7.50 PM : Internal Medicine Resident (PGY2) in charge of the Intensive Care Unit (ICU) handovers a note.
1 Say Hello to the intern ( and That’s so sweet )
2 Take down their Phone Number
3 Send blood for Artierial Blood Gas Analysis by 4 am (Bed No: 2,6,7,8,9)
4 Send Blood for Liver Function Test ,Renal Function Test and Complete Blood Count, for all the patients.
5 Blood culture for Bed No : 11
6 Stool Routine for Bed No: 8
7 Femoral catheter tip culture of Bed number 9.
I Shifted Bed No. 2 for Magnetic Resonance Imaging ( MRI) Brain , handover given by the day ICU intern. I injected the dye ( I had never done that before ). MRI took around 20 minutes.
9 PM : Encephalopathy patient is yelling and is trying to pull off the clothes tied to his limbs to the bed.
(Dramatic events follows !
“ Nurse, Blade Kodi..bega kodi… “ ( Nurse, pass me the blade….give fast)
“Nurse, or else give me 1 rupee, let me go and buy a blade and cut this stupid thing off”
“Doctor – Nimage chooru budhiyilla ?” ( Doctor, don’t you have a brain? )
“I want to leave this huanted place”)
A women opened the door a bit and peeped in. Oh! It’s for Bed 12 : She has been there in the ICU for a while. Around 6 months. Her mother has come to feed her dinner.
I sat on the chair for a while, reading “The Namesake”. It was an year ago I had visited Harvard, Boston ! The words made me nostalgic.
10 PM : My Resident who is working in the wards came to call me for help. There is a snake bite case in the casualty. I collected an antibiotic vial, emptied, washed and dried. 2 ml Blood. It clotted way before 20 minutes. The patient is a chef who while collecting logs for the kitchen got bitten by an unrecognizable variety of snake. I drew blood for all routine investigations as well. His bystander and the Boss of the Hotel gave me dubious looks : “ Now, How much will this cost ? Make everything free for us – It’s a government hospital right? Discount should be there “. The entire course of Anti snake venom will itself cost around 7000 rupees. I called the resident to speak with the furious bystander.
10.30 PM : Again my ward resident calls me for an emergency ECG. Only casualty has ECG machine. I ran to casualty. The technician is already taking an ECG for a Myocardial infarction case. As soon as it was done, I pulled the technician to the medicine wards. Technician had filled 2 bottles of water from the cooler “ Doctor, this year’s summer is way too harsh than the last year’s.” I held the water bottles and she carried the ECG machine. It was almost a hilarious scene.
11 PM: While returning from the ward, I saw our discharged patient from our medicine ward. He had passed stools on the floor. Security guard yelled at him and calls cleaning personals. He is a destitute. Some political parties on a national imprtance day on the gound of social service picks all the destitutes to hospital and admits. I heard that they get paid according to the number of people they get admitted in a hospital. He never gave any history. A reference to psychiatry was given. The only time he spoke up was to ask for a discharge : It was a DAMA – Discharge Against Medical Advise.
11. 15 PM : We have a new patient in the ICU. Shifted case from the Cardiac ICU. A rare case of Juvenile corpulmonale. 21 year old girl, Past history of Tuberculosis. Her Chest Radiograph was not taken from our hospital and hence I ran to room number 14 to call the XRay technicians. The attending of this girl called the ICU resident and asked him to repeat all the investigations done for her (Obviously – I am the one who is repeating the investigations).
12. AM : There is only one computer for the entire hospital during the night shift . Outpatient department of Surgery has a computer but the room will be opened only in the daytime. I went to casualty computer room to check whether all investigations were billed or not. I clicked a photograph of that screen and returned to the ICU. I switched on my internet : Weirdo (My best friend) had sent me a text “ Pupppppps, made pancakes – image” I hid the notification and started entering the old investigation reports in the case sheets. Everything is on paper.
12.30 AM : My batchmate came to charge his phone in the ICU. He is pediatric ICU night intern. He waves at the ICU resident.
Resident: “Hey! How is it going man ?”
Intern : Busy PICU – Full bed Sir”
Resident : “Why have you bathed in sweat? What’s up?”
Intern : “I was doing CPR Sir, We had a death. 15 year old HIV positive patient with tuberculosis. Continous succtioning – Full of blood. We gave CPR but she passed away.”
He left his phone in the ICU for charging and went back to PICU. Nurses went to sleep, taking turns. ICU resident went to have coffee. I went back to ‘The Namesake’. He came back with “Twix”and a water bottle for his hardworking intern.(How sweet!) I started filling forms as well labelling the vacuitainers which has to be send by 5AM.
2.30 AM : Resident went to sleep and I started off with the ABGs. ( Well, I love to do this !)
Bed No 4 : “ Doctor, don’t prick…last time they hurt me alot…so please don’t prick… Don’t touch me…no more blood”
I somehow convinced the patient.
Patient is silent . – Novagiddhiya ? (Did it hurt?)
Not even a little, Doctor : Thank you ! ( I went all “Aww” )
4 AM : In our wards, we had a case of tetanus and my ward Resident asked me to go and do a monitoring. He was admitted in the isolation ward. The room had no lights. I called the patient’s bystanders and advised diet modifications – especially the protein diet. His respiratory rate was fair. General condition was as well good. No laryngospasm. I wrote my notes in the case sheet.
5 AM: Bed No: 12’s mother came inside to change her daughter’s diapers. She wiped her daughter’s body using a wet cloth, combed her hair, applied kumkum ( https://en.wikipedia.org/wiki/Kumkuma) and vibhuti (https://en.wikipedia.org/wiki/Vibhuti)on her forehead. Bystanders of other patients came following that – to do the same. I gave the urocol bottles to them for collecting urine and stool for the investigations. The entire ICU was stinking. Staff nurse who just came passed a mask to me. I went to check blood pressures of all patients. One patient, I could not even feel the pulse. Most of the patients were edematous. While removing the cuff of the sphygmomanometer, I could see pitting edema.
6.30 AM : I replied to my weirdo
“Ah! Pancakes – save one for me”
I received an almost instant reply
“Idiot! You are replying after hours, meanwhile – I slept and woke up.”
“Weirdo man, I had night ICU duty”
“ Oh, I feel you puppps, I have OPD today, Let’s have breakfast today”
“ Sky bakery 8.15 AM ?
My ward Resident called me again for a diabetic foot dressing and sending blood for the routne investigations of 3 new admissions. That would make around 30 ml blood and 18 vacuitainers. I had ran out of vacuitaniers, I had almost 60 of them at 8 PM yesterday night – All got over. I called my Ward cointerns to come a little early with the vacuitainers.
7 AM : Few more XRays. I again ran to Room No. 14, for some reason it was closed. I returned to the ICU to write follow ups, Blood Pressure, GRBS and the investigation reports.
8. 05 AM : The day ICU intern came. I thanked nurses and residents for the great work and walked back to meet weirdo for breakfast with my backpack. A great company, hot sulaimani (black tea) and an authentic Kerala (https://en.wikipedia.org/wiki/Kerala) breakfast. Scorching March summer’s Sunlight sparkled and danced with the top layer of my ‘sulaimani’. I was gleaming !