“Tube is in false tract……re insert the ETT” , I shouted to the anaesthetist. I could feel the panic over each one surrounding there. Suddenly everybody’s eyes glanced at the SpO2 monitor, which was slowly but steadily traversing the eighties. George suddenly pushed his tube back inside through the mouth and started pumping hard. I felt relieved momentarily but it was very short as soon he shot back, “ Vernie, the cuff is gone, I cannot maintain the positive pressure…..for god’s sake do it fast man”.
I felt a blackening sensation in front of my eyes. And yet in between that misty black, I could see red….I mean blood red…..there was now blood splattering all around. I had pulled out the tracheostomy tube but in the process seemed to have injured some artery and now blood was spraying around from it over everybody’s surgical gowns. Somebody caught hold of it, like a squirrel in hands, with the artery forceps. I realized it was Mini, my two year junior colleague, and yet seemed to be holding herslf much better than me in this situation. She gave me a jerk across the lady lying on the bed with her neck now lying wide open, and I came back to my senses. Immediately my eyes went back on the monitor………..fifties…..I felt my nightmare was finally coming true.
Earlier in the morning, I got up as usual at five. After all a PG can’t afford a very long sleep. For past two and a half years now I had now been getting up in the morning at 5 and so it was not difficult for me now. Immediately got off the bed and brushed my teeth, and then went to my study table to read for an hour on that day’s upcoming seminar topic. By six I went for the bath, changed fast got ready and reached the hospital for my ward rounds by seven. I was shocked to find the previous day’s stapedectomy patient sitting outside in the garden. Dr. Harris had been very clear…complete bed rest for two days….and it was left to us residents, to impress upon our patients the importance of it…..and if he was still out of his bed….and what’s worse walking in the garden……things were going to be very bad, both for me as well as the patient. I shouted at him,”how the hell did you get out of your bed, I told you very clearly not to move around, can’t you understand such a simple thing….”.
He kept on watching me for a minute, and then gently replied “Doctor, have you yourself tried ever lying down on bed turned to one side continuously for 24 hrs….”. I had not, I immediately realized what he was saying….but dammit, it was for his own benefit. Why couldn’t he understand such a simple thing. He turned around and went back to the ENT ward which unlike other wards, was a single building situated at one end of the hospital with a garden lying right in front. Seeing this secluded ward, it always made me feel, ENT is always given much less priority than it really deserves.
I moved inside the ward, examining all the patients, taking their vitals, recording the findings in the case sheets till I came to the last bed, 11 year old child with hearing loss since birth. And now had developed discharge from ear. How can God be so ruthless, he looked so young…but then I remembered my graduation teacher’s words,” Life is not very fair…as doctor you will see many things which to any normal individual will haunt for their life..but you are a doctor….you have to keep youselves emotionally detached from your patients….only then can you treat them well”. In fact later when I used to think about these words, I realized that patients most difficult to treat for me would be my own family. May God have mercy.
It took me an hour to complete my first morning round. And now I had to wait for my most difficult task of the day, to take rounds with my faculty. I was looking towards door to see the appearance of his face. But miraculously the face instead appeared on my mobile and I was advised to rush to OPD as there was already a ruckus there with patients pouring in a beeline.
OPD is a place I used to detest in my first year, coz the seniors won’t let me do a thing. But now in third year, I was the boss,….err at least somewhat; And enjoyed the God like feeling while talking to patients ( though many a times my guide use to advise me, doctors should not consider themselves God). But this patient was bringing this God to his wits. While taking personal history, I asked “Do you smoke”.
Prompt came the reply, “no, I don’t”.
“Do you drink”
“No, I don’t”
“Do you get good sleep”
“Not for past one week”
This time I was prompt with the ques”WHY ? “
He replied bit sheepishly “Since I quit smoking and drinking one week back, which I used to do since I was ten, you know it becomes a bit difficult to adjust, you see”. Of course I didn’t see. I just wanted to pull my hair.
I somehow got rid of him and sent him for completing the admission formalities. But he had taken too much of my time, and the waiting line was getting longer. I decided to go faster. A female patient came holding her neck and started saying “I have a sore….”. I had already started writng my regular URTI prescription, and even finished it but she was still going on, “ and you know doc, then the pain goes to my head and finally it releases from my head like steam, but my hair…..”. I said, “ errr…….stop miss, I have written your medication, take this and I am sure you will be perfectly fine” and turned to see for the next patient now desperately looking through the door for past five minutes. But she seemed dissatisfied, she did not budge, “you haven’t written any medicine for the steam coming out from my head, you had stopped writing even before I told you about it”. I reluctantly added a multivitamin to the prescription as a placebo, cursing myself for finishing the prescription writing before she finished talking and made a mental note, not to repeat it.
OPD kept on going till four at noon,and only a couple of patients remained. I was looking forward to finish it and finally go for lunch when I received the wretched call,”Vernie, it’s your lucky day, there’s a tracheostomy call from ICU, seems a simple CVA case requiring it for prolonged ventilation, so my dear senior resident, do you think I need to come or you can handle it “. “Sir, no problem, I’ll handle it” I said, remembering my previous innumerable tracheostmies I had done in past three years, which included a few which I had done without observation of faculty as well, and also while trying to forget my lunch.
As I went into ICU and saw the long neck, became more confident thinking it’s a childs play, and yet those nightmares of failing to do tracheostomy midway always lurked at the back of my mind. I called a junior resident to give me company and told her to call me once things were ready so that I could finish my remaining couple of patients in OPD.
“Forties” shouted Mini and George in unison, “Vernie,what are you thinking”. I snatched the suction from the nursing assistant and rapidly removed the blood from the wound, tried to visualize trachea, couldn’t see it. Put my little finger in the wound, and immediately I realized the problem, thyroid gland had slipped down from the retractor above and was now covering the tracheostomy opening which I had made. I took the superior retractor from Mini’s hand, brought thyroid back into Langenbach’s notch, and finally saw my silver lining, I mean the tracheal white outline. To be doubly sure, ran my finger over it to feel the cartilage rings. Yes ,they were there,as well as the irregular small anterior wall cut which I had given earlier (it was supposed to be larger round cut in this old patient, but overconfidence can bite you like a snake without notice). I widened the cut, put a size 8.0 tracheostomy tube in and shouted, “check ventilation”. George was prompt, he checked the ventilation on both sides with his litmann, took his time, there was pin drop silence for now the reading was in thirties and everybody knew, this might be the last chance.
Finally after an unending wait, he gave a smile,”it’s in”. I felt as if I had won my Olympics gold medal. I had encountered my worst nightmare and come through it, hopefully with successful end result, because it would still take days before the CVA patient improved on his GCS and we could know if there was any apnoeic brain damage. But for me, I had earned my bread for the day.
However, it seems others did not think so, my mobile read a text message from emergency,” Foreign body trachea, come fast……”