A Night in Casualty

Night-shifts were a part of our EMR (emergency medicine registrar) posting and we thoroughly enjoyed them. We liked the kind of work that was assigned to us and were also able to understand how patients should actually be managed in an emergency setup. Besides, it was one month of legal 'night-outs' - with very little or no work after 3 am. After 3, it was five hours of complete non-specific gossip and nonstop laughter. Missing those days [:(]

A night in the Casualty is never like that in the EMR. You feel like a hermit trapped in a forest from where you can’t escape. You are doing nothing, just issuing ‘case papers’ and not even remotely concerned with the patient management. This was how life was in the last week:

After a long OPD in the morning where at least five multi-drug resistant tuberculosis (MDR TB) patients coughed on my face, Casualty was next on the list. There are usually two interns at night in the Casualty, unless of course one decides to escape. Luckily, that didn’t happen. We were two of us; the Casualty Officer allowed us to divide and my co-intern went off to sleep at 12 midnight. He was told to relieve me at 4.00 am.

Soon after he left, the horrid exodus began. One after the other, patients arrived and demanded immediate attention. I was examining a kid who was down with fever. Since he was really young, I was dealing with him first as you can never take chances with paediatric patients in the casualty.

There was no looking back – entered a lady with a breathless kid in her arm. The kid was only 3 months old. Rush! A woman with severe giddiness was brought by four relatives. Each relative was holding a limb – they didn’t even care to arrange for a wheelchair. A young married girl entered with a deep cut on her wrist, exposing her tendons. Obviously, I realised that it was a suicide attempt; her scared husband was dangling behind. Hesitation marks around the cut were confirmatory. It was a police case and the Casualty Officer was busy noting down the details thereafter (I had to wake him up!).

A hefty middle-aged man arrived with a towel covering his ear. The towel was soaked in blood. He had a fight with a guy in his neighbourhood sometime back. The fellow with whom he fought took a knife and chopped off half his ear. A lady in her forties came with a deep gash on her palm. She claimed that she cut herself while peeling an onion. I couldn’t believe her story because I did not find any reason why a female should peel an onion at 2.00am. Anyways, there was no time to argue with her.

There was a loud noise outside. It was the siren of an ambulance. Correction – there were three ambulances carrying accident patients. Within seconds, there was a flurry of footsteps and wheels of a trolley were heard clearly. A man was brought with multiple fractures on his left leg and a head injury. As I got up to examine him, another trolley was brought in, with a woman in a really bad position. She was trolley no. 1’s wife. As soon as I saw her vomiting blood, I handed the police ‘pink slip’ and she was immediately escorted to ESR (emergency surgery registrar).

‘Pink slip’ is given by the Casualty doctor to any patient needing immediate attention. For patients who are really critical, where one can’t waste time issuing a ‘case paper’, pink slips are used.

Next second, another wheelchair was dragged in the casualty. It was the third accident patient, involved in the same mishap. He was bleeding profusely from his skull. A young boy, around 17 came with his friends. He had fallen from a staircase and an iron rod made a 3 – 4cm hole in his lower back. A girl hurt her eye while playing with her friends. Her friends threw a stone that hit her left eye causing a grievous injury.

At 4.15am, I couldn’t sleep. I was in the hostel room with darkness all around…

[…looking forward to ESR where I’ll play a role in patient management. I hope I get the same (/kind of) co-interns like in EMR.]