Nod and shrug.

It always starts with a seemingly benign phone call.
“Doctor?  Could you come and review this patient? They’re a bit breathless.”
It’s been an easy day so far, I’m in a good mood, and not doing much so I wander down to the ward to find the nurse who called me wheeling an obs machine into the patient.
“He just doesn’t look right”  she says as I pull back the curtain to find a scared young girl and an old man in bed.  And she’s right.  He’s very very still, and breathing very very quickly.  I ask him what’s happened, notice the single word answers, and suddenly my easy day goes away and suddenly there’s just that tiny cubicle with the scared girl and the breathless old man.  I take a quick history with one eye on the obs machine which isn’t showing good numbers, and simultaneously nodding my head calmly like everything is going to be just fine.  I examine him, I listen to his chest, and don’t hear a whole lot which chills me.  The nurse is giving me one of those looks and I try to keep looking at him because I know the scared girl will notice our exchange of looks and I don’t want to freak her out further.  I switch him to some nebulisers and a better oxygen mask where I can better control what he’s getting, ring for a mobile chest xray, get a blood gas, all the while keeping my calm face on.  I check his fluid chart, notice 6 litres has gone in and only 3 has come out.  I give him the right drugs, wait 20 minutes.  More nebulisers, more of the right drugs.  More calm face.  His oxygen level only improves minimally, and all the while I tell him it’s going to be alright, that I think he’s fluid overloaded and an asthmatic and we’ll get him better.  After a while I start to wonder if I should be moving him to high dependency, I’m struggling so much with his oxygen needs, the girl still looks scared, and my calm face is hurting.

It happens.  Excruciatingly slowly it happens.  He gets better.  He breathes deeper.  He starts speaking in sentences.  The scared girl looks relieved.  Two and a half hours later he says he’s feeling 70 percent better.  He relaxes back into his bed a little bit.  I notice the scared girls pretty sari and the cubicle melts away.

10 minutes later my reg and the boss arrive, they’d been in a meeting.  I tell them the story and they nod and shrug.
“So did you save his life?” the boss asks with a half-smile.
I suddenly want to laugh.  What this guy had is one of the easiest, acute problems to treat but the treatment is life saving and when you’re not used to doing it, it doesn’t feel like a nod and shrug.  And it doesn’t always end that well.

I nod and shrug. She tells me to get another blood gas later on in the afternoon and we move on to our other patients.

I thought doctors were heartless once.  They’re not.  They’re just holding it together, for you, and for themselves.


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