e 3 a s h i g R E F L E C T I O N S

I Killed Someone

“I killed a patient and I am going to go to jail for it” I thought to myself as I bleeped my SHO out of theatre.

OK that was just a dramatic title. I didn’t really kill anyone but you guys like drama. I bet someone out there reading the title thought “just like my grandmother got killed by an ignorant evil doctor!”.

It was one of the bad experiences I had in hospital early in my first job. I was on call and it was quite in admissions so I joined the SHO and SpR in theatre as the later was feeling especially charitable and said he would teach me how to do appendectomies and supervise me do one. As soon as I scrubbed up however, the bleep went off, and again and again. I asked one of the nurses to answer it for me and she gave me the usual dirty look older nurses who have been on the job for ever give newly qualified doctors who tell them to do things.

“There is an old woman fitting in V4 and they want you there urgently”

At the time, I wasn’t quite sure what the priorities were. I was still new and in any case, the boss was there so I looked at him inquiring whether he wants me to stay in theatre or go sort this woman out.

“why dont you go and come back after. There is an other appendics on the list that you can help with.”

I left theatre and headed to the ward, thinking of what I can remember about fitting old women and searching through the medical knowledge stored in my brain. I remembered quite a lot about epilepsy and its classifications and what causes it and its natural history and few things about fitting women and what to do with them. I will just go, give her diazepam or lorazepam, and if she doesn’t stop I will call the boss to sanction phenytoin. I even hid in the staircase for a minute and consulted my junior doctor’s survival guide and that is exactly what it says. With a false sense of security, I got to the ward and walked into a room where a group of new nurses were gathered around an alpha male nurse putting a plastic needle in the poor woman’s arm and declaring: “and if you hold the arm really stable, the veins really do stick out”. “Mad man!” I thought to myself. I wouldn’t go near a fitting woman with a needle in my hand except with 5 other people holding her down and perhaps tying her to the bed with a 10 inch rope. But now that he managed to get a needle into her my task is easier.

“Great. While you are there would you take bloods for FBC, U&Es, glucose, calcium, magnesium and phosphate.”

“Will do. What do you want me to give her?”

“Diazepam” and I paused a little looking at the poor woman who has been jerking continuously for the last 10 minutes and then I said the stupidest thing ever: “10 milligrams i.v.”

I must have said it in a such a confident tone that no body questioned me. You don’t give people 10 mg of Diazepam when you first see them - fitting or no fitting. Camels yes maybe, but not old frail women. The standard protocol is to give 5 mg rectally, then 5 mg rectally, then 5 mg IV and if that doesn’t work you pull out the big guns.

Sure enough, she stopped fitting almost immediately and I had my moment of victory for I conquered epilipsy on our first encounter. I conquered the daemon that lurks within. Aren’t there still parts of UAE where epilepsy is largely thought of in terms of jinns possessing humans. I myself have attended few so-called exorcisms and if only I knew diazepam then, I would have been both hero and merciful. Enjoying the occasion, I kept looking at her flat in bed, alone now as the nurses left her in my good care. A minute passed, then two, then three. Something is wrong. She is still breathing but completely flat. This is quite different from the post-ictal state medical text books talk about. I got closer and examined her. She is still breathing, pulse and BP maintained, no verbal response, no motor response, no eye opening - a 3/15 grade comma (on Glasgow Coma Scale). This is not right. I rush to phone my SHO.

“You know the woman I was asked to see on the ward”

“Yeah?”

“She is flat now, breathing, with GCS 3/15. pupils equal and reactive to light”

“What did you do to her?”

“10 mg diazepam iv?” I responded, hesitantly.

“Oh dear!” I heared him say on the other side in his posh English accent, “..we better call anaesthetics.”

I put the phone down and started contemplating what is going to happen now as I walked back to the poor woman’s bed. Luckily, by the time I got to her room, she was making noises. Good, GCS now 8/15 and in less than a minute when my SHO walked in, the GCS had risen to 14/15. She was confused, disoriented and exactly like my text book says she would be after a fit. An hour later, she was sat up in bed telling me about her grandchildren.

People do indeed think of hospitals as the most secure, safe and *pure* places on the planet but they are not. There is a lot of politics (the most shameful cause of death in hospitals) and there are a lot of mistakes. Hospitals are run by people, medical and administrative staff, and people make mistakes. These mistakes, I am glad to say, are very few and most of them are non-lethal.

I remember back in med school, a teacher once said: “You will all make mistakes in your careers. 99% of them will be in your first year as doctors. Just pray that it passes without you killing anyeone.” He was so very right.

PS: This post and the above piece by Yanni are dedicated to uaekitten for being a nice person, a workaholic and a big nerd and for having one of the bestest websites in UAE.