news details |
|
|
| A day in the Surgery ER (Emergency Room) | | |
Dr Shehwar koul
Its kinda funny and ironical but it is a matter of fact as to how so many of us doctors dont find enough time for our own physical and mental health but when it comes to our patients we would prioritise advising and taking care of their health issues.We would see patients in Opd and ER suffering from gastritis for instance, but would have neglected our own for years. We would advise them against caffeinated drinks and spicy foods,but have left with no option but to take heaps and cups of the same things when we find some time at our cafeteria to keep ourselves awake and energised through the Emergency duty nights. We would write hundreds of prescriptions advising increased fluid and fibre intake. Taking care of their bowel and bladder habits and at the same time not remembering when was the last time we took care of our own. With emergency duties there’s usually so much and so many patients to treat and care that we routinely forget to eat, sleep, drink, pee or poop. As a surgeon its more ironical when you have helped so many people in getting rid of their urinary retention, evacuation of their feces, treating uti’s, constipation, gastroenteritis, piles and fissures and advising them lifestyle changes while following such an unhealthy lifestyle ourself. It does make me feel the irony and have a laugh at myself when we would walk miles to explain simple lifestyle changes to patients like “take plenty of fluids”, “Avoid spicy and oily foods”, “Take diet rich in fibre like fruits and vegetables”, “Regular exercise atleast 5 days a week”, “restful 8hrs sleep” while we as emergency doctors wouldn’t have the privilege of following any of these advices. On an average, a doctor on Emergency duty goes through a whopping 36hrs of continous duty hours. And almost every ER doctor goes through such duty 2 to 3 times a week. Sometimes even on consecutive days during weekends getting some odd 5-6 hrs of rest in between only when these duties fall on consecutive days and not otherwise. The rest of the days also do not comprise of a typical 6hr duty days as expected by most of the readers. They also span a minimum of 8-10 hours per day. These duty hours comprise of all kinds of patients including road traffic accidents, fall from heights, vehicles, physical assaults like stab injuries, gunshot wounds, acute abdominal conditions like acute cholecystitis, perforation peritonitis, appendicitis, intestinal obstruction, gastritis and myriads of other common and uncommon cases. And then there would be patients who would ask for bed rest for the common ailments on their prescriptions and my colleague doctor sitting next to me suffering from the same ailment would be working on the same table neglecting his abdominal cramps, nausea and loose motions and trying to forget it while handling and treating patients so that there no derth of manpower in the Emergency Room (ER). And also because he couldnt find a replacement for himself so that he could take a day off from work. For those who do not know let me tell you that doctors in ER do not get to take leaves, or day off at work just like that even though they have their leaves unused. They need to request another colleague/fellow doctor to replace themselves who most probably would either have given an emergency room duty previous day or would have to attend his own the next day. Now for those wondering why is this so, it is because we have an actual ongoing shortage of specialist doctors in the government hospitals. And hence all the brunt comes on to the emergency room doctors. I have myself been sick with acute gastroenteritis on one of my ER duty days during my first year residency and I couldnt arrange for a full day cover(another colleague surgeon covering for your abscence in ER). My colleague could only give my cover for a few hours and meanwhile I rested in the doctors duty room upstairs in the ward. And when I came back I had to sit on the ER table (our first point of contact with the patients) writing prescriptions with one hand and having a bottle of iv fluid and medications running on my other hand. Here I would apprise you of the fact that surgery ER duty is not a table and chair kind of work. It has least to do with sitting actually. You need to first admit patients, examine them head to toe, get their labs done which might involve the ER doctor pulling patient trollies from one radiological cabin to another. Let me apprise the public here that doctors are not supposed to do that and neither get awarded or paid extra incentives for that, we just do it because we can’t just sit and wait for the patient’s attendants or almost zero administerial staff to help the patient. The other half of our duty comprises of OR/OT(operation room/theatre) where the patients requiring surgical intervention are operated. Here the surgeons keep operating the patients one after the other while standing for the next 36hrs on an average, with some 1-2 hrs of sleep if they get lucky enough. In between we also need to get these patients investigations collected and get their PAC (pre anesthetic clearance) done.
