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The Little Angel – At an Emergency Room in Iran

Submitted by on August 17, 2012 – 4:31 PM 45 Comments

The first thing I remember about him was the blood leaking out of his fingertips on the ground. I had never seen so much ottorrhagia before.
Groaning, struggling to keep his eyes open, he was somewhere between life and death. The emergency room floor was full of blood. It appeared as if we were walking in a shallow lake of blood!!

 

The nurse was trying to intubate him when I shouted: First Collar! Also two IV lines!!!!

It was weekend and most of the doctors were away.  No Anaesthesiologist, no Surgeon, no Internist…

I was the only physician in the little town on that weekend. The nurse was unable to intubate the patient by Collar, so I had to do that by myself.

There was a lot of bloody secretion inside his mouth.

After using 3 intubation tubes, I was afraid to try more. There was no Packed Cell in hospital and the patient bleeding was more serious and concerning than his breathing.

Therefore I decided to send him out to a more equipped hospital in the neighbouring city which was half hour away along with two nurses and a referral note.

Through this uproarious situation, when finally I raised my head, I saw a little girl with fearful and worried eyes, peeking around the corner of Emergency room behind her crying mother. Her little eyes were looking for her father’s saviour angel inside me! An angel with white scrub full of blood stains, who knew that she was not angel and just like her prayed for the little girl’s father from deep inside to survive before reaching the hospital with requisite facilities.

 

******************************

I still smelt blood in my nose when the Nurse said that the wounded man died before the ambulance reached the other hospital.

In deep sorrow, I was trying to concentrate on another patient when the phone started ringing .It was the surgeon of the neighbouring city hospital on the phone, yelling at me madly demanding to know why I had not incubated the patient.

” I tried my best but it did not work…with collar and so much bloody excretion in the mouth, it was almost impossible!” I said.

“You must have intubated him, no matter how!” he replied furiously.

“I am only a GP; this patient intubation should have been done by an Anaesthesiologist. Even the operation room personal are on leave today. Whom should I have asked for help??”

For a few moments, no reply from him and then I heard the extended beep in the phone…

“Should I have tried more? Could I have tried more? “

Turning the pages of the book, I started reading the Contraindications of intubation again in a patient suspected of base skull fracture. The only feasible intubation can be done without extension  of the head.

The surgeon didn’t forget about the story, he decided to call up the hospital chief. The answer was the same.” Only an Anesthesiologist was capable of doing this patient’s intubation“

Nevertheless I kept asking myself: “Did he have any chance to survive after this massive bleeding even if he had been intubated? If I had done intubation for him in the extension position, he would have stayed alive but most likely become paralyzed and for a life time moved on the wheel chair! Could this have been a better alternative for him? If I did so, wouldn’t he get upset with me? What could be really his own choice? Life on wheel  chair or death? Had I made the right decision ? He might have wanted to stay alive even if it cost him a life time paralyzed on the wheelchair! “

For the first time I had realized the depth of the ocean I was swimming in.

I had to choose between the most difficult options for another person.

After a few days we received the Autopsy results:

“Base of skull and C2 fracture “

And this was verification of my right decision. However I still smelt the blood of that man…I remembered those little eyes following me through the partly open emergency door, assuming I was an angel. But I never was and will never be the angel.

Only for a moment, I became the little angel of a world as big as the Emergency room and the intensity of this commitment had bent my shoulders may be forever…

 

About the Author: Dr. Faraneh Oraei Abbasian is a physician (GP) at Mashhad University Of Medical Science , Iran. She is an active blogger in persian language. She can be reached at:  [email protected]

 

About this article: This article is competing for the JPMS International Medical Writing Contest 2012

To learn more about the contest and to participate in it, follow this link: http://blogs.jpmsonline.com/writing-contest/

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  • alone

    it’s best …

  • faraneh

    thanksss

  • Sepideh

    U arealways angel of the hearts
    belive it

  • soorena

    so impressive:)

  • Maryam

    You’re making such difficult decisions constantly. I’m sure you are an angel.

  • Shahram SD

    thanks angel

  • negar

    negar
    it was great.u are an angel my friend.

  • DR nafis

    I hate autopsy results !
    but you are good, even in writing stuff

  • deljeen

    great

  • GOD

    GOD
    WILL DECIDE WHEN LIFE WILL END:

    WE SHOULD NOT ‘PLAY GOD’

  • niloufar

    it’s best

  • Yasser

    goog writing;)

  • honey

    The text was interesting.

  • rabooli hasankoor

    Its very beautiful
    i hope she win your gold medal!

  • elham

    you’r also good in writing stuff Dr.Faraneh… :)

  • amin

    very nice angel

  • samaneh

    great….i believe u honey

  • narges

    it was really nice

  • mostafa

    thanks for your article
    i have best wish for you

  • mithra

    this was an impressing event which you described in the best and most beautiful way

  • soofi

    great.

  • Babak Barfeh

    wow is the only thing that i can say.but honestly it didnt impress me.
    maybe we all would have do the same thing while facing the same situation.
    being a doctor is awfull.

  • Naser

    Imperssive! That shows it how it is to practice medicine in a third world country, where u`r faced with life n death,while u know what to do but can`t. And u truely are expected to play god without the authority granted. I feel u my friend…

  • armin

    i can just say ; WOWW’ !!!

  • sajjad

    it,s very good

  • mina

    great

  • Med-Blogger

    A professional blogger who writes ten years, we always expect the best!GREAT Persian Blogger!

  • zebel khan

    not only by perfect writing method, but also her humanity astonished me

  • Parya

    I’m sure you are a great angle…

  • dr,hamide karimi

    :)

  • mohammad

    it,s very good

  • crescendo

    great

  • rozgol

    you are the best faraneh

  • nandita

    I think the GP doctor (i suppose it is a fictional account) erred. She should have done a cricothyroidotomy in the absence of falling vitals and absence of specialist. That would have saved the life of the person

  • سید بریتانیا

    همه که فارسی بلدین ایشالا
    رفقای همکار
    همگی از دم خاک تو سرمون
    برای همگی متاسفم
    نسخه فارسی این نوشته کوفتی کجاس؟
    خانم دکتر با توهم نویسندگی، فارسیش رو کجا نوشتی؟

  • f sh

    very nice

  • Lili

    Nice

  • mohanna alinejad

    it was embarrassing,but it always occure in society andit will occure…..
    no body is responsible.

  • sara

    She is awesome….

  • hezarpa

    very nice dr faraneh

  • zahra

    very good

  • Vahid aus Deutschland

    Wunderbar geschrieben, ich muss zu geben, dass bislang habe ich nie solche wunderbare Erzählung von einer Ärztin gelesen habe

    • ایرمان

      vielen danke!!!!

  • marjan

    but you have to oxygenated the patient with mask or cricothyroidectomy

  • homa

    It was great
    Being a doctor is so hard!!!!!!
    I appreciate ur bravery and confident!
    Good luck