Oct 16, 2012

He who gives life and take life.


It was my 1st week in Pediatric Department at RSUD Banyumas (main district's hospital), my first night shift. Fresh. I have this 2 months old baby coming with tachypnea, intercostal retraction, nasal flare, stridor and I was told that he often choke while being breastfeed. He had no fever, yet (thanks to my WHO pocket book) I was sure this baby was having pneumonia. After calling Dr. Tien to confirm the managements, I rushed to nebulize the baby. He had his nasal canule and nasogastric tube inserted but the whole night, till the next morning, I could hear him crying. The baby- Putra to be exact, able not to sleep.

Next day, he got fever too. After being checked by the specialist, I discovered that my dear baby patient also have laryngomalacia. Pity Putra... Born with laryngomalacia and now having pneumonia.. For laryngomalacia, the management is for the caregivers to find in what position does the baby look most comfortable in. Insya Allah, his laryngeal problem will improve within 6 months.

A week later, there I have my Putra giggling. He laughed when I tickle him while doing a check up. And I have that baby- talking moments I always love, miss and want to have.. It was wonderful to see him sleeping soundly at night.. His pneumonia was recovered. He was now adapted to his laryngomalacia.

Alhamdulillah.. Time for Putra to go home:')

Cute baby, Putra


He was the very first patient I handle almost from A to Z. His parents first lend him into my hand in such a terrible condition, hardly breathing and biidznillah, i now lend him to his parents, cured.. It's either I was touched because of such or I was too fragile as he reminds me of Fateh- I bursted into an ocean of tears to bit him farewell.. Doctors should be happy when patients can go back home, aren't we..?

Take care Putra dear..



*****

14th of October 2012. It was my night shift.. Around 6pm, after I had my dinner, I was told that 3 patients had just being admitted. The nurse told me that two cases were diarrhea with vomiting and another one was anemia. I first went checked the baby girl who was the nearest for me to reach and she looks very weak. While examining, I took a glance to another new baby girl patient of the same diagnosis. She looks well hydrated and quite fine so I head to the anemia patient.

Feri. He was the boy who was admitted about 2 weeks ago, diagnosed with Acute Myeloid Leukemia. Discharged last week, referred to RS Sardjito (a center hospital, located in Jogja) but the parents haven't brought him there yet.

Visually checked: Somnolent. Nasal flare and deep costal retraction. Orbital edema, bleeding lips, and gums too- as I could see his left cheek swollen. Distended abdomen. These indicate internal hemorrhage. Emergency.

Physically checked: Cold extremities, tachypneu, tachycardia. This boy was in hypovolemic shock state.

Internal hemorrhage + Hypovolemic shock = Super emergency.

I quickly told the nurses that we have to resuscitate Feri fast. 2 or 3 IV lines needed, best if we have 3-way IV line.

"Mbak Fiqa ini bernafsu bangat.."

I felt quite hurt. Yes. I'm extremely "bernafsu". Tell me, how could I be not "passionate" over a shock patient..?

They asked me to consult this to the residents first. I called our doctors, no answer. I called the laboratory to ask for his blood routine result. His result was not ready yet.. 

"Ini CITO ya."

Urgent. I clearly remember the hypovolemic shock patient I had with Dr. Titi days ago. I rushed to Feri, set that 1 IV line already infused to 20cc/kg body weight as fast as possible. I made a strong push. Pressing that Ringer Lactate hard and fast with one hand, and another hand tried calling Dr. Titi.

I finally able to call Dr. Titi. Yesss, shock resuscitation. I told the nurses and we ran over to that desperate boy.. Feri's mother told us that Feri previously asked to poo. No. Not this time, honey.. Whilst trying to infuse him another IV line, Feri's breathing dropped into apneustic state. His mother shouted. My heart shaken.

We rushed  him to the action room and that time, Feri was in an apneustic state. A huge, very huge number of his family members followed, observing from the outside together with the families of other patients.

How I wish they could go elsewhere..

Inside the room, his pulse was no longer palpable. I checked with stethoscope. Silent. I passed that RL pushing part to another nurse, and asked the other nurse to help me performing CPR. Feri was 13 years old, and even the cancer had taken a lot of his weight away, he has quite a tough body built. The small me climbed on the bed to gave a maximal compressions.

No improvement. No volunteer breathing at all. No pulse. I checked his pupils with penlight. Mydriasis.

"Lahaulawala quwwata illa billahil 'aliyyul 'azim.."
"Allah.. Tolong.. Ajar Pqa kena buat apa.."
"Feri.. Kuat! Kuat!"

Epinephrine bolus. CPR repeated.
No improvement. No pulse.
I checked his pupils again. Doll eye phenomenon.

Allah knows what I have in my heart. I stood still. Looked at the two nurses.
One of them finally whispered, but enough for everyone in that action room to hear;

"Sudah tiada.."

At once, the shout of cry exploding out loud. Very loud. Extremely loud.
Being that "doctor of the day"- it feels like the whole world was on my shoulder.

Ain came over. Allah knows how much I felt like hugging and crying on her shoulder.. But no, I couldn't. I hold my tears back, I swallowed my pathetic gulps and disappointment.

I looked at my watch. It was exactly 6.30pm. In less than 30 minutes, I lost a soul.. I called Dr Titi.

"Dokter, Fiqa ga bisa.. Feri plus."
"Ya.. Sudah Fiqa.. Fiqa sudah coba yang terbaik.."
"Ya."
"Nanti Fiqa terangkan kepada keluarganya.. ya.."
"Ya."

I called the laboratory. 

"Hemoglobin 5.56g/dL."
"Thrombocyte 2 x 10^3/mL."
"etc etc etc.."

Allah.. This boy was in an indeed terribly severe state..
May Allah place you amongst those of righteous, amiin..

I went out to find his parents. They were crying badly.. I went out to seek for his other family members and Feri's uncle volunteered to have things explained.. My heart soaked in tears. My eyes felt very warmth. No tears please. No. I explained things up, apologized and thanked his uncle with a plain smile. A smile as a closing curtain of a death news. Bravo Taufiqah. Bravo. So professional, eh..?

I went to take wudhu' and performed my solah. There, I bursted into tears. Great tears. It was great to finally able to cry. Great, indeed.

It's only to Allah I could let myself in..

I got another 3 new patients admitted that night. Diarrhea with a non- severe dehydration, seizure, and meningeal encephalopathy. No time to have that so- called proper mourning session over the death occurred just now. No space for tears or sour plum face.  After checking, stabilized, prescribed what were necessaries for them, and made notes of all 13 patients in that ward for the references of my friends whose having their shift tomorrow, I finally slept at about 2 am plus. With a tired body, tired heart. Pale heart.

"Allah.. Peluk piqa kuat2.."

*****

It's easy for Allah to give life.
It's easy for Allah to take life.

The Great Almighty, ALLAH.



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