Last Duty Syndrome Part 1

LAST DUTY SYNDROME... def: a)toxicity x 3 during last duty b)no sleep on shifting out day c)toxic Sunday duty

I have recently coined the term because of my experience in my Surgery rotation. Be it the ward, the ER, and the Operating Room. I usually have an uneventful duty, however with the recent events I have been forced to think that maybe, my last duty is bound to be a toxic one. parang binabawian ako sa benign-an ko. In non-med lingo, toxic roughly refers to something that is difficult, time consuming, or anything that is out of the ordinary hellish.

Take for example my duty in the Surgery ward on June 11. Being the intern on duty, we monitor 2 wards for Surgery, wards 2 and 4. The Surgery ward 2 and Medicine Ward 1 are recently being renovated so the old ward 12 (of Ophthalmology) has been converted into 2 half-wards to accomodate the patients.

Usually the patients in ward 12 were usually stable during our 2 week ward duty and we only monitored 13 patients for both wards that day. But on my last duty, (which coincidentally fell on a Sunday) as I entered ward 12 I saw the ECG guy leaving Bed 20, a middle-aged female who had breast cancer. So I thought, standard procedure before a scheduled operation. No biggie. As I finished monitoring the rest of the ward, I saw a group of people crowding around that bed.  Apparently, they had just called a code and the patient expired before I entered the ward. And this happened at around 2 pm, a time when most of the patients would be having their siesta. And in the interns' callroom, the other surgery interns would just be sleeping too.

6 pm.. PACU (Post-Anesthesia Care Unit) The surgery intern on duty is tasked to monitor the post-op patients every 15 minutes for the 1st hour and every hour thereafter.  You are also tasked to get blood extractions and other procedures.  My co-intern endorsed several blood extractions that he couldn't perform on an intubated combative neurosurgery patient. The patient was a 34 year old guy, intoxicated while driving his motorcycle and met a road accident, fell off his bike and hit his head on the pavement. the usual story for PGH ER patients.

As I was getting his ABG, he flailed wildly even when he was tied to the bed and his bantay held his hand. Horror of all horrors, the 1 cc syringe filled with the patient's blood, flew mid-air and hit my index finger near the nail with no/minimal bleeding.  Paranoid ako sa needlestick injury, my very first! I searched for his chart, looking for a history of Hepatitis B. What if may HepatitisB/Hepatitis C/HIV+ sya? Oh no!!! I got the patient's name and had to report it the Infectious Disease Section so we could run my blood and check for antibodies and test the patient's blood. but the next day was June 12, so the office was going to be closed. malas nga naman! shet last duty syndrome na naman ako. For several days after that, I couldn't think of anything else except my needlestick injury.

9 hours later, I was called to assist in the operating room for a triple A. What's an AAA or an aortic abdominal aneurysm? Basically, an aneursym is when a blood vessel becomes abnormally large or balloons outward. The abdominal aorta is a large blood vessel that supplies blood to your abdomen, the pelvis, and legs so when your aneurysm is at risk for rupture, it is definitely an emergency. I thought, isa siyang madugong operation! Get ready for the sight of gushing blood.

I was sleepy pa because it was 3 in the morning, and as I entered the OR, I saw a thin man, with white hair on the operating table. He was 84 years old, making the procedure more risky. He came in tachycardic at 120s (a fast heart rate). Even before the anesthesiologist could induce the patient, suddenly his blood pressure monitor dropped and went blank, his heart rate dropping in the low 50s. They palpated the arm for his pulse and couldn't feel any. I instinctively reached for the patient's neck and couldn't feel any pulse. Another code. Last Duty Syndrome. The anes resident handed me his stethoscope, "Doktora pakinggan mo." while the other one called the service senior. The junior anesthesiology resident said, "ito kasing intern natin last duty na daw niya ngayon!" He had to blame me, even in a joking manner. We ended up trying to revive the patient on the operating table for nearly an hour. The epinephrine was the only thing that's keeping his heart rate up.  Of course, if the surgeons proceeded with the operation, the patient will die on the operating table. After 5 epinephrine vials, the thoracocardiovascular surgeons talked to the relatives and they decided, to keep him on supportive care in the ward, if only to make the patient's condition a bit better until the eventuality of death.

I went down the OR at 5:30 am, feeling a bit defeated. tired.. 2 codes, 1 needlestick injury after.. In 1.5 hours, I'll be starting my 2 week trauma rotation, a Monday... the start of my new week. I have to change my mindset.

Comments

[Julius]

Todo! Kung magkaka-HIV ka na rin lang [knocks on wood], sa needlestick injury pa. I hope you'll be more benign than my benignest Last Duty Syndrome: zero patients on a Friday in Psych. Hello?! Psych?! Enjoy your last 43 weeks of internship!