a day at the emergency room

yesterday was my ER duty along with sambhav, from 8 am to 8 pm.

totally unready for what to do and what are the expectations from interns in ER, we just left after having breakfast.

sambhav was there earlier, coz thats him, he likes to be present everywhere earlier than the others. so when i got there there were a few cases only, some old man with COPD on nebulisation and a lady with abdominal pain who was waiting for the surgical consultant to arrive.

we started chitchatting and introduced us to the nurses and the MO on call.

then some patients started to come.

what we realised by evening is that patients come in hoards, and when its empty its empty, you hardly have one or two patients ever, its either 6 or none! :P weird isnt it ?

and all we had to do is do the forms, follow instructions from the MO / consults.

we had to make calls to the dept.s to send consults. we had to collect lab reports. we had to take history and do general examination and fill up the file with relevant data.

we could help the nurses with procedures but we were new, so they let us watch first.

i did my first PR exam on this old guy with urinary retention (big prostate felt!!)

(PR = per rectal exam, basically shoving your finger up the anus)

tried to cannulate a patient but didnt get the vein, so the nurse took over. next time might get it right! :)

by the time it was 7.30pm a load of patients arrived! one guy with serious head injury and bleeding came in moribund condition. i checked his pulse, carotid pulse was palpable, i checked his pupils , non-reactive !!

rushed to fill his forms, ran with him to CT scan his head. he had a big fracture and hematoma.

his brainstem had bleeding so when the neurosurgeon arrived he said, this patient will not survive!

we had to leave coz our time was over, when we left we hadn't seen anyone die under us! thank god!

we heard that this patient didnt survive as expected.

there was another patient yesterday, she was suspected of heart attack / acute pancreatitis. she was shifted to ICU, heard today that she died too!

sad!

got to learn so much in emergency duty!

this woman came with 3 kids. the girl in pink held in the mother's arms had a greenstick fracture to her right forearm .

assisted in her plastering.

sanumaya sister from the OBG ward. time passing down here with us early in the morning when the load was less.

she is a very nice fun lady. very helpful, very knowledgeable, knows who are keen and who arent and helps those who are to learn a lot.

sambhav was really good in handling the phone calls and taking the history and all.

didnt expect so much, impressed me to some level.

we might be able to do more and do better in our next ER duty i hope.

feeling the cervix

did the PV and PS examinations on a particular lady today with dr.talitha's help.

PS/PV is basically vaginal examinations using your fingers or an instrument.

felt a retroverted uterus and appreciated the 'retroversion' part of it.

HOD gave me and ken a job to fill in a long pending birth register. and this register is humongous!
we ended up doing that the whole day and it is still not done!

tomorrow i have my emergency duty with sambhav from 8am to 8pm.
lets see what happens, totally unprepared for emergency duty !

the slack days are gone.

yes, they are gone.

the slack days are when you are posted in OBG-miscellaneous duty.

you will just have to go to the OT and that too, not everyday, only on occasion when your name is on the list. surprisingly, mine was only there for like 3-4 times in the whole month!

i used this time mostly taking part in the expressions!

was one of the MCs the 1st day, then had a western dance on the 2nd day and an eastern dance on the 3rd day!

in the fete, i took part in the sack race and the 3-legged race and won 2nd prize in both! lol. was surprised myself that i won!

now tomorrow starts my OPD duty (ie, out patient department)

i'm with ken, tsering and sambhav. 

opd duty is also pretty cool. you dont have odd hours like in ward duty, you are off by 4.30 pm and you get 2 days off for 1 day of duty!

this is to accommodate all the interns in the dept, coz we are a lot of em!

lets see how tomorrow goes.

i have some idea about what to do, like receive patients and take their history (a big chore, coz i hardly understand what they say in nepali!).

then you have to present it to the consultants, and they will instruct you to either prepare them for examination or to send for some investigations.

you have to fill in the investigation forms, or in the other case, do the general examination.

internship started 2nd march 2009

my final mbbs exams were successful and i have passed with decent marks.
now begins the year of internship, where we'll be working in most of the different departments in our hospital through some point of time this year. after the internship is done we are due to receive our degrees.
i wanted to start a new blog for pics and incidences during my internship year.
so along with my previous blog, now i have this one too.

currently, i am posted in the Obstetrics and Gynaecology department (OBG).

