Antara Dua Doktor ..
Mungkinkah oncall pada 14hb September hari itu adalah yang terbaik bagiku? Housemen memberitahu aku ada seorang pesakit yang mempunyai GCS rendah.
” Dr. Khairul, nak inform, ada seorang patient yang GCS 3/15 dan masa di kecemasan tadi GCS dia 14/15. Suddenly not responsive Dr. Khairul! Nak saya buat apa?”
Jam menunjukkan pukul 2.15 am dan aku baru sahaja masuk ke kamar doktor untuk berehat sebentar. Baru sahaja mahu melelapkan mata.
” Tak pe, I datang sekarang!”
Dalam hati, nak sahaja aku marahkan HO itu kerana lansung tidak memberikan initial resus pada pesakit itu. Tapi tidak mengapa kerana mungkin dia, first posting sebagai seorang HO.
Ketika aku sampai di sana, aku dapati ada sekujur tubuh yang muda lebih kurang dalam 20-an dikelilingi sanak saudara serta ibunya yang menangis.
“Minta maaf, saya perlukan ruang.”
the Malay version!
Sometimes you just wonder, may be certain Oncalls are meant just for you. Still struck between wondering and understanding, the last oncall was my calling for Allah.
It started when my housemen called me up at 2.15 am, to inform on a low GCS patient. A young 20-ish patient with no medical history before transfer from a small district hospital and was diagnosed as meningitis. The thrill of this call was not entire the predicament of the diagnosis. But rather a spritual initiative seeing Allah’s wonder.
Sometimes unfaithful simple decision can lead to a lot of mistakes. It is those times when you need guidance that Allah will somehow or rather make you realize that He is with you. In na Allah ha ma ‘ana.
Upon attending to the patient stat, he was unconcious. GCS was 3/15. Pupil were not reactive. Mildly neck stiffness and hypotonic all over the limbs both upper and lower. CVS was normal and Lungs were clear. Unremarkable abdominal findings. He was febrile to touch and temperature was 38 degrees. Must be something affecting the CNS and an infective cause which made him as in his current condition. May be a post fitting episode?. He was already on the broad spectrum antibiotics.
To my suprise there was also the Ustaz reading the Ayat kursi next to boy. Further then he was reading Inna fatahna la fatham mubina translated to English, ” Indeed, We have given you, O Muhammad, a clear conquest” and Al- fatihah next to the boy. I knew these were the rukyah or readings and supplications for healing from the Quran. Nothing new, and nothing wrong. So I let the ustaz continue to read it.
My further assessment noticed that this boy was having a pink branula at the left hand, which the IVD did not functioning. Probably, extravasated into the soft tissue.
I asked the nurse to get the dextrostic reading immediately, and the reading was 3.1 mmol/L. For a boy it is already a low reading.
Oh this patient was hypoglycaemic! I lamented quietly.
The ustaz who was concurrently reading the ruqyah to the patient left ear, blowing into the ear by the word of Ayat Kursi was convinced this must be somekind of external disturbance. I was not going to stop the Ustaz.
I immediately got another IV branula line on the left flexor surface and had given this patient a bolus of 30 mls of D50%. The first response was his eyelids were moving and he was able to hear me as he was nodding his head minimally. The further boluses given made him ‘concious’ and then was able to move entire his head, then his arm and finally the feet. Its like giving life to the body!
The patient then sat up and cried to his mom.
The ustaz who was always next to the boy, was already reassuring the mother and boy that they are going to be ok.
The ustaz then read few more verses to a bottle of water and let the boy drinks or sipped some of the water.
My egocentric nature wanted to stop the ustaz from the initial treatment of ruqyah, drinking the water and reading the dua. But praised to Allah, I have learnt this from readings and studying from Prof Dato Dr Hasan, Daru’ syifa books.
I know that this patient was only hypoglycaemic, causing him to be in a hypoglyacemic -near comatose state.
Deep in my heart, I know I have done the right thing. I gave him a bolus of 30 mls of Dextrose 5% and he revive like a dead body waking up from the grave.
Despite the credits and acknowledgments were given to the Ustaz, I was happy because I did the right things. Everyone was praising the Ustaz for helping out, I was also happy for him. I know that the Ustaz did not understand the hypoglyacemic coma state, but I did not lose temper.
I kept my cool.
And I found the right diagnosis emergency diagnosis.
I am also happy that I did not ambushed into, intubating this boy just because he was not responsive. Allah helped me understand that, the dynamics of life is both ways, intervening and prayers. Thank God! Maybe the Ustaz did just that!