I have begun to fear these words more than anything now.my morbidity tracker shot up through the sky and sailed in free air on its way to glory as I entered my 4th month of residency in Unit 10/II, the most feared of all units because of the Godzilla of a Unit Head it has. True, I did not take up the Male Emergency cabin any single day, but to be honest there was no such thing as a male emergency cabin.....sick patients were every where, and that one month, we had more people coming with CVA's than anything else. To my credit, I handled 80 percent of all the deaths in that unit that month.....
And every single CVA patient who had come, and trust me these are so difficult to give nursing care to, with bed sores and thrombophlebtis...was taking a toll. I remember this one female with a large IC bleed in her Right Frontotemporoparietal region, with a midline shift of 1.8 com to her left who somehow managed to open her eyes and accept food....I looked after her day and night, and her 2 sisters and mother were very cooperative as well. To the point that she was even managing to do some active physiotherapy herself. I was happy with the result..I hadn't seen so many managing to so much as breathe properly on their own with an IC bleed.
Life was hectic those days, I used to reach ward before 8 in the morning, and it would be often that I would return after dinner to work there till 12 in the night as well. Somehow, she went through the first week and though her thrombophlebitis was beginning to show, her vitals remained stable and she was passing stool normally. Slowly that week dragged on and I had a crazy night at emergency with over 37 admissions...The next week it wasn't possible to be ther everytime her sister called me. Often, I would tell her that I would come but then go away as something or the other always kept me. They did not complain much, seeing how busy we always were. She started runinng a brief fever but that went down after sometime...I honestly did not think too much about it.
On her 14 th day of admission, Professor finally decided to discharge her withh advice for physiotherapy and follow up. That night, I told her sisters " Tomorrow you will be free." Her sister asked me some trivial question about her ryles tube and I came back, not paying much attention.
Next day morning, with packed bags, she arrested.
Bottomline is: How many IC Bleeds can actually make it? I havent yet managed to find time to go through the literature. Neurosurgeons had ruled out any surgical intervention as a possibility. She had extensions into the ventricles as well. Then apart from Decongestants and Physiotherapy is there no other treatment for these people?
None of the IC bleeds I have seen so far has survived. They always collapsed. And it totally saps the energy of the resident managing them because they take so much time, planning fluids and ensuring physiotherapy and that terrible smell of unclean mouths....
Lesson of the day: Never encourage attendants into believing the patient will be back to normal. In our setting, with our pitiable nursing care, and limited resourses for personalized care, where the resident doctor has bags under his/her eyes catering to these people, its more sensible to keep watching without commenting much on future aspects.
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