The Last leaf – by Tom Houtman
In Việt Nam, we have a national holiday in these days. The April 30th is the anniversary of the end of the war in my country, this day is unification day of my country, and the May 1st is the May Day, the Labor Day. We have 2 day-offs.
Of course I can have my holiday with free mind, with nothing in my mind, absolute at ease. But yesterday was my duty day, I had my responsibilities at my hospital. That was really tire and onerous day, and this morning I came back home and took a sleep until noon but with trouble in my mind.
Actually, I have my duty at hospital every eleven – days. It is really a long time because the doctors in the other hospitals have their duties every 4 or 5 days. But the hardness in my duty is only a team with eight doctors have to assume responsibilities for the whole hospital. In general, we can afford to finish our duties, but sometime we get in trouble.
Last night, I lost a patient. Yes, I felt true regret about that. This is a middle age woman with recurring breast cancer after surgery and radiation therapy.
The first time I meet her when she had breathing difficulties (dyspnea). She said she was exhausted and had chest pain. My diagnostic was angina pectoris (in Vietnamese: đau thắt ngực) (myocardial ischemia). It was just my diagnostic without proof. I wanted to have patient’s ECG (ElectroCardioGram) (in Vietnamese: Điện tâm đồ) , but I couldn’t because they didn’t have any thing to record ECG in this department, and the nurse she didn’t know how to record an ECG. In fact, I could try to have patient’s ECG by asking the resuscitating unit help me to record the ECG but I didn’t try. This is my fault and now I feel sorry about that when I am writing this entry.
I decided to let her respiring the pure oxygen and to prescribe some anti-anginal drugs. After 30 minutes, I came back to visit her, she looked better and she told me that she felt pretty good. Actually, she was still in tachypnea at about 40 rates per minute. At that time, she could set up on her bed and talking with her relatives. No one knew what would happen. But, suddenly she lost her consciousness when her son helped her laying down. I accidental passed there and the nurse grabbed me. I went to her bed, tried to awake her, but she had no respond. I checked her vital sign and found nothing, no chest movement, no breath sound, no carotid pulse. At that time, I knew I could lost a patient. I started chest compression immediately, and asked the nurses help me. I asked intravenous adrenalin. I needed endotracheal intubation (in Vietnamese: nội khí quản) for this patient, but I was really not (proficient in) familiar with this procedure. It was my fault too. Finally, I asked to call the nurse in the resuscitating unit to help me, she could do this procedure well. I was still continuing my chest compression, but I didn’t have the monitor for monitoring the heart beat of the patient.
After 20 minute of endeavouring, we didn’t obtain any result. Everything was late, we couldn’t save our patient.
When my older colleagues knew what happened, I was blamed because many things. The first why I hadn’t asked any other doctor to help, the second why I hadn’t tried to have patient’s ECG, the third why I hadn’t consulted with the colleagues of the Gia Định hospital – the neighbouring hospital. Yes, many things. I know I had got many mistakes in this situation, but the most important mistake I have that my knowledge and my skill is very bad. I didn’t pay enough time and endeavour in training myself. I am really bad at internal medicine (in Vietnamese: Nội khoa), and critical care medicine.
You know, my hospital is a specialist hospital in cancer. I feel when the patient and their relatives come to my hospital they seem to be in forlorn hope. They think cancer is really a fatal disease, no more chance for them to live. I feel that they are easy to accept their death and their relatives’ deaths. And the horrible thing I feel that I am easy to accept our patient’s deaths too. I am getting accustomed to laying the blame on the cancer diseases. I don’t pay enough attention to train skills in critical care and internal medicine.
Another thing I want to mention that our difficulties in equipment for patient’s resuscitating and life support. The problem is that we need more money and we need more help because these equipments are really expensive whereas our hospital is a public hospital and we don’t have much money. Our patients are often in working classes, they hardly afford enough for hospitalization and treatment expenses. The hospital fee must balance with the average living standard. Hence, we can’t have the high hospital fee.
Finally, I know I can’t blame everything on the difficulties I meet. The difficulties can’t be resolved in a few days, but I can overcome the obstacle by more studying.
My Log-book 