Friday, April 16, 2004

Graveyard shift in the ER

It was 4.45 am. I was working the graveyard shift in the emergency department. The call that came in warned us: 2 ST elevation MIs coming in.
Mr. X was a guy in his 60s. Typical of a Minnesotan farmer, he was big, overweight to be precise. Pretty stoic, but he stingily offered his story, he was awakened by crushing chest pain. Never had it before. Never had any cardiac problems.
The EKG rhythm strip from the ambulance told us all we needed to know. ST elevation. The 12 lead confirmed it. We call it ‘tombstoning’ patterns, for the ominous meaning it held.
The CCU fellow assessed him in the ER. We did what we had to, and got him ready to go immediately up to the cath lab to have emergency angioplasty. Not bad, if you consider that he was wheeled in only minutes ago. He looked pretty comfortable. For now.

“Ohh, I don’t feel too good.”

I look at him, and find him ashen-faced. Suddenly he’s out like a lamp. Alarms go.
“V-fib!” someone yells. Essentially, unless we bring him back, he’s dead.

Charge to 200J. Clear.

His body jolts with the energy being pulsed into his chest. A small stream of blood trickles down his mouth, likely from his biting his tongue with the shock.
Normal sinus!

He opens his eyes. “What happened?”

He’s back, and 30 secs later he’s off to the cath lab with nurses and a cardiac monitor.
I catch myself thinking, this patient was dead and back in that 15 seconds. No chance a patient in Malaysia could have had this benefit. Silently, I say a prayer for him.

I wish I could offer my patients back home the same benefit. At the same time, I'm grateful that medicine has progressed, at least in the USA, to such an extent. I'm frustrated, that the dean of my undergraduate school in Malaysia, a hematologist who died of an MI while waiting in the ER of the University Hospital of KL, probably could have been saved had we had the resources.

Cath lab in 30 mins? What a joke. We don't even have crash carts there.

Friday, April 02, 2004


I just spent a month of elective in Malaysia (yes, medical residents in the USA have elective time as part of their training), working at one of the hospitals in NS. I must say that I left feeling terribly frustrated.
I worked in this 700-bed hospital, lacking in so much amenities, that it just made me sick. I suppose coming from my hospital of employment has something to do with this (ranked 2 in the USA, 1900 beds, 90 ORs, 3 helicopters). The 3rd class wards were just appalling. No private rooms, air conditioning, isolation (even for TB and methicillin-resistant staph aureus). The beds were 3 feet apart, separated by curtains. No privacy.
The ICU had just several beds. Lack of ventilators (a good friend who works there tells me that as a junior doctor you can get yelled at if you 'waste' a ventilator on a patient unlikely to survive. Basically 3rd-world wartime triage). No MRI scanners, and only one CT scanner. No cardiologist.
This pisses me off.
Because Malaysia is not that broke. We have money, but for reasons unclear to me, we spend millions trying to get the tallest this or longest that or get Proton in the book of records for functioning in bloody antarctica. And why, oh why, would we want to purchase Russian subs??? Just so we can show off to Singapore?
The corruption, or idiocy, of the powers that be, is just amazing. These people don't prioritize. And ultimately, the patients suffer.
I have seen so many cases, in the hospital, as well as know people personally, who died or suffered because we didn't have the proper facilities or expertise. Geez. I mean, they have to freaking send patients an hour from Seremban to KL for an angiogram!!! Can they not say "ST ELEVATION MI??" Here, a STEMI patient is rushed into the angio lab within 10 minutes. Stents are deployed within an hour, and patients who have had heart attacks are dismissed in as short as 4 days!!
You could count the number of defibrillators they have with your hands.
Of course, when Mentri this, or Dato' that gets admitted to the hospital, they stay in 1st Class. So why would they care?
I guess one must always see the bright side as well. Although the powers that be are totally brainless and/or corrupt, the people who actually work in the hospital are amazing. They make do with the lack of facilities, and improvise well. To the best of their abilities, they take care of their patients. I just hope they never see how medicine is practised in the US, for they will never want to return.