple as that. And so I concentrated on my 1 breath every second…

Look after yourselves please.

Love.Cybelle

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One response to this post.

  1. Oh – I forgot. I also helped to insert a cathetar!! 😀

    Reply

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