Hectic ICU Pool

Assalammualaikum.

 

In my workplace, we pool the medical officers into OT pool and ICU pool. As the name implies, one pool of doctors will only work in OT and its related services for example pre op assessment clinic, pre op assessment in ward. The other pool works in the ICU, and takes care of all the other critically ill patients in the ward, and sometimes ED. 

New doctors will usually spend a few months in OT before being allowed to enter the ICU pool, as it is a tougher, and more demanding job. Perhaps because I am a Masters student, or because we really don't have enough manpower, I was put in the ICU pool in January - my second month here. That is a real fast-track. 

For that reason, during the first long weekend of January, I wasn't oncall. They can't have a totally new (to the system) doctor to be oncall on a weekend.  Hence I had the 3 solid days to myself, and even went to GH Premium Outlet!

Little did I know, that was the calm before the storm. 

My first day in ICU pool - ie 4th Jan was a nightmare and it demotivated me so much I started to consider if this is really the path I want to take. I've never felt this way before, not even when things were crazy back in HO time and during my time in the district hospital before. 

The situation was way worse because of the current COVID situation. We are not supposed to take care of COVID patients - in fact, we weren't prepared for it. But things have gotten so bad that we are suddenly faced with so many critically ill COVID patients in our hospital. My bosses were very busy setting up the ICU to cater for COVID and PUI patients - things change on a whim, so many new instructions and guidelines being posted in our WhatsApp group, I can't catch up with them. To make things worse, many of my colleagues in ICU pool had to be quarantined, hence the workload increased tremendously for all of us who are not. 

This is a COVID patient's x-ray. This is bad, nearly no normal lung tissues. 

I had to reintubate two patients that morning - 1 COVID positive, and 1 PUI. I was blessed with a chill and calm Specialist. He guided me well, considering the fact I have never worn the PAPR (that spaceman suit), as I've always used a different kind of protective gear in my previous hospital. The reintubation went smoothly but it delayed my work for the rest of the day. 

I missed my lunch, had some leftover mushroom soup and biscuit at 3.30pm while my colleagues were busy moving things out of our on-call room to be put in a new ad-hoc room. I went home two hours later than usual, and by the time I reach home, I started to have a migraine, was exhausted and famished. 

Things were a little bit better on Tuesday since there was no reintubation hence I had enough time to settle all the work. But we have more and more ill COVID positive patients. I still went back later than usual. And no, we cannot claim overtime - no such thing in our profession. 

I was on-call on Wednesday, took care of all the critically ill patients OUTSIDE the ICU - had only two hours rest within the 24 hours and unable to keep my eyes open during the drive home. It was dangerous but I didn't have another option. I can't sleep in the hospital as they are limiting the nos of people in the room, and there is no place for me to sleep midway since my house is <15km from the hospital. Thursday was a rest day, I woke up nearing 3pm, hungry.

Friday was hectic too, as it was my first day in the newly transformed ICU. I struggled to remember all the details of the patients - their culture results, blood results, antibiotics, and plan. 

Oncall again on Saturday, this time in charge of INSIDE the ICU. This was by far the worst day of the week. I cried silently underneath my N95 - overwhelmed and overstretched. Tears and sweat mixed together beneath the mask and the face shield as I looked out the window, trying to recollect myself. It was 3pm, I had so many works undone, rounds have just finished, I felt inadequate because I didn't know the in and out details of all the patients hence the round was longer than usual, I have not had my lunch, the air conditioner was switched off, it was freaking hot in the PPE. I've not had a single drop of water since 9am and one of my COVID patients was scheduled for a scan and I was supposed to accompany the patient down to the CT suite which will easily take another hour. The nurses were pressuring me to order meds, blood investigations from the system (only doctors can do this online), everyone was tired and exhausted, politeness is at the bare minimum. So I broke down. 

But Allah was with me the whole time. My Specialist (who was already outside at that time), realised the trouble I was in, and instructed another colleague of mine to accompany the patient to Radiology. I managed to go out at 4pm, had my shower, gulped down litres of water in one go, and had a quick lunch, before going back into the ICU at 6.30pm. One of my patient passed away that day, it broke my heart to inform his son that the patient was dying and no one is allowed to come and pay their visit in his last hours. The patient only had the nurses to be with him during his last moments. 

Sunday is another much-needed post-call rest day - managed to cook dinner and prepare my next week's BuJo spread sheet. 

 

I didn't realise I was showing signs of exhaustion but my husband noticed that I obviously look very drained this one week compared to the 3 weeks in OT pool in December where I was very bubbly and active. He even brought me out to Secret Recipe on Friday for some cheering up before my on-call. 

I keep a log of the patients I see, and to my surprise, I encountered a total of 41 patients in the 3 weeks in OT pool in Dec, but within this first week of January, I have already encountered 43 patients. That is a quantitative measure of the workload we are facing, taking care of the ills in the hospital. No wonder I was on the brink of collapsing. 

Hoping For The Best

Every day, I shudder to see the number of patients in ICU and ventilated patients released by the MKN - they just keep increasing. I hope things will be better soon, please all adhere to SOPs, stay home if no important issues outside, and don't go back to visit your elderly parent yet. If you love them, protect them. Despite seeing my mother every day, I can't remember the last time I actually touched her - salam / hug her. I was too scared of passing the virus to her. She's asthmatic and diabetic - I don't think I can keep calm if she's ever infected. 

Let's all do our part and pray for the best.

'til then.

Akmar