October 05, 2004
Oz Medicine
The other night I was working a shift in the emergency department when the ambulance brought in a lady that had just been discharged from the hospital the same day who was having difficulty breathing. I heard a shout from behind the curtain,“somebody help me I can’t breathe!” I walked into the resuscitation area to take a look. I saw a large woman sitting upright inthe bed obviously having difficulty breathing. I introduced myself. I looked into her eyes. They looked glazed over. She answered a few of my questions with answers that drift off into uncomprehensible words. Then she gave me one final look before her eyes rolled back into her head, she slumped over in the bed, stoped breating and became unresponsive.
Practicing medicine in australia is different than the United States. The drugs are different. The terminology is different. The hospital I practice in is a public community hospital in a government system that provides free health care to all of its citizens. The hospital that I trained at in the states was a county general hospital that provided health care primarily to indigent adult patients. In the states I provided health care to people that I would probably never have met or run into outside of the hospital. At Launceston General Hospital, I routinely take care of one of the staff member’s family members. LGH is the only public hosptial not only for the city of Launceston but is also the major refferal center for the north, northwest and east coast of the state. Consequently, I take care of patients from all walks of life, socioeconomic backgrounds and ages.
The difference that I really enjoy is that Tasmanians are fairly laid back. Patients are very patient even when they have long waits in the emeregency department. I think there is the view that health care is a service provided to a citizen and not to a consumer. People are eager to chat with me once they recognize my American accent. Patients are fairly apperciative and almost always polite. Even patients that are drunk are usually polite and well mannered.
The differenes that I don’t enjoy are as a public community hosptial, resources are limitied. I can’t order tests as freely as I would in the United States and after a certain time I have to call people back in from home for everything from basic x-rays to lab tests to CT scans. Therefore every thing has to have a really compelling reason. There is no radiologist on call in the hospital that I can consult for advice on a subtle x-ray finding. There is a different practice of medicine in terms of willingness to take risk and certain evidence-based medical practices.
Overall, I am still learning what is expected of me and how to get things done. It has been a great learning experience to practice medicine with a very different patient population often with interesting and challenging medical problems that I have seen all too infrequently in the states. I have met wonderful people and have an eclectic team of nursing, physicians in training and support staff to work with.
Back to the patient. I checked fo a pulse. No pulse, no breathing. We started CPR. We started two intravenous access lines, checked glucose, gave oxygen and breaths by bag valve mask for the patient and cpr continued. I looked at the heart monitor. No electrical activity. No pulse. No respiratory effort. The patient had died. We give adrenaline IV push. Once. No change. Twice. A pulse came back. The patient was still not breathing. I placed an endotracheal tube into her trachea and we administered oxygen and breaths for the patient through the endotracheal tube. The patient heart was beating again. I called the ICU physician for the patient to be admitted. The ICU physician comes down to see the patient. Her pulse slows again and stops. I gave another dose of IV adrenaline. The Pulse returned. We did a quick head to toe check again. The pulse faded away and disapeared again. We started CPR again, gave IV adrenaline and started an adrenaline drip. We continued the process four times losing her and getting her back again. Finally she seems to have satbilized enough that I thought she could go up to the ICU. I sat down with her son who was anxiously waiting in the waiting room. I explained how sick his mother was. I explained that she had stopped breathing and her heart had stopped a few times and that we were doing everything we could for her. I let him see his mother before she was taken up to the ICU. I inquired to the ICU physician a few days later and to my suprise, she survived neurologically intact.
This is the reason I went into emergency medicine. Sometimes I get discouraged because I see so many patients at the end of life that despite our best efforts die. I try to provide quality compassinate care to every patient I see but I’m there for the people in crisis. The people that are the sickest.
Posted by at 6:47 pm
Wow, man… Wow.Wow.
timsamoff () (URL) - October 05, 2004 at 10:56 pm
Bro – Once again – the reason your butt is flying back to the states if I ever need a ‘real’ doctor. You’re the best – as I’ve said before – your personality is refreshing, for sure, for patients that are blessed to have you as their doc in that crazy time of need… glad you’re my friend!jason () (URL) - October 05, 2004 at 10:58 pm
Rob,Thank you for sharing this story about your experience. I admire your knowledge and intellect but more importantly your heart and compassion. I hope that you and Erica continue to have a wonderful experience. We miss you and can’t wait to see you again. Take care, Love Rick, Paula & Christian
Rick Lay () - October 12, 2004 at 6:59 pm
ok – you have to come back home and live near me. you are the only person I want to see if I have an emergency.sach () - October 14, 2004 at 3:46 pm
Alright Cupp – what about me? I know I’m a radiologist, but am I really chopped liver? Hehe.p.e.horner () (URL) - October 15, 2004 at 06:59 am
