15 days in ER

EXPERIENCE

In the hospital where I work, every 15 days, a list of eight house officers (junior doctors) is posted in Emergency Room (ER) during their house job training. I was doing my 24-hour duty in ENT (Ear-Nose-Throat) ward when I was informed that I had been picked up for the next 15-day duty in the casualty room of Emergency department.

I was frightened and excited at the same time. Excited, as I had always wanted to experience the thrill of working in an emergency unit and frightened as I knew it would not only be hectic but demanding as well. The experience that I gained during those 15 days in ER is the one that I would not have achieved had I not worked in the Emergency. It taught me to be vigilant all the time and to have patience. And since some of the worst cases of violence have taken place in the ER, I was cautious enough not to make a mistake that might put the patient or myself in jeopardy. Those 15 days of hard work and tiring duty taught me a lot and gave me the insight I feel obliged to share as a healthcare worker.

N-V-D aka

nausea-vomiting-diarrhoea

The most common complaints of patients presenting to ER are abdominal pain, diarrhoea, nausea and vomiting usually following ingestion of a heavy meal or unhygienic food from the hawkers. Some are even present with signs and symptoms of Hepatitis A and Typhoid that are mostly transmitted through contaminated food and drink. This may not sound so serious, but believe me there is something so severe about the pain and vomiting that compels the patient to seek help in the ER. A piece of advice: eat healthy and keep yourself hydrated.

Dog bites

Dog bites are the next most commonly encountered complaints. This is something for the authorities to take notice of. In the government hospital that I work in, rabies vaccine is available only in the morning. People with dog bites come in the ER all the time and we have to tell them to come early the next morning.

Don’t panic if you get bitten by a dog. Get yourself a tetanus shot, clean the wound with soap and water and get the rabies vaccine within 24-48 hours.

Poisoning cases

A stretcher comes rushing in with a dozen of people wheeling it right into your face and when you inquire about the commotion, you find out that the patient had ingested poison in an attempt to commit suicide. People have landed in the ER after drinking bleach, rat poison, insecticides and even chlorine. You give them two bottles of antacids to drink after which they throw up crazily littering the entire ER and then you wash their stomach through a nasogastric tube for any remnants. Some cases are accidental. For this, please label the bottles in which these chemicals are stored and if you did it intentionally, I am sorry for a failed attempt thanks to your loved ones who brought you on time.

The ever-growing nuisance of hepatitis B and C

A major chunk of people visiting ER were known cases of Hepatitis B or C. Most of them have had it for several years and were now in a chronic state of liver disease. Their complaints varied from bleeding in stools or in vomitus to swollen feet, jaundice, loss of appetite but most of them presented with a distended abdomen, full of fluid. It’s a grave reality of our country how the burden of Hepatitis B and C is escalating at an ever-growing rate and it is the need of the time to educate people about the risk factors of transmission for this disease and to get themselves vaccinated for Hepatitis B.

Covid-19

With the Covid on the rise, we are encountering people with symptoms of fever, cough and shortness of breath. When you get their X-Ray done, their entire lungs are affected compelling you to get their PCR test done. Many Covid positive people also come for admissions and you are always cautious because you not only want to help the patients but also protect yourself and your families once you get back home. At times, people aren’t wearing masks and do not follow the SOPs and it has always been a challenge to make them abide by these SOPs.

Referring patients out

At times, you may be dealing with four to five patients simultaneously and then another patient comes who you think needs a referral to some other department. It may not be easy to explain to them that their problem cannot be solved in the Medical ER. Rather, they would have to go to the Surgery department or go to the OPD for instance. Sometimes, the severity of the symptoms is not that much as portrayed by the patients or their attendants, but you need to explain this to them and guide them where and when to seek help in the best possible way you can so that they are satisfied.

BD - Brought dead

The BD patients are the hardest to deal with. Even from afar, we can tell that the patient has no signs of life. Undoubtedly, it is very difficult to break the news to their loved ones. The deceased are usually cyanosed (their lips and nails turn a bluish hue due to lack of oxygen supply), they do not have a pulse, their pupils are dilated, fixed and non-reactive to light and finally when you carry out an ECG, you get a mere straight line which indicates their heart has stopped working. There are cries and moans and at times, attendants are not willing to accept the reality. It’s a really sensitive situation that needs to be dealt very diligently and to be as empathetic as possible. Sudden deaths are often hard to grasp by the loved ones in contrast to the death of someone who was terminally ill and relatives knew that they would pass away soon.

You need a lot of stamina to work in an ER. Some days are good, others not so. But one thing is for sure: it is always hectic. If you act promptly and judiciously and work in the best interest of the patients, you are bound to succeed and get rewarded with many well wishes from them.