Four critically ill patients, one on bed no. 19 in the male medical ward likely to die at any moment. Three medical reports pending examination for court purposes. I checked the register and assumed the night charge. It was summer and wards were full in this season. There were 343 admitted patients in the 400 bedded hospital. Since many hospital cots were not functional and just added to the bed count, patients occupied the floors, also.
The first thing an emergency doctor does in the night shift is to make arrangements for vacant beds so as to accommodate emergency patients. Government hospitals are bound by regulations on not refusing admission and patients start piling up in such hospitals after 9 p.m.
‘’Bed number 9 is a fractured thigh with bleeding and collapse. Was admitted in evening at 6 and is stable now.’’ The staff nurse rattled off about the patient. I did not want to shift the patient but had to do it as the beds had to be kept vacant for night arrivals. The patient was shifted even though he needed full emergency care. Hospital bed occupancy is a dynamic process and in most hospitals the beds are always occupied. I visited a cancer hospital a few years back and was surprised. Their hospital beds were available on hourly basis. These were allotted on how long a patient was likely to wait for an intervention, a diagnostic service or stay indoor for treatment. The bed occupancy income of that hospital was almost 89%.
After the emergency rounds, a gunshot in the chest was waiting. The patient was bleeding excessively and turning bluish. The triage team had already set in the basic central life line. This is a catheter inserted in a large vein and, in case of collapse, drugs and fluids are pushed through this route for faster delivery.
“Oxygen on high, and Injection Coramine,’’ I told the nurse and immediately an injection from the emergency trolley was taken out and administered. The patient was gasping by now and in complete collapse. The superficial veins were flat but the lifeline worked for us to push the drugs. Meanwhile, the team nurse managed to pressure bandage the bleeding area and the X-ray technician was on the way.
With best surgical efforts, the patient waxed and waned. I remained awake the whole night in the vain hope that he would survive, but the patient gave up and died at half past three in the early morning. It defeated the very purpose of my staying awake the whole night and wasted the team’s effort at surgery. The patient could not be saved and our efforts did not show any results. In such situations, when doctor and his team put in their best efforts, then mental satisfaction is obtained if the patient remains alive. But if the patient dies after a prolonged battle, then the attendants usually never appreciate the doctor’s efforts. Here we feel cheated and humiliated.
I am posted as an intern in the obstetrics department (dealing with births). The department’s shift is 8 hours for senior residents & nursing staff, but 24 hours for male interns. The logic is that male doctors do not have any work in the labour room and they get posted for getting acquainted about one important life process. With this feeling, I stepped in the labour room.
There was total chaos. Women in various stages of deliveries occupied the labour rooms. Patients wailed and among these shrieks, constant crying of the new born was a regular feature. It continued throughout the night. Along with other male interns, I got the job of recording blood pressure of these patients. I ended up measuring blood pressure throughout the night and my fingers ached. It remained for the next day and then persisted till we got used to these crampy fingers. The posting in the labour room made me feel the joy of motherhood and the humble beginnings of life.
Interns are supposed to work for 80 to 100 hours a week as stipulated by medical education regulatory bodies. But, on the contrary, these junior doctors end up being on duty for as long as 120 hours a week. We arrived in the wards in the morning before grand rounds and completed our documentation work. It is a laborious procedure to write down details of symptoms, clinical findings and treatment of each admitted case in the wards. The resident knows well that whatever he/she has written in the case sheets will never be read or treatment followed but still they go on writing the standard protocols. Many investigations are ordered routinely by these new residents which are not even needed in the case. Residents work in the wards and continue after evenings. If some emergency case turns up for surgery, then these residents try a hand job on the case.
Doctors who work in the night, like night shift workers, develop changes in their bodies. Their digestive juices do not work properly if they remain awake the whole night; the ingested food tends to ferment. This emanates a foul smell in the morning and is very peculiar to residents who return to sleep in the morning hours. Chronic lack of sleep causes lots of problem in these doctors. Studies have shown that surgeons and physicians who are sleep deprived commit more medical errors, which translates into loss of lives.
Mostly medical errors in hospitals go unreported or undetected but the threat to patients is real. It is necessary that the public be aware of such doctors who work in the night and get back again in the morning routine without a wink. The night duty doctor must be allowed to sleep the next morning in the interest of the public.