Emergency: "A serious situation or occurrence that happens unexpectedly and demands immediate action; a condition of urgent need for action or assistance"
I am not sure that it is possible to marry these two ideas as they seem to directly oppose each other, but something needs to change in my department, appropriately named "Casualty". The saying throughout other departments is that "they are too casual in Casualty." While I believe this attitude is widespread across the hospital, my goal is to at least make some improvements in our department.
The week brought many frustrations in this area. There certainly is no sense of urgency in this culture. No vital sign is alarming. No lab is stat. No medicine is critical. To me, all of this says: no patient, no life is important. As is customary when I arrive to work, I usually find a few patients in desperate need of attention. I found this chart on the desk:
No one seemingly aware of who this patient is, where he/she is, or that there is anything terribly wrong with those numbers on the page. Already, the patient had been sitting somewhere for 30 minutes without any intervention. Granted nearly every patient here is terribly sick...cachectic and wasting away from AIDS, has a decreased level of consciousness, is actively bleeding, or has bones where they shouldn't be...I would be pleased with some hint of awareness or concern regarding the degree of illness in Casualty.
I found this patient sitting in the waiting room, a young woman weak and pale. It became clear after my examination that she was in shock from a septic abortion. In the Kenyan culture, women often have little control over their sexual lives which leads to many unwanted pregnancies. Once pregnant, everything rests completely on the woman's shoulders as the sole individual responsible for the care of the child. Often in times of desperation, women will go to unskilled traditional providers to try to end their pregnancy which is very unsafe and often fatal as was for this woman.
While I worked quickly to get her fluids and antibiotics, she needed more. The lab wouldn't answer the phone to come do a point of care hemoglobin as well as the tests to get her blood for transfusion. The nurse then sat down as if we had done all we could do. After asking her to run the blood down to the lab, I just got a blank stare in return. I also asked if we could call the OB/GYN to come see the patient and take her to the operating room. The medical officer stated that usually we don't call anyone; she will just go to the ward where the team will review her case and then take her to the operating room. Knowing how the wards work here, I know that is not true...maybe the patient will be seen later today or maybe in the morning during rounds. She needed immediate attention and operative treatment. I called the ward, but all the doctors were at lunch. Despite trying to page them, no one answered. While I don't know if the outcome would have been any different, it is hard not to feel as if we failed this patient.
I left angry, frustrated, and tired. Some days I just want to take a poll to see why people are even in this line of work. If I knew why they do what they do, I would at least have a source of motivation for them. I want to push them in a way that they will respond, a way that is a little more emergent and a little less casual.
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