Indexing Title:  HABalucating 06-03

MAR Title: The Big C

Date of Medical Observation: October 2004 

Narration:

                 While working as an ER Resident Physician in a secondary hospital in Cavite, I had one of my most memorable experiences as a new doctor.

                It was around midnight when a 40-something woman rushed into our ER carrying her 10 year-old son who was in active seizure.

                We immediately lay the patient on his side, hooked him to O2 cannula and IV fluid, and started giving Diazepam TIV.  It was during this time that I started assessing the patient and asking the mother for  brief history.

                The patient was afebrile, in active seizure for approximately 10 minutes, no history of drug intake, no seizure disorder, and was in normal health condition prior to consult at ER.  Most of the data were  spontaneously given by the mother so I was thinking that the mother may be a nurse or a paramedical staff, or works in a hospital.  But I felt it was not the proper time to ask for that detail.

                I have noticed that some of the other NOD, including those in the ward went down to the ER check on the patient.  I overheard one of the nurse staff, “Doktora, ano nangyari kay Yuan?”

                It was then I realized that that the mother is one of our pediatric consultants in the hospital and the patient was her only son.

                At that instance, I suddenly lost my nerves and was in state of panic.

                I checked again the patient and he was still in active seizure.

                I remembered during my internship our protocol in status epilepticus that we can give a second dose of Diazepam  at 0.3 mkd if the patient is still in active seizure, 10 minutes after giving the first dose.  But I became hesitant and had to ask for permission to the mother/pediatrician who was herself panicky and crying while talking to someone over the phone.

                She handed me the cellphone asked me to speak to one of her friends, a pediatric neurologist.

                Over the phone, her friend told me to go ahead with my treatment plan and advised me to give Phenobarbital slow IV push if the second dose of Diazepam will not work.

                After giving the IV Phenobarbital, the patient’s seizure stopped and he was asllep with stable vital signs.  The mother then decided to transfer the patient to a tertiary hospital.               

Insights (Stimulus, Discovery, Reinforcement)  (Physical, Psychosocial, Ethical) 

                Looking back at what happened there were still some things that I haven’t resolved yet.

                Was I able to handle the situation well? Did the nurses-on-duty notice that I panicked after knowing the background of the patient? Did I lose my composure? Did I lose my confidence? Will I have the same reaction if a similar thing happen to me again?

                Perhaps, I would answer yes to all of the questions.  Losing our composure is a normal reaction that is new to us.  The more important thing is we should be able to pick ourselves up, relax and make a sound judgment during a crucial moment.