Translator's Note: Only Chapter 1 is available from now on. I will not publish the rest. Please buy the official English version once it is out. More information will be announced soon.
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Thud!
It was the sound that woke me up from my slumber. I jerked up from leaning over the table to sit up straight. I looked around me and for a moment I thought, where was I.
"Dr. Tin!" Someone's voice calling my name has seized my attention. I looked at Nong(1) Aim, and saw the young nurse was placing her hands on the table. Then I realized that the sound I heard earlier was from Nong Aim who was trying to wake me up by knocking the table. "How could you sleep when there's a war outside? Could you go out and help the others?"
"...Really? I'm sorry." I bent down to take my favorite black edition stethoscope that had fallen down from my neck onto the floor a while ago. "Phi(2) was only going to eat for 10 seconds and return. Didn't think that I would fall asleep like this."
Nong Aim glanced at my dish that was almost left untouched, and sighed. "Ao, you fell asleep instead while eating. Dr. Tin, are you alright? Do you want to take leave?"
I stood up and hung the stethoscope on my neck. "Even when I'm not okay, having a cold, diarrhea, fainted, or getting hit by a ten wheels, I can't rest if I'm not dead." I turned to Nong Aim who was standing with her arms crossed in front of her chest. "Even if I die, I must revive myself and come back to work."
Nong Aim laughed a little, "You are so funny, now get out!"
I gave her a mocking salute, stepped out and turned around the small pantry next to emergency room (ER). I tried to fix my dishevelled hair which had not been taken care of for a while. My current life was like the worst moment in my life since I was born. I stayed up late to finish my case(3) conference that was badly criticized by my professor. Then I had to work the morning and afternoon shift without a break. Did I make the right decision about continuing my study in the emergency medicine?
But soon it would be my last year as a resident(4) in this hospital. Only some time left, then I would return to work at my hometown hospital.
The first thing I saw after walking into the ER was a chaotic war. An old man was pushed on an emergency bed in front of me. Nong Gap and Nong Pin, the first and second residents were running between the beds. Two externs(5) were in no different situation. One was running to pick up the new case that had just passed in front of me. The other person saw me and made a face like he just saw God.
"P'Tin!" It was Nong Wan, calling out my name loudly. "Please help me!"
I rushed to Nong Wan who was watching the middle-aged man who had difficulty in breathing. Nong Wan was an extern who had just started to work in the ER for a few days. He was still lacking of experience in dealing with emergency cases. It was my duty to help by teaching and assist them in this field. "What's the case?"
"A 52 year old man suffering from asthma. He had a bronchodilator(6) and a spray. He felt tired for 20 minutes before coming to the hospital. The first vital sign was a rapid heartbeat, oxygen level 94% and there's a wheezing sound in the lungs. So I ordered the nebulizer(7). He has consumed three doses but he's still tired. But the oxygen in his blood looks good."
"Yes it is, but he still couldn't breath well." I took my stethoscope and listened to the uncle's lungs. I heard a loud wheezing sound in both sides. The heart was beating so fast. "Uncle must use his abdominal muscle to breath. This is a sign of respiratory failure. The oxygen level is fine, but uncle is still very tired. You need to put on a ventilator(8)." I told the patient. He nodded his answer as he was unable to speak. "Insert the ventilator. Get a tube no. 7.5 with 10mg of valium(9)."
"No. 7.5 with valium!" A nurse responded to me and rushed to get the equipment. A young nurse aid ran to take a mask with ventilator balloon and connected it to the oxygen tank professionally to prepare for the job.
"Wan, you've put it in once right?" I turned to Nong Wan who went to stand by the head of the patient.
"Yes, I have." Nong Wan got ready to put on the oxygen mask on the patient. "But phi, please stay here to assist me. I'm afraid if I can't put it in."
"Okay, phi will stay here." I looked around to see if there is any case which needed to be concerned about. If this case was done, I would go see every bed if there was any that can be cleared out from the ER. After the sleeping drug has started to take effect, Nong Wan also positioned the patient in a pose which he can see the respiratory tract clearly. He used a tool which resemble a sickle blade and carefully placed it to enter the patient's mouth and then drew it up. Ai'Nong(10) seemed used to it and has experience putting in the tube before. Probably there was nothing to worry about.
