Quirks of the past weeks
August 7, 2007
Here comes August.
I have been pretty occupied with a bunch of stuffs during the past few weeks. Mainly been busy due to work for my current rotation (emergency medicine), where as other times I would be occupied with a few questions in relation to the working life next year. Fortunately however, that I finally gained some closure to some of my doubts. My internship is finally a certainty so that ‘s good news 😀 Prior to that, it was filled with a bucket of “what if?”.
Ah…being in the dark and all uncertain is indeed anxiety-provoking. I understand that there are some things you can do about, where as others we would have to let it be and allow the results or finality to reveal itself with given time. But still, the waiting is definitely not a fun process to go through. So when I finally knew for sure, that was a huge relief.
Now, life in the Emergency Department.
To be honest, I find my emergency medicine rotation pretty nice. We would get thrown into the deep end of the pool where we’d have to learn very quickly on how to deal with a specific case. I find that in my field of work, the best way to really learn is to go out there and do it yourself. The learning curve is indeed very steep but then again every one of us started out the very same way. The nature of the job requires a huge pool of knowledge so when it comes to medical students like us (newbies!), it could feel like we each have a huge mountain to climb.
Looking at the bright side, we (one part our own efforts; other part out of necessity) ended up learning a huge amount of stuffs in a short period of time. Not bad for efficiency right?
One thing about emergency medicine is that all the patients you see are in the Emergency Department (ED) itself. If they get admitted, they’re no longer under your responsibility as they’d be under whichever ward they’re at. This makes things much more convenient for a lazy bugger like me.
What happens is that when you receive a patient in ED, you would of course stabilise and treat the patient. If the patient’s ailment proves to be minor, he or she would be discharged post-treatment and that’s it. If it proves to be something pretty major or serious or spectacularly mind-boggling, then most likely the patient would need to be admitted to the hospital. Once you’ve made the referral and the receiving ward confirms that “Yes, this patient warrants an admission”, then that’s it too as now the patient has been released from your care unto theirs.
So in other words, the ED is where people get sorted out based on their need to receive ongoing treatment (admission) or to be prompted back to their muffin and cupcakes (home!). But of course before any of that happens, the patients would have to be stabilised (especially when heavily injured/medical emergency i.e. heart attack) and assessed before any decision is made.
The ED is where you chance upon extraordinary patients, and sometimes extraordinary staff.
I have seen one patient who came into the ED cause he could not stop hiccuping. I was reading his notes before I went to call him in and was actually half-amused at what I saw written there. It seems that he has been having his hiccups for almost a week. With my overactive imagination I imagined some guy doing whoops all over the place which somehow was promptly replaced by an image of a seal. Oops.
I called him in and wow, they weren’t kidding. He was hiccuping so hard and so quickly (one after another!) till he couldn’t breathe properly. He’d double over and tremble with each passing hiccup. While talking to the patient to get a good history of what could possibly bring on this hic-hic spree, I was racking my brains inside. What’s with the hiccups? I pondered.
In my entire almost 5 years of medical training, I have never come across any hiccupy ailments ever. Until now, of course.
Funny how much we all had read about heart attacks, strokes, appendicitis, asthma, fractured limbs, the works etc so much so that when faced with something as innocent-looking (or sounding) as hiccups…we’re hopelessly clueless.
I thought the above to myself and laughed (of course I did scampered away from the patient’s field of vision and laughed to myself so he wouldn’t think he’s my source of amusement). What do I do? I went off to ask the consultant.
Me: I have a guy who’s been hiccuping for a week now etc etc
Consultant: So what treatment do you recommend?
Me: *with a helpless half-smile* I HONESTLY don’t know.
Guess what? The consultant planted himself at the work desk and proceed to google a cure for hiccups. He clicked on the first result which popped up and began to read through it. I was standing right behind him glancing over at the screen as well. The ‘Mr. Glee’s (name has been changed) 100% guarantee to hiccups!’s page was filled with instructions on how the forceful swallowing of water would treat hiccups. It said something about getting a cup of water and pinching your nose before taking a quick huge gulp down.
You can’t be serious, I murmured to myself.
The consultant closed the webpage, slapped his knees and said “Why don’t you give it a try? Then come tell me if it doesn’t work”.
My eyebrow-raising reflex kicked in and I had to quickly force a frown in an attempt to disguise my subtle “HAH??” reaction a split second earlier. Okie then, worth a try anyway cause we’re clueless.
I filled a cup of water and was lingering along the corridor for a few seconds. What would the patient say? I don’t think he’d come into ED expecting to get some home remedy fix-up. Nevertheless, I proceeded.
“Are you kidding me?!?”, said a shocked he. Half-resignation, half-disbelief.
Ah, I saw this coming. He mentioned that he has tried almost everything, certainly this water gulping trick but was still cooperative enough to give it another go. It didn’t work.
The patient groaned and buried his head in his hands. I just managed an “Oh” in acknowledgement of the failure and headed back to report.
A mischevious part of me almost wanted to blurt out to the patient “Well guess what, you just disproved the method’s 100% guarantee!” with much glee but of course, ahem, that would be professionally inappropriate. If not professional suicide.
Told the consultant it didn’t work, and he wrote down a prescription for a muscle relaxant/anti-convulsant. We thought hey since hiccups are caused by diaphragmatic spasms so maybe this would work. The patient popped the pill and we waited like 10-15 minutes for it to work.
Not a single hic was heard after that.
Brilliant. The patient was very grateful. I could see his face was all red and flushed from the forced hiccups. He took a few deep breaths and savoured the time when he could actually inhale and exhale without any interruption. The hiccups were so severe that he hasn’t been eating properly for the past few days as he could not keep the food down long enough. Wow.
So folks, sometimes I think working in the ED is almost like being a handyman or a fix-it kid for medical odd-jobs. You see stuffs ranging from the funny to the bizzare with an equally fascinating range of proposed treatment to match them.
These kinda incidents make my shifts more interesting, and it certainly feels good to be able to resolve the weird and wonderful cases no matter how simple it may be. They are not your usual casualties or medical emergencies per se, hence it makes them out of the ordinary.
And what do you do when you see the extraordinary? You’d do the extraordinary.