This post is not to glorify my work. Millions of doctors around the world are more learned, knowledgeable and skillful, doing a better job than me…but still, the following remains a memorable event in my little world.
A 55 year old male was rushed into the ER in an unconscious, unresponsive state with no recordable pulse, blood pressure or spontaneous respiration. An advanced airway (Endotracheal Tube) placed within 45 seconds of arrival, heart rhythm progressively changing from an initial rhythm of Ventricular fibrillation to Ventricular Tachycardia, Torsade de pointes, Return of spontaneous circulation (ROSC), bradycardia, Pulseless electrical activity (PEA) to finally an asystole.
For all those who have done the American Heart Association BLS/ACLS (Basic Life Support and Advanced Cardiac Life Support) courses, this would look exactly like the Megacode part of the examination, but for me, it was a real 70 minute ordeal yesterday as we desperately tried to save this patient’s life who had complaints of chest pain since 1 day and suddenly collapsed at the GP’s clinic 15 minutes before being brought to my ER. CPR, intubation, Adrenaline, Amiodarone, Magnesium Sulphate, DC shock, Dopamine and Adrenaline infusion, etc, there was not a thing done wrong as per the recommended AHA guidelines.
What made it special was that with no seniors around, for the 1st time, I got to independently be the team leader (and in charge of the airway too) running such a RARE CODE (Most patients brought in asystole that I’ve seen never even made it to an arrhythmia that we use anything beyond CPR and adrenaline). I would have been happier had the patient survived but unfortunately, the strip on the defibrillator during the 10 minute ROSC showed a massive MI and he couldn’t sustain for long with the damage to the heart.
The reason I write this post is that retrospectively when I look back at the past 3 years after completion of my MBBS, I’ve evolved from a medical degree holder with no practical knowledge and little bookish knowledge (I was among the Rahul Gandhis and Ishant Sharmas of the batch), from someone who hated medicine thinking “Saala, kahan phas gaya” (my old blog posts say it all) to becoming who I’m today. It really has been a long journey growing up. With all my heart, I say that I love and I’m proud to be an Emergency Physician (Casualties and CMOs will soon become vestigial) in spite of the stressful working conditions, odd working hours with night shifts, hyper relatives, etc.
Gone are the days when some nurse would call, “Ae Intern, iss patient ko RT/Foley’s/Angio daal” (I leave those primitive procedures for my juniors now) and have moved on to more challenging ones like intubations, putting central lines, arterial lines, Hemodialysis catheters, doing Cardioversion, Defibrillation, 2Decho, etc. What remains on my “Basic Things to Do as an ED physician list” now are Trans-venous pacing, ICD insertion, Pericardiocentesis and few others.
Looking forward to life.