More than half a minute passed by, there was no sign that nong could make it.
"Did you see it?" I asked Nong Wan's hand that was holding the blade started to shake.
"I don't see anything, phi." Sweats appeared from the young extern's forehead. And then not many seconds afterwards, there was a loud beep sound coming from the monitor screen. The patient's oxygen level slowly reduced from 90 to 80, and then 70 respectively.
"Hey, squeeze the AMBU(11) first." I quickly told nong to help the patient to breath by squeezing the balloon because the situation was not good. "Phi let you do it again. If you still can't do it phi will put it in alone."
Nong Wan brought the blade out from the patient's mouth. He raised his arm up to swipe the sweat from his forehead and picked up the mask to cover the patient's mouth and nose again.
"An unconscious patient coming in!" Someone's voice attracted everyone's attention in the ER. I saw a group of people ran together to take a look at the accident patient on the bed. The patient was a young man, placed on an orange spine board bind with the straps. His neck was cast temporarily and his right leg was spliced. I looked at the asthma case and turned back to the patient. At least Nong Pin, the second resident, also ran to the patient made me feel relieved.
"Wan, go help Pin. Phi will put in the tube myself." I told nong to go and see the accident case. I quickly put in the tube and then I would join them to help. The young patient should only be unconscious, but his heart should still beating. I wore my gloves and took over Wan's position. I helped to recover the patient's oxygen level until it rose more than 90 and hurriedly put in the tube.
Damn...it really could not be seen. This case was hard.
"The patient's heart stops beating!" I looked up. Did the patient's heart stopped beating due to the accident? I wanted to go and help but I also could not leave this case. Nong Pin was a skilled person. I knew that she could manage to save the patient's life properly.
I spent a lot of time with this uncle case. But with a God-like hand, finally I was able to put in the tube in my second attempt even though it was hard. After I have connected the tube to the ventilator, I hurried to the telephone and contact the resident who was on call in the ICU to receive the case.
After the uncle's condition was stable, I ran to see the accident case that arrived just now. A breathing tube had already been put on the young patient. The pulse has returned to a satisfying rate. Blood pressure was low. Nong Pin came to report the case to me. She was a year younger than me. Usually she was very pretty and brighter than this. But today's shift made her hair look messy.
"A 23 year old male patient in a motorcycle accident which he has fallen down on his own. When he was rescued, he was already unconscious. Vital sign is good. Only has a quick heartbeat. When we started the assessment, his pulse suddenly stopped. EKG is PEA(12). He had 2 cycles of pump(13) for the pulse to return."
"He's still young. What could be the cause?" I looked at the monitor and ponder.
"Pin thinks it's because of blood loss. But there's no external bleeding. Only the right leg is broken. Pelvis bone looks okay. The lungs are also the same. There's probably an abdominal bleeding. I'm about to do the ultrasound."
"Yeah, go do it. Don't forget to prepare the blood quickly. And monitor the EKG. Get a nong extern to call for a surgery. If his relatives come, phi will speak with them."
"Understood." Pin nodded then turned around to talk with Nong Wan. I was certain that Pin would be able to take care of this case. Then, I walked to other beds and sent whichever case that was in serious condition to be warded while sending the ones who got better home. I wrote in some documents for those who have to sleep in the hospital before sending them to the ward. I might be in trouble and get cursed at for sending many patients to the ward because they did not have more room available.
"There's no pulse anymore!" Nong Wan shouted out while I was on the phone consulting a matter with a medical instructor. Nong Pin ran to the patient so I felt confident to let her handle it again. I decided to finish consulting with the instructor before joining her to help.
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30 minutes passed. The case has ended with the cries of the patient's parents.
Two nurses entered to help clean the blood-stained patient. The tube, saline stream and the monitor has been removed. Since the patient's heart has stopped beating, it made us unable to bring him to the CT scan(14) or to the surgery room. I did not know what damage has happened to the patient's body. I would probably find it out from the autopsy result.
I stood up looking at the lifeless body in front of me with a broken heart. The patient was still only a student. He had a good complexion and appearance. He should be famous in his faculty, became the national future and the hope of his family. But he had to leave this early because of a motorcycle accident. I sighed deeply to expel the exhaustion and quickly walked away from the area. I went to the new case that just came in.
