I closed my eyes, asked the Holy Spirit, and He told me to give digoxin, I ordered digoxin, and my team was scared because this would be their first time to give this drug. I reassured them that I would take full responsibility and not them. So, the drug was given. I was standing right there guiding them in the administration of the most dangerous drug in emergency situations.
As was ordered by the Holy Spirit, the patient responded, heart rate dropped from 150 to 140, Blood pressure picked up to 100 systolic, respiratory rated dropped down to 40, bingo! Confirmed diagnosis, severe pneumonia with heart failure, requiring digitalization. So, I ordered 8 hourly digoxin doses for the first 24 hours.
First dose was given at 12 midday so second dose would be at 8 pm, and third dose at 4 am.
I came back at 2 pm to review the patient, and he was more settled, and conscious, however, there were no observations!
The ED nurses where busy so no one monitored the patient. They were just waiting for Internal Medicine team to come and take over the care of this patient. The ED team had done their part and were just waiting for admission to the medical ward.
So, I gave directions that this patient needed to go to Intensive Care Unit (ICU) for continuous monitoring and care. The ED team had to send the patient directly to ICU so the nurses can help with hourly observations. I needed to reassess the patient’s organ functions, and see how we were going with stabilization of the patient.
I came back at 4 pm to ED, and patient was still there with still no recorded observations and not seen by Internal Medicine team. I reminded the nurses in ED to transfer the patient to ICU.
I left the hospital grounds, and headed up to the village for volleyball training.
Straight from the village at 6:30pm I headed ED. The patient was still there without continuous monitoring.
This time I noticed a gauze dressing around both right and left sub-clavicular regions. I knew straight away that someone had tried a central line insertion and failed. I asked and it was confirmed that the Internal Medicine Registrar finally arrived after 4 pm, and tried the central line.
I advised the sister in ED that I have been managing these patients without central line, ONLY LOOKING AT THE OBSERVATIONS AND MAKING TIMELY INTERVENTIONS, AND MY PATIENTS RESPONDED FAVORABLY, SO I DON’T NEED FANCY MONITORING DEVICES!
JUST SIMPLE CONSCIOUS STATE, ORIENTATION, RESPIRATORY RATE, PULSE, BLOOD PRESSURE, AND URINE OUTPUT MONITORING!
“Please, send this patient to the ICU so nurses can help me do the monitoring”.
I left to freshen up at home and came up to ICU for the 8 pm review with my newly formed core of Critical Care Medical Services team. Anaesthetic Scientific Officers (3 young enthusiastic men, Goliath, Justin, and late Kingsley).
We entered the ICU, and the first thing I wanted to know was whether the 8 pm digoxin dose was given.
I asked the senior Intensive Care Nurse and she looked puzzled at me, like I was a ghost!
I repeated myself, and asked about the 8 pm digoxin dose, and she replied that she didn’t know anything about the 8 pm digoxin dose for this patient.
I lost it there and then…I started swearing and shouting in rage, because I was under immense pressure during the initial stabilization of this patient and wanted to make sure that I was doing the right thing for the patient.
I got so angry, and everyone in the hospital were thinking that there was a big fight in ICU.
I left and went home without attending to the patient.
As God planned, my new recruits the three Anaesthetic Scientific Officers took over and carried out my orders.
Their first real exposure to Critical Care Medicine in Alotau Provincial Hospital. I can remember clearly just like yesterday, this was on a Thursday, and Friday would be the Continuing Medical Education program for Medical Team at Alotau Provincial Hospital.
Friday during the CME session, I was sitting in the front row next to my mentor, Dr. Noel Yaubihi (First National Anaesthetist from Goodenough Island, Milne Bay Province, PNG), he recruited me to Alotau Provincial Hospital to take over as the Anaesthetist, because he was now the Director of Medical Services.
After the presentation, he pulled out a note in his shirt pocket, and handed it over to me. I opened the note and it was a filled in INCIDENT FORM, by the senior ICU nurse regarding my outburst at 8 pm in ICU last night. UNPROFESSIONAL CONDUCT!
I acknowledged the incident and told the Director. “THAT’S FINE, I WILL ALSO FILL IN AN INCIDENT FORM, AND SAY WE DIDN’T MANAGE THE PATIENT WELL!”
In his wisdom (a wise man), he replied, “SO WHAT DO WE DO?”
I replied, “YOU SUPPORT ME AND WE DEVELOP CRITICAL CARE MEDICAL SERVICES HERE IN ALOTAU PROVINCIAL HOSPITAL “.
Honor and Glory to God!
Thank you, Lord, for His Grace, Mercy, Wisdom, and Blessings upon Dr. Yaubihi, and his family.
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