All my 3 calls since 2021 has been busy. I barely slept and still had to work the next day all day and then I'd still have trouble sleeping on my postcalls. Anxiety gets me. I don't know how to shut my brain off.
Anyhow. My most recent call was on Sunday. I did my rounds in the morning and the sickest kid in our acute bay was worrying me. She was a POD 6 bowel anastomosis done and had spiking fever all night. I thought she was more tachypnic and tachycardic and her abdomen was distended compared to when I last saw her on Friday and I planned to repeat cultures for her now. I need to exclude leak as well.
My surgeon came and said the abdomen is full. Yeah it is but it's distended too is it not to you? She told me to monitor the temperature first and repeat culture if another spike in. To off her Ryle's tube and to allow her breastfeeding today. But do one AXR first before feeding her.
I remember thinking I wouldn't dare to feed a septic child with distended abdomen post bowel anastomosis until I've totally excluded leak. But she was the surgeon and she did the anastomosis. Okay then.
I settled my ward work. I waited for the AXR and called Radio twice for it. Why are they late, I need AXR for my patient TRO intraab sepsis. Cmon now. I was jittery because I had referral from COVID tent and I need to settle her first, who knows how long the referral will take me.
Xray came and I urgently asked my nurses to go trace the film. They came back much later than I know it would for a round trip to xray with food in their hands while there I was pacing. Dammit. They should have told me they were getting food too, I would have gone to xray myself.
Her bowels were dilated with paucity at right lower abdomen, exactly where the anastomosis would have been. Damn. Can we not feed her?
I updated my surgeon. I asked her if she still wanted to feed the kid. She told me to keep NBM. Thank God. I would have gone behind her back and kept the child NBM anyway.
I went to COVID tent. I exited it after an hour to a text message from my staff nurse telling me the kid was getting more tachypnic. Which was 30 minutes ago. God! I remember breaking into a run while replying "Insert a Ryle's tube first! I'm on my way!"
I stared at the kid's eyes while I stood next to her, my sweater off and my gloves on. She looked at me smacking her lips and nasal flaring. She looked so sick.
God help me, please help me help this kid.
Supported her airway and breathing. Decompressed the abdomen as much as I can. Repeated all her bloods and prepped her for laparotomy. Made sure she got her stat dose of escalated antibiotics. She looked puffy but her urine colour isn't as good as I hope so and her peripheral circulation are not as good as her central. I need dopamine, she had accumulated positive 3000ml balance already and I didn't dare overload this kid unless I'm ready for her lungs to get wetter and intubate her. She already had atelectasis.
My surgeon texted me about the adhesive obstruction I attended in COVID tent. I told her the kid is obstructed but stable, but this one here is not. I told her everything I was doing. She replied me that she agreed with my plans and told me she'll come after Maghrib. Maghrib was in an hour.
Took me two hours resuscitating the kid before my surgeon showed up. The first thing I said to her was "PSICU ya Miss? Sorry but I wrote in my review TRO leak."
"Yeah I think so too." I just needed that one greenlight. She's the gazetted surgeon, I'm just a medical officer. A scared medical officer who knew this kid could have died faster if she was fed today.
Ken came and pushed her straight to PSICU. Dr. Hidayah reviewed her straight away and started her on the dopamine. It was only 8pm so I asked my surgeon if we're going in tonight. She said to get an ultrasound first. I called up Radio. The MO came straight aeay since I told him that we need to go in for the kid. And yeah, it was a massive complex ascites.
INR was 4 plus. Dr. Hidayah said they'll correct all the bloods and push to OT first thing cm. I couldn't thank her enough. I knew the kid was at least in a better care than it would have been with just me and my ward nurses.
My night was sleepless with referrals afterwards as I periodically checked up on her, powered by 1g of paracetamol and a short 30 minutes nap. I had to despite one more COVID tent referral; my head was pounding probably from hypoglycaemia and dehydration. By 4am I was done with my work and I was famished (last meal was breakfast at 12pm) but damn sleepy. Forget food, I need sleep. I refused to sleep on a hospital bed so I went home and slept on my bed. Groggily and super reluctantly got out of bed two hours later.
They went in while I finished my rounds. And then I had to go to clinic where my nurses greeted me with "Doktor ada makanan untuk kau dari BFF kau kali. Kami tidak kenal."
I went to the back and there it was a pack of bomboni doughnuts and coffee milk. Written on the packaging was "Good day Tiqs. XOXO"
Mizah texted me in my hectic morning asking whether I'd be in clinic or OT today and only then I remember reading them but not replying them. I replied her then that I love her. What would I do without people feeding me. I'm so bad at that.
I finished clinic at noon. Went up to see the kid post op in PSICU and saw she was extubated. Read the op note and remembered feeling terrified of the op finding.
It was a dirty abdomen. Slough and bile everywhere in all corners.
What if I was too late? What if I had been ignorant? The kid wouldn't have survive. I'm so glad I caught it and thankful God had mercy on her and on me. Oh God we should have opened her on Sunday morning itself.
