Story time... I cried in front of my patient's father.

So this happened around 4 days ago, I was on 24 hour duty at the ER. At around 12 noon I recieved a phone referal. A 12 year old dengue patient presenting with pleural effusion (fluid in the lungs) 1/17

The referring doctor endorsed the case. The reason for referral was PICU admission. The patient seemed stable enough, so I accepted the case. Fast forward 3 hours. 2/17

The patient arrived at our ER. Strong pulses, irritable but awake, but had a respiratory rate of 40s when the normal rate for this age is 20. I was a little apprehensive so I placed the patient on low flow O2 3/17

Referred the case to the pediatric intensivist and was advised to place patient on BIPAP a higher form of O2 support. However since the patient was considered a Covid suspect the hospital administration would not allow it. So the patient remained on low flow O2. 4/17

3 hours of intensive monitoring went by and the patients condition worsened. Respiratory effort increased while sensorium decreased. By this time I was already considering intubation. However I had a dilemma 5/17

This patient was 57kg, was not cooperative and had dengue. If I had the slightest amount of difficulty to intubate this patient and injured her airway, she had a high risk of bleeding. So I appraised the father that I would place her in a medically induced coma 6/17

The father was apprehensive. This might be the last time he would see his daughter awake. But I convinced him that this was the most appropriate course of action. I sedated the patient and intubated 7/17

But despite my best precautions, I was not able to prevent bleeding. And what's worse, when I inserted an NG tube fresh blood drained from the patients stomach and aside from that, her urine and stools were already bloody to begin with. 8/17

Her pulses weakened. The patient was in shock! I had to act fast and give IV fluids fast to compensate for the acute blood loss. And after an hour of resusitation her vitals stabilized. But we were not out of the woods yet. 9/17

Fluids would only do so much. The patient needed blood, and fast! So I called the blood bank, but they told me the earliest they could release the blood was in 2 hours. And I did not think this girl had 2 hour, but I was left with no choice. 10/17

It took another 3 hours before we could start giving blood to this patient. It was around 3am now. And while we waited for the blood patient still had a bloody NGT drain, bloody stools and urine, and now her eyes were also bleeding 11/17

At around 5 am her condition was looking grim. I appraised the father of a poor prognosis, but despite everything I assured him that we will do everything we can. At this time he was considering pulling the plug and take the patient home. 12/17

My heart sank, right then and there. This little girl, who I fought tooth and nail for, was going to lose her chance at life just like that. I understood the father's plight, but I couldn't help but feel emotional. 13/17

I don't know if it was because I felt very sad for them or if it was because I was tired and sleep deprived or both. I tried desperately to make him change his mind. I talked to him with tears swelling in my eyes. 14/17

I told him that despite the low chances there still remained a chance. A chance that he... We should cling on to. And maybe when he saw those tears forming in my eyes, he understood, that his child was in good hands and he decided to stay. 15/17

I don't know how to end this story. Maybe I just wanted to vent this all out. Maybe I'm just saying that as medical professionals, it's not always bad to show your emotions to your patients. We're all just people, despite the white coat and stethoscopes. 16/17

I guess Grey's Anatomy does get it right sometimes! Hahahaha!
End of Thread 17/17

Thread update!!!

She's alive and doing better!! Extubated and talking already!!

It's the little victories like these that reminds me why I started doing this in the first place.

Talked to this girl today... And here's how it went.

Me: ok na ka?
Her: oo *thumbs up and smiles*
Me: kaila ka nako?
Her: shakes her head
Me: (in my mind) haaay if you only knew...

But my heart was full 19/17

Talked to the dad one the patient was transferred in the regular ward

Dad: gang mao bayad ni imong doctor sa ER. Ni pirma na bya jud unta ko na i-uli na lang tika pero gi pugngan jus ko ni doc.

Doc salamat kaayu ha, wala kid ko gamahay na ni salig ko nimu

20/17

He asked if we could have a picture together before they left.

Being busy at the time they were discharged will always be one of the greatest regrets of my life.

But them being discharged will also be one of my greatest accomplishments

21/17 END OF THREAD