Tuesday, February 07, 2006

Triage Tales 6

Disclaimer: The following story is a work of fiction. All similarities to people, places, things and events are coincidental by nature.

As you will all know, I have this disdain for the system which relies heavily on the hapless first-time bantay. My previous post reflects on how they could be the source of much anguish.

But the worst thing happened - no bantay.

A 47 year old woman is brought to the ACU by a concerned citizen from the Anti-Rabies Unit. A vagrant, she was scratched on the left foot by a cat one month ago. Three weeks later, completely ignoring everything about hygiene, the foot swells and becomes tender. Cellulitis.

Social emergency - this patient definitely cannot be sent home because of compliance issues. Also, the foot looked damn swollen that it could rupture and all the blood and pus could ooze out any minute. (But that's just layman speak. I would be more concerned about sepsis, blah blah blah...)

She went to ACU at about 12:55PM and I told the good samaritan to get a stretcher. Lo and behold, the good samaritanship only extended to bringing the patient to the ER. He miraculously disappears. Needling the patient about the samaritan, she goes searching and comes back 5 hours later. And I waited for her the whole time.

What to do? I become bantay for two hours.

IV line established, blood samples taken. All supplies gratis from my tacklebox. (Usually we prescibe needs while doing this, so supplies are replenished for the next patient.)

Lab requests made. Pleaded with the Social Worker to talk to patient and assess her for a possible "White Card", the highest classification of need where some lab fees are waived. The other labs have to be paid so I went to the Senior House Officer to have them waived, too. (Bantays do all of this on foot.)

Brought patient to Xray. (Bantays do all of this on foot.)

Referred patient to Surgery. She was non-diabetic by history and by a CBG (in the 90s).

All in two hours. I am proud of myself.

While patient was being interviewed, I snuck out and called my girlfriend.

At times when I want to leave the program, change my career path drastically, or just plain go home, she is there to remind me that I need to stay and finish what I started. And for that, Joy, I loved the whole year our hearts have been together, and am looking forward to more and more years with you.

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