If all this wasnt enough there would be multiple instances of ill words, slanders and even souffles from the attendants accompanying the patients. They would naturally be aggrieved seeing their loved ones in pain. And once they reach the hospital bringing their patients in whatsoever critical condition, they deem to have this perception that Doctors are Gods and there is a magic wand that we possess and it would cure them instantly. Amongst this perception, when they see lack of helping staff like nursing orderlie’s, paramedical staff, basic medical equipments, and even emergency medicines at times, they immediately get aggressive and that too on that miserable ER doctor. There was an instance when I received a road traffic accident patient in ER who was smothered in blood and vomitus. I took him to the intubation chamber(a place where critical patients are treated and eventually intubated to put them on a ventilator). When i say I took him, I literally mean I dragged his trolley with my own hands and on the other side my other colleague or some random attendant (if anyone accompanies him) helped me in transferring him. On reaching there I called the nurse and we tried to secure his airways and iv lines, rushing some emergency medications, drawing blood, sending it for crossmatch to the blood bank for need of transfusion and other myriads of emergency procedures. But the patient started experiencing seizures (fits) and at that instance there was no antiseizure medication available in the hospital. I was standing there alone with the patient, helpless, scared with his lone attendant missing, probably went looking for either laboratory, or medicines, or blood bank. The nearby attendants had almost till then gathered around, not one of them trying to help, but giggling and passing comments that the doctor isn’t treating his fits, to the extent of almost having a scuffle. And in such circumstances you would rarely find any paramedic, administerial, or security staff coming to your rescue. You would have to deal with all this, all by your ownself. I did stabilise him though with whatever resources were available and he eventually got better in the coming weeks at the hospital.
Amongst all this hassle we forget that we also have families at home. Our parents, siblings wives and children for those married, whose calls we constantly neglect while in the ER or OR. What if some of those calls are urgent or distress calls? Who would take care of our elderly parents or young children? All these thoughts do scare us all along but we keep the fight up.
SARS covid 19 pandemic saw an increased toll on the mental health of the health care workers world wide. While the world could stay home with their families and work from home, our leaves (which were almost non existent before the pandemic also) got cancelled and duty hours increased. And this time we were on the frontline whether it was the vaccination(we were the official lab rats to get the vaccine tested), or the virus itself. Almost all of us got infected, not once or twice but even thrice or more. And with the level of viral load we took in I would tell you it wasnt mild at all. It was moderate to severe in majority of the medicos that got infected.
The scare was real and we were mostly scared not for our ownself but for the fact that we shouldn’t be taking the virus home and infect our families, especially our elderly parents. Howsoever protocols we followed, scores of doctors and their families did still get martyed from the disease.
With all this happening, media hasnt ever portrayed this side of the medical profession. This compassionate side where we are doing things out of our way,where we do not get paid extra for the extra hours or efforts we put in as does happen anywhere else around the globe. Leave aside extra hours paid, we didnt even get any incentives for the risk and hours we have put in during this Covid 19 pandemic. And to make things worse media has been potraying so many negative things against doctors for things that arent a ‘doctors duty/jurisdiction’ that doctors association needs to come out with an advisory stating the duties of a doctor especially in a government hospital.
Out of all this what hurts the most is when we do not even receive a single thought of gratefulness from our patients or attendants. The mentality we are dealing with in our society is that healthcare is a commodity and doctors get paid to deliver this commodity to their patients.
They see us as any other business/government servant delivering services. This model can never be applied to health care services not even in private hospitals leave alone our government hospitals which we have been talking about in this article. But little does our common public understand this. They have never been apprised about the struggles of a common government hospital doctor. The media and bollywood industry has always shown medicos in a dark perspective. And the public believes what is fed to them.
The responsibility here lies on the shoulders of the media at large to first make themselves and then the public aware of the responsibilities, duties and plights of a government doctor especially the most vulnerable and aggrieved ER doctor serving people at the cost of his and his family’s mental and physical health.
Amongst all these adversities the ER doctor still continues to serve the common people relentlessly not paying heed to administration, negative media coverage, or ungrateful patients and attendants.
But if adequate measures aren’t taken soon at all these levels, it wont be very far that the poor and aggrieved ER doctor gives up either on this society and administration to leave for jobs abroad where he’s paid well, paid for the extra hours, incentivised, and most importantly respected and thanked upon by the society. |
|
|
|
|
|
|
|
|
|
|
|
|
| |
| |
|
|
|
|
 |
|
|
|
|
STOCK UPDATE |
|
|
 |
| BSE
Sensex |
 |
| NSE
Nifty |
|
|
| |
CRICKET UPDATE |
|
|
|
|
| |
| |
|
|
| |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