the march crisis at MCOMS

so just into the first week of my internship in the OBG dept, and havent learnt much of anything, our hospital faces a crisis situation with a huge influx of patients. the other hospitals had apparently shut down due to a strike (which is a popular way in this country to solve problems).

so in the morning we have like 10 - 15 patients in the ward and by nightfall the number is around 60 - 70!!

all the inters in the dept get called for extra duties.

many of us gave in our best to help around, and many did not come. 

i stayed overnight once or twice too! and we learned such huge loads by delivering so many babies!

monitoring patients in the antenatal unit, those in labour. performing PV examinations. catheterising. putting IV lines. giving injections. conducting deliveries. giving episiotomies. cutting and clamping the cord. suturing the episiotomy wound. etc etc.

didnt do too much paper work though cause had little idea about the paperwork. those in the ward duty did that! anindita, prashanna, rashika, adhya and a few others.

overall had loads of fun, though it was an exhausting experience, giving up on meals and sleep and working in a taxing environment is not easy. 

thankfully, i have got a great bunch of friends as my colleagues.

looking forward to great camaraderie in the future.

the HOD called us all in his office yesterday, thanked us all for the extra hard work we put in.

thank god, all the deliveries and babies born were fine.

it was an amazing experience working and running the wards and labour rooms with the help of just 2 MOs and guidance from the consultants. we actually run the show!! and we had zoheb over there from paediatrics to resuscitate the kids born. he's my new room mate, so to look at each other working was great fun.

from the left, dr.Talita (or dr. T), HOD's wife mrs. Dey, dr.Gurpreet (or dr. G)

at the party in mahindrapul. all from OBG dept.

this was one of the first deliveries i saw, where they had to use forceps to remove the baby as the labour was not progressing! was quite impressive. saw dr.vijay do it and he's pretty good at using the forceps.

due to the prolonged labour, this kid was born with a big caput succedaneum! 

just some random cute newborn i came across while doing the rounds!

this is when the crisis period had started and we were called to help out in the ward. i was given the job of monitoring few patients in the 1st stage of labour.

anju neupane was my first patient. and i stuck to her. and monitored her diligently. she was a primigravida, i.e. 1st pregnancy. 

i had to monitor - fetal heart rate/sound (FHS), BP, pulse and contractions of the mother every half to one hourly.

i was entitled to help in her delivery too. i was prepared, i stayed overnight from the previous evening, monitoring and eventually she was shifted to 2nd stage labour room where deliveries are conducted. 

unfortunately, it was around 6 am and 4 hours of waiting and the labour was progressing. she eventually was decided to go for caesarean section and i didnt have the energy to stay up and go see that in the OT.

so i left for sleep.

next morning, i went up to see that she had given birth to this beautiful kid. her husband and mother kept smiling at me and thanking me as if i had done the operation. i guess just because i put in the effort to stay awake all night and monitor her, was enough to win the trust and appreciation of the family members. felt great, even though i didnt get to deliver her.

adhya sitting there in the labour room, waiting for the patient to deliver. she is a really smart girl both academically and practically. what you would call beauty with brains. she conducted that whole delivery herself and even sutured the wound left behind completely!

gonna learn that too myself soon, hopefully.

one night when zoheb was the paediatric intern on duty to resuscitate the babies born, there were two babies born simultaneously and with only one incubator, they had to share.

some said they gave a very cute pose, one of them hugging the other!

thankfully zoheb didnt mix up the babies with the parents!

tsering, one of us in the miscellaneous duty, got called up and gave in her best work too. these nepali interns have more work because they are always needed to converse in the local language with the patients for the other doctors and even some of us interns.

here she helped out assisting a delivery. happy as always.

i take pictures of people in the delivery room, but many are not like me and they dont take picture, so very few of mine here.

here, i'm sitting with the nurses in the nursing station. 

i believe, the nurses are more hard working and gave in a lot of their time and rest to work the dept and ward smoothly during the crisis. yet, they are not given enough credit for their work!

these are really sweet people here, especially in the OBG dept. very friendly.

right next to me is Rita sister. and then are some nursing students.

tushar is not in the OBG dept, he's in the surgery dept now. was here with geetanjali.

nitesh and geetanjali have OPD (out patient dept) duties now.

a few nights back, when prashanna and i were in an especially cheerful mood. took the newborn baby in our hands and danced around taking pictures.

yawning kid! not ours!