The Fifth Horseman

The Roof Part 1

If there is one thing anybody who works in a hospital will agree to, it will be the fact no day ever feels the same. Some elect the various jobs in tertiary healthcare for that exact reason, and in Dr Lily's ward, some days can get particularly capricious. This was always one of if not the biggest challenge for hospital personnel especially the house officers.

Sheila had a task-list like most of them did and, as always it was prone to amendments. Things change, patients crash, people complain, new admissions take priority, iv lines leak and some nurses wouldn't get off your back until you had changed it for them. Some say the very definition of housemanship is basically to always be on top of your task-list and that was pretty much it but still it was no easy feat.

Sheila was trying very hard to set her patient's iv line. She had no tool to image her veins like in private centres, rather it was part of the training do it the old fashion way with a more tactile approach like feeling for the veins and mapping their course before puncturing a 18G cannula into the cephalic. Unfortunately being a kidney patient meant Mr Ahmed's veins were no longer as youthfully healthy, bouncy and compressible as they once were rather collapsed and stretchy like an old deflated party balloon. She had 3 more of such lines on different patients that needed her attention but his was most important as the ice box that carried the next pack of blood were ready to be transfused.