Monday, February 10, 2020

ICU Oncall Diary


Disclaimer: This post is going to be very medical-jargons studded. It's my MO Diary anyway. 😆😆

Nisaq, Insyirah, Me, Diana on our way back from peri rounds. 

Yesterday I had a tiring ICU call.

My First Lumbar Puncture

I did a lumbar puncture for a suspected meningoencephalitis patient and truth be told, this is the first time I performed a lumbar puncture for a non-surgical patient.

Yes, I can do spinal anaesthesia with one eye closed, and anatomically spinal anaesthesia and a lumbar puncture are the exact same thing.
But for spinal anaesthesia, the patient is sitting up straight and I have the luxury of it being in a controlled situation although at times I really need to be quick (eg in fetal distress cases) while in a lumbar puncture, patients are in the lateral position (imagine lying down by your side, cuddling your own knees). Obviously, the challenges are different.

I attempted twice at the lumbar puncture - first using the 22G Spinocan that the Medical team already has. I can't feel the give classically described as I pierce the layers using the Spinocan hence I requested the Pencan needle I've always used from the OT.

I succeeded in my first attempt with Pencan; but since the needle diameter is smaller ie 27G; the Medical MO had to stay longer to collect adequate CSF samples into small bottles to send to the lab. Haks, sorry pal.

The Difficult Ventilation Patient

My first referral of the day was at around 4.30pm.
It was a gentleman with severe pneumonia; and the ED instead of the usual Medical team referred him to me. They could not ventilate the patient - that shows just how bad the lungs were. The highest saturation was only 93% despite 100% oxygen.

We brought the patient into ICU and then my nightmare started. It was so difficult to maintain his saturation - this basically means the lung condition is so bad that we have to tailor our machine to give such high pressure to make sure adequate oxygen reaches his lungs so that it can then go into his brain, heart, and kidney. If we can't oxygenate him, we worry about the effects on his brain. He might not be able to wake up even if he survives this ordeal.

I did not sleep at night, kept requesting for ABGs, listening to his lungs, monitoring his urine output and cracking my brain on what to do. While fighting my tiredness and sleepiness at night, I then remembered my night houseman. Anaesthesia don't have many house officers and consequently, they are not available all the time. Sometimes when they are on leave, post night, etc, only the MOs are working and we are okay with that - we are independant like that.

My Houseman

But that night, my houseman slept through the night while I wake up every hour to check on my most critically ill patient. He was sleeping in another room and really there was not much I can ask him to do even if I wake him up. So I just let him be. Even the nurses did not call him to inform any abnormalities, they called me straight away and I prefer it that way.

That got me thinking, I used to spend the night sleeping too during my time as an Anaesthesia house officer. And the nurses did not call me too.
Did my MO also sleep through the night that time? They didn't call me at night either.
Did they think I was useless as well? Were the patients during my one month in ICU stable most of the time or did I not recognise they were ill and ignorantly went to sleep?

I shudder to think if it was the latter one.
Sorry, my MOs.


I went home after brunch, slept and woke up 5 hours later 😅😅
But despite this tiredness, I enjoyed the call - because I passed over to Dr Rey 😍 and she always made my day brighter even it was a tiring day.

'til then


  1. What a small world, cuz I know Diana from HTAR. Say hi to her from me lol

  2. loveee reading your blog. good luck, Dr Akmar! <3