From the other side

The ambulance call

"Can you have a look at her?"

That morning I was awoken by distressed cries and loud bangs on the door. Her tongue was swollen, in pain, and she couldn't speak or eat properly. The ambulance was called.

Sleepily I sat on the couch beside her. Ironically, we had just revised the ALS protocols the previous day. Airway, breathing, circulation. Tongue was mildly swollen but nothing else to suggest anaphylaxis. No respiratory distress. Er, what else would cause this? I sat in silence, watching her cry and struggle in agitation, unsure of what to say or do, not knowing whether it was appropriate for me to examine her further or to try to calm her down. Sorry, I wish I could have been more helpful. Fortunately the paramedics arrived, and I watched in marvel at how they turned chaos into peace; just simple measures of putting on a saturation probe and listening to the lungs, or speaking to her in a calm but authoritative tone.

Greeting the second ambulance that arrived, I stood sleepily on the front steps, with messy morning hair, in my bright stripy pyjamas. Are you the patient, they asked. Is she your sister? What?! Being used to the assumption that I was part of the medical team (even as a student), I was taken aback by the question. Then, I struggled to give a concise briefing on what was happening, especially not knowing how much of her past history to say or omit with her there in front of me. What did I do all those long case presentations for if I can't give a one minute handover?

I reflected, was it the hospital (or clinic) environment, the medical gadgets there, the doctors and nursing staff surrounding me, that bestowed upon me an ability to think and management problems medically? Void of those, I felt that a layperson could have handle the situation more appropriately. Maybe that's why unlike some of my classmates, I'm not excited about the prospect of finding myself in the middle of an emergency on the streets or on the plane. Surely, had I been dressed for work, wearing the stethoscope around my neck, hospital badge clipped to my shoulder bag, walking down the Emergency Department, the same presentation would have been met with a more active response than simply sitting beside her once I worked out that there was no immediate risks to her life, and that she was far from needing chest compressions. Yet it still makes me doubt whether I can be a doctor at all.

The inpatient

"Doctors! They can't make up their minds," she told me in exasperation, about how her elderly mother with rectal bleeding was managed on the acute wards.

One day they prepare and fast her, the next day they say the procedure is too risky. One they they want to do the colonoscopy, next day they decide to do CT instead. Now they scheduled a PillCam for next week. Angiogram was planned and cancelled. She's working but visiting the hospital every day, feeling frustrated with the decisions that are being changed all the time, not certain of how long this will go for.

So that's what it is like from the other side. Not that patients and relatives don't express similar frustrations during their stays, but I guess it's different when someone confides in you outside your medical role, and when the person is closer to you. A reminder of why good communication between the team, patients and their families is important.


Ziph said...

During my recent ED rotation, I also started reflecting on what a tough job paramedics have.

As doctors, even in ED we have some idea of what's coming. Either triage or paramedics will give us advance warning so we can be prepared. Also, we have access to equipment and more importantly the experience of other health professionals.
Even with all this I still feel somewhat under-prepared when watching a resus in ED or the med reg running a met call on the wards.

Paramedics have so much less to work with and probably won't know what to expect at the site.

The only person who has a harder job is the person who sees the unwell patient and has to provide first aid on the site. I remember one of my first aid instructors saying, "First aid is a tough job. You have the least knowledge and equipment and have to do the most."

Winnie said...

cool, it's not just me who feels unprepared for next year... haha

I think I too appreciate the work of paramedics more through this experience. I was also thinking, just going into someone's house, you never know what's there, whether it's safe etc.

guess it takes a certain type of person to want to be at the frontline, I'm quite happy to only have to attend to those sort of situations (out in the community) very occasionally


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