On Duty 24/7...Just Like 7-eleven!!!

At This particular moment in time, these words describe everything that I feel.


FATIGUED.

TIRED.

BURDENED.

BURNT-OUT.

STRESSED.

You see, the husband of my aunt is currently battling for his life against a very fatal disease. He has been confined in the hospital where I work for almost a week now after undergoing surgery and battling the complications that are the sequel of what he has.

ACUTE NECROTIZING (HEMORRHAGIC) PANCREATITIS.

Here are the events that happened which led to the current emotional, mental, physical and I know, soon, financial stress that my family is bearing right now.

Saturday (January 31, 2009) - Tito Emmil started having generalizedvague abdominal pains with vomiting episodes. I was called to assess him, told him not to eat anything and decided to just observe it for a day. He took his Esomeprazole and a dose of Hyosine-N-B-B as he attributed what he was feeling to his history of Acid Related Disorders when he was in the States.

Sunday (February 1, 2009) - Morning came and Tito Emmil, though still experiencing some abdominal discomfort actually said he felt better. However, in the evening, his pain intensified and we decided that we will bring him to the hospital first thing the next morning.

Monday (February 2, 2009) - Upon arriving at the hospital, I immediately had Tito Emmil worked-up. Blood exams were done and X-rays were taken. His blood pressure dropped at the ER. Signs were not good. Dra. Marci Cruz, an internist, and me, decided that Tito Emmil needed to be openned up. The condition might be due to septicemia from a ruptured appendix or bowel as his BP really dropped considerably. I burned the phone lines looking for blood as it would be imperative to start a transfusion as his circulation was already failing. Luckily, through the help of a good friend, Dr. Shearwin Soyao, I was able to find blood at the University of the East Hospital. I went to pick up the 3 units of whole blood at around 2pm. I arrived back at the hospital at around 5:30pm, just in time to see the surgeon, Dr. Flor Mendoza and the anesthesiologist, Dr. Barbosa finishing up the Surgery. It was Dr. Santiago, the cardiologist, who broke to me that the case was not a simple ruptured bowel or appendix, but an Acute Necrotizing Pancreatitis. That instant, I knew it was bad...too bad.... Tito Emmil had one of the worst cases for an Acute Surgical Abdomen. A case whoose mortality approches 100%. Surgery ended at about 6:30pm and Tito Emmil was brought to the ICU. All this time, Tita Sonia was trying to be strong. We all knew Tito Emmil was on towards the battle for his life. Three different tubes were coming out of his abdomen and not less tha 5 intravenous fluids with different medications were hanging above his head. Inspite of all this, his BP remained critically low and to compound it more, his kidney had already shut down. Tito Emmil gained consciousness at around midnight. But he was very weak and obviously in pain. Tita never left his side. All we could do was pray.

Tuesday (February 3, 2009) - Tito Emmil's condition was getting worse. His medications were increased to maximum levels just to be able to sustain his very low BP. He still has no urine output which meant his kidneys are not functioning the way it was suspposed to. However, Tito Emmil was very alert and very conscious of what was happening. This gave us hope.

Wednesday (February 4, 2009) - With his kidney still not functioning and all the fluids we put inside Toto Emmil's body, it was but a formality that his lung would begin to congest. And it did. Pulmonary edema arose. His O2 saturation was below 85 and still decreasing. Dra. Estrella, a nephrologist, along with the other doctors, decided that Tito should undergo an emergency Hemodialysis despite his very low BP. Tita consented. The Hemodialysis was started at around 3pm. By the second hour, due to the further decrease of Tito Emmil's BP while on dialysis, he lost consciousness. The hemodialysis was stopped and he was brought back to the ICU where he again regained his consciousness. We thought we lost him. Thank God we did not. He woke up. His dad arrived from Canada and saw him ok.

Thursday (February 5, 2009) - Tito's O2 sats went down again, another HD session was in order. Tita, because of the incident yesterday was wary of the HD. I had to convince her to give it a go. No sense holding back then as we already did what had to be done in the first place. Besides, the previous HD proved beneficial. Tito's BP went from 80/60 to 120/80. "twas a very good sign. And that increase in BP was a good indicator that he will tolerate the procedure very well. And he did. Tita was all smiles after the HD. Tito seemed stronger. Everybody was relieved. The firsts good day after the surgery ended with smiles.

Friday (February 6, 2009) - Tito's BP was already stable. His meds were being tapered off. However, he started to swell. Too much fluid was accumulating in his body due to his renal failure. His mom and siblings arrived from Canada just a day after his dad came. He was happy albeit sad at the same time. Another HD session was scheduled to remove the excess fluids and relieve the edema. It went well. Tito is doing very well.

Saturday (February 7, 2009) I was from duty and went home for a while then went back a few hours later to monitor the dialysis. Tito was awake the whole time. Everything is going well. His BP-elevating meds were tapered to a minimum. I explained what happened to his relatives. It was tiring. Much like a revalida case back in med school.

Right now, everything is going well. We hope he recovers fully but we are thankful he is still alive and literally, still kicking. And as for me, well, I am still...

TIRED...
FATIGUED...
BURDENED...
BURNT-OUT...
STRESSED...
And I don't see it ending anytime soon...

The dilemma of being the only doctor around in the family right now...