This story took place some 5 months ago, and yet, I am unable to get it off my mind. I guess this is just like one of those experiences some doctors talk about that they are unable to part with.
I was a surgical intern in one of the hospitals, in country A (I'd like to leave out the country as it may offend some of the readers). In this hospital, and it this country, living by a hierarchy is above all else. With this understanding, let me begin my dreadful story...
It was a Sunday morning, about 8.30am, I was in the ER arguing with a junior resident that his method of treatment for active tetanus infection was lacking one drug which was recommended by WHO for "this" country. It wasn't a fruitful discussion, but at least the junior resident now knows what he lacks and hopefully, someday, will take it up with his seniors to follow the improvised WHO treatment plan. A sudden rush in the ER caught our attention as I saw 4 nurses wheeling in a patient of his early 50s, with obvious breathing difficulties. Naturally I jumped to measure his blood pressure which was low, and immediately started him on fluids to sustain his pressure within normal limits. The patient had subcutaneous emphysema on his neck and arms with crepitation (a term more familiar with fellow doctors, which means he had ruptured an organ that contains air in his body and the air is now in his skin). I looked up at the junior resident and suggested it could be a possible rupture of the esophagus as the patient also had some broken ribs. The junior resident agreed with me and as we prepared for an emergent mediastinostomy (a puncture into his chest to relieve the air from causing a block for the heart to pump efficiently), a procedure the junior resident was pretty competent with, the senior resident walks in and stops him! He tells us in his SLOW lazy voice that we are wrong and that an x-ray needs to be done first because this man had ruptured his rib cage and so he might have a bleeding chest (hemothorax).
As angry as we were, the junior resident asked me to help him get this patient into x-ray and stay with the patient to ensure adequate blood pressure is maintained. I got a fellow intern (my friend) to help me get more fluids and help this man with his chest x-ray (which should not have been done at all as it wasted time and was dangerous as we could have caused his broken rib cage to puncture his lungs). The senior resident walks into the x-ray room and as we're about to leave, he says we had to repeat the x-ray pictures of his broken leg bone in his lower leg! I insisted we get this man out and drain his chest of the air to save his life, but I was shut off (because according to hierarchy, seniors don't take advice from interns or juniors).
This patient lay there breathing shallow and looked at me, "please just call my family, I'm not going to be here long", and I replied, "hang in there sir, I know what is wrong with you and we're all going to help you. I am here for you." I wish I had brought his family into the ER instead.....
The x-ray took an hour (which should have only been 10-15 minutes)! It is now 9.30am and the patient gets hesitant and starts struggling with his breathing. He is extremely anxious. Now I looked at the senior resident who was busy teaching my friends (other interns) what a pneumomediastinum (air inside chest cavity) looks like (an x-ray was not needed to see this as it was pretty clear from the physical findings as I had pointed out earlier, and of course, there was no HEMOTHORAX), and I said to him loudly, "now can we save this man?". The senior resident laughed at me and said I needed to learn to relax. He got his team (along with the junior resident I was working with) to do a mediastinostomy. But it was too late .... 9.35am, I was holding this patient's hand and saw him take his last breath. It was too late. The patient's rib cage did indeed puncture his lungs. The last minute resuscitation that took another 15 minutes thereafter did not bring this man back to life. I stepped back, looking at it all....
The junior resident stands next to me, eyes filled with tears and says to me, "you must think we are slow in handling our patients in this hospital", and I replied, "No, your hierarchy system killed this man today. You are part of it, as am I"......
