CASUALTY DAY ONE

we're hanging around the casualty being busy with what it entails us when a neurosurgery PG wanders in. he's a short guy, with a crop of hair that looks like a spikey spider's web.
then suddenly, wheelchair with a patient happens to be rolled in. the patient doesn't seem to be in his senses. he blabbers constantly. i go towards the patient and ask him what happened to him. there's a glee in his eyes and he smells strongly of a peculiar odour.
he doesn't reply and speaks incoherently.
i ask the bystander(the person with the patient): "what happened to the patient?"
he says : "the man fell from a height of 3 floors".
i ask: "was he on alcohol?"
the patient then points to the bystander that he'd like to drink.
i ask again " did he fall from some place or is he drunk?"
patient: "i fell from the sky! i fell from up there!!"(points skyward)
the patient's evidently disoriented, so we call the NeuroSurgery PG to the scene.
he asks the bystander: "when did he fall down?"
ByStander: "3 years back."
NS PG: "give me his reports."
now, the NS guy isn't keen on taking up too many cases. so the NS goes through the reports and decides. "the patient's constantly blabbering. i cant get too much of a history from the bystander too. give a reference to the Psychiatry PG".
Enter Psych PG.
the Psych PG begins to assess the patient.
he rules out psychosis and mania and narrows it down to an organic brain syndrome. a report says that the patient had a sub-dural hematoma in the past. the present condition is a sequelae.
NS pg: "alright, so you'll take up the case".
Psych Pg: " me?! we cant admit him into our department! its an organic brain condition!"
NS pg: " but we cant treat him! i just spoke to Sir. and he said that the patient was on conservative
treatment and he has to continue conservative treatment."
Psych PG: "he seems to have encephalopathy. that is causing all his symptoms. we aren't equipped to deal with that!"
NS Pg: "then treat him conservatively"
Psych PG: "obviously we psychiatrists treat patients conservatively! we put patients on anti-psychotics. what else do you think we'd do?"
NS pg: "either way,we cant admit him now!"
Psych PG: "yeah, so put him on conservative treatment"
NS pg: " yeah. ok.."
meanwhile two female interns enter the casualty, collecting blood samples. they say
"hi victor! hi vijay! "
"hey!"
"so you guys have day duty?"
"yeah"
"do you guys have an umbrella? its raining."
"nope! use your aprons!"
they look around and walk out. the next minute a breathless patient is wheeled in and vijay and i get busy tending to him. during this time , i notice the two interns walk out carrying a black umbrella with them. the patient we're tending to gets a little more critical, and so anup and i spend the next half hour monitoring him.
a little while later, a tall burly looking man walks in, a little harried, and asks the staff nurse.
"sister, did you see my umbrella that i kept outside my room?"
vijayram and i reckon that he's a Medical Officer, suggested by his Demanour.
Staff Nurse: "sir, 2 interns asked us and took it. they went for lunch. they'll be back in an hour"
the MO looked on. Vijay and i couldn't look anymore and we started giggling quietly.
there were 2 other patients who came in disoriented.
on examination, we found them to have crepitations.
one seemed to be on the verge of developing seizures. i was concentrating on catheterizing one patient when the other was being examined by a post-graduate.
(if you want to learn how to catheterize, read my 'unofficial notes')
after about 5 minutes, i found the PG vigorously pressing upon his sternum with both hands clenched.
"get an ambu bag and mask," he told me.
i rushed to get it and he pulled the ventilation mask aside to allow me to use the ambu bag.
perspiration drained his forehead. and he kept pumping his chest. another post graduate joined him later on. each taking turns to revive his heart.
" have you injected Adrenaline?" he asked the nurse.
"yes, " she replied.
15 minutes. and they kept trying to infuse life into him.
feeling his pulse.checking whether his lungs expanded.
but to no avail.
the patient was quiet. blank empty eyes that stared at the ceiling.
finally, after 5 minutes they decided to call it off.
Let go.
there are other lives to save.
we walked away. a curtain concealing the newly dead.
i looked at Vijay and Anup.
There was a faint sense of dejection in their eyes.
i asked Anup. "dude, what did he die of?"
"CRF" he told me.
"but I felt he had pulmonary oedema"
"yeah" VIjay said. "towards the terminal stages, it becomes a multi-system disorder"
"couldn't anything have been done man?" I asked anup, "and dialysis is costly right?"
"dialysis. Yeah. thats the only way out."
we came back and sat at our desks quietly.
the next 5 minutes, we spent in silence.
i cant remember now, but later on i found out that the other disoriented patient also succumbed to renal failure. A