This was a situation that I must encountered everyday. Get used to the failures and continue to help save other lives.
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"I'm so tired." I cried out. I was inside the break room, stretching my shirt down to cover my exposed belly. Ai'Gap, the other resident pulled his shirt off completely to the public eyes. Our uniforms consisted of a blue shirt and pants. The hospital logo was on the left chest. I had another uniform to change when the outer shirt was splashed with blood. This was commonly happened in the ER.
"Stop the show and sit with me. My legs will break, and I'm going crazy."
I glanced at the clock, it was half an hour past midnight. I sat my sagging physique on a chair next to the exhausted Ai'Gap. "Don't complain. I will return for the morning shift. Poor me."
The morning shift would be from 8 am to 4 pm. As for the afternoon shift, it would be from 4 pm until midnight. I must wake up again tomorrow evening. I yawned again. Face fell down on the table. I would have to drive back to the condo I was renting not far from the hospital. I was not sure if I had more energy left to drive.
"As for this case, what might caused it, phi?" I heard Nong Wan's voice.
"There's bleeding inside. Phi saw a bruise on his belly, and it felt hard when phi touched it." Nong Pin talked as well, her tone of voice showed she was deep in thought. "There wasn't enough time to do surgery on his abdomen and save him."
"Hoh, Gap didn't see the case entirely, or I can be crazy about the case and join them. Now my eyes feel sleepy. Gap will go back, hia(15)." I feel a hand tapped my arm, followed by the sound of a chair skidded.
"Phi, I'll also leave." Nong Pin said. "See you again na, P'Tin."
"Yeah." I groaned with my face still on the table. I thought I should take a nap before driving. Or my body would become a case for the night shift. Before my brain switched off, the face of the young man who has encountered the bad accident flashed into my mind. I thought it would not disappear. But like I said, the young man was not the first person we could not save.
When everyone left the room, I entered my slumber easily.
To be continued..
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Glossary
(1) Nong: The proper term to address someone younger, which translates as younger brother or sister. Also used as first person pronoun, which is "I" and "me".
(2) Phi: The proper term to address someone older, which translates as older brother or sister. Also used as first person pronoun, which is "I" and "me".
(3) Case: A particular instance of a disease or other problem, sometimes used incorrectly to designate the patient with the disease.
(4) Resident: Doctors in training, have graduated from medical school and been awarded an M.D. degree, and now are training to be a particular type of doctor in certain department. Dr. Tin was an Emergency Room resident doctor.
(5) Extern: A nonresident doctor or medical student who assists in patient care in the hospital but does not reside there.
(6) Bronchodilator: A type of medication which commonly used in treatment for asthma, makes breathing easier by relaxing the muscles in the lungs and widening the airways(bronchi).
(7) Nebulizer: A medical device that turns liquid medications into a fine mist, allowing for easy absorption into the lungs.
(8) Ventilator: A medical device that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently.
(9) Valium: Other name is Diazepam, is a medicine to treat anxiety, seizures, alcohol withdrawal syndrome, muscle spasms, insomnia, and restless legs syndrome.
(10) Ai': A term in front of a male's name used by adults to refer to a younger male with affection or intimacy, or to show disdain.
(11) AMBU: Artificial Manual Breathing Unit, which is a bag valve mask used to force air into a patient's lungs.
(12) EKG is PEA: EKG or ECG, is an Electrocardiogram, a line graph that shows changes in the electrical activity of the heart over time, made by an instrument called electrocardiograph. PEA, Pulseless Electrical Activity is a clinical condition where there is a lack of a palpable pulse, which means cardiac arrest.
(13) Cycles of pump: Involving CPR or Cardiopulmonary resuscitation along with Defibrillators to restore the normal heart function.
(14) CT Scan: Computed tomography scan is a medical instrument that combines a series of X-ray images taken from different angles around patients' body and uses computer processing to create cross-sectional images of human anatomy. In short, CT scan images provide more detailed information that X-ray images.
(15) Hia: A term used for older brother instead of phi and is slightly more intimate and familial.
Sources: Google feat personal knowledge.