The Terrible Wednesday

It started out innocently enough but ended up as one of the days we’d really rather forget. After a fairly harmless Morning Worship (except for the very strange musical rendition of the Lord’s Prayer that we were treated to), we headed out onto the wards…luckily there was a staff nurse on my ward so I didn’t have to take charge as we have done lately, with increasing frequency, but by lunchtime my enthusiasm for being there and patience for the utter nonsense that goes on most days had completely disappeared. By the time we’d swapped tales of the morning’s catastrophes half an hour later, Ali and I just couldn’t face going back out but knew we couldn’t bale out either. We can see the attraction of hiding out in the offices a la our colleagues, but it won’t really get anyone anywhere so we shifted ass and got back out there, agreeing that hometime could be a smidge earlier than usual…

Well, that wasn’t to be…I got back to the ward to find 2 first years bumbling about in ITU trying to look after a lady who they’d fished out of recovery 30 mins before. She’d had surgery to fix a femur fracture but was now in a lot of pain. Her vital signs hadn’t been done (Madam, there is no BP machine) and she had no IV access (Madam, it is not working properly). They had tried to at least fix a new cannula but failed and the poor woman had little stab holes all over her hands and arms, which didn’t make the fact that she was in a lot of pain any better. She looked pretty dreadful. I must learn not to do it but for the sake of the patients I just can’t help it sometimes – I took over. I got the IV going, I went to get the BP cuff and stethoscope I use for teaching so we could do the vitals, I got the pethidine organised and the surgeon to review her. It infuriates me that everyone with any shred of responsibility seems to lose it between 12-2pm and patients and students are pretty much left to fend for themselves. How? How can this be allowed to happen? Before I could really think about it, another student sidled up to me and asked if it was ok for me to ‘escort her to her patient?’
‘Now, now’ I said ‘or can it wait 5 mins while I finish talking to these two about their surgical patient?’
‘No, now’ said the student.
‘Ok, whats wrong? Which patient is it, what is the diagnosis?’
‘She is my patient on female side. She came this morning, Madam from a far village with her husband and sisters. She is having malaria I think and blood transfusion because of anaemia’
‘Alright, so what is the problem now’ I ask.
‘I think you must come because the family say she is not breathing’

Oh, God – here we are again. I hate it, just hate it, walking down the ward, knowing I’m about to see some poor person who got here too late. I hate it because resuscitation is just not possible. I hate that someone has just lost a member of their family and there was so little we could have done to prevent it. I hate the fact that they are so accepting when it happens.

The student handed me the stethoscope, I listened to the woman’s chest, there was nothing, I looked in her eyes, they were still and dilated. I can’t certify a death so we then had to leave and find a clinician. I went to Paeds to see if there was anyone there, but there was just Ali having a crisis all of her own. I went to OPD but no one was either. I got back to the ward to find the on-call student clinician had pitched up and so he did the deed, swiftly and without any real sort-of feeling it seemed to me. A good 15 mins had passed since the guardians had told us she wasn’t breathing but still they were quiet and composed. As soon as the clinician said the words, announcing her death, tears sprung out their eyes and they sunk to the floor, wailing.

I’ve been around while the students have been doing last offices but I’ve not done them here myself and it was all familiar yet so different from how I’ve done it before. The creaking, gappy screens were wheeled in, the cannula was whipped out and bandages were tied round her hands and feet. The female family members took off their chitenjis and they were used to wrap the body. A trolley was brought in alongside the bed and we moved her onto it and covered her over with a thick, bright orange drawsheet with a cross stitched on it. A piece of paper with her name was sellotaped on top and off we went to the morgue, her guardians, and all those of the other patients following behind, singing their haunting song.

I really don’t know what I was expecting when we got to the mortuary – a white tiled room? A wall of stainless steel fridge doors? A sympathetic man in green scrubs ready to receive the body? No, no, no. I was handed a bunch of keys by one of the students and as I wiggled the door open I saw a small room, concrete shelves built into the wall, numbers 1-12 crudely drawn on in white paint. We pushed the trolley inside and I quietly shut the door on the gathered group outside. I wasn’t sure I wanted to let them see what it was like inside but maybe I needn’t have worried. The students didn’t seem fazed. We hoofted her onto slab of concrete no.7, signed the book and filed out. And that was the end of that – awful, horrible.

I don’t know what upset me most out of all that but I knew I couldn’t deal with whatever the next disaster. With tears pricking my eyes, I decided to go home but as I went back to my office I remembered I’d lent the key to the secretary, who was now not in her office, neither was the lady I share with and no spare keys about either…luckily she turned up not long afterwards. I tried to have a stern word with myself on the way home about being silly and getting over emotional about things but I just couldn’t do it – if I stop getting upset about the standards of care I think I should just jack it all in and come home.

I tried to take my mind off things by making some fudge for Kim’s birthday but it just made me cross because it wouldn’t boil for ages and when it did, some jumped out the pan and burnt me. Then it stopped boiling again. I realised that the hot ring wasn’t hot anymore and there was an accompanying smell of fish and burning plastic – the adapter plugged into the socket was smoking…The plug itself was ok but was a round pin one and without the adapter, or a new plug, it meant no more cooking…So I got out my trusty toolkit, cut the plug off the kettle and rewired it and carried on but I don’t think it appreciated the short intermission as it didn’t set and 5 minutes out of the fridge and it was a gooey sticky mess again.

The only good thing about The Terrible Wednesday was that as I got into bed I remembered that we had 4 days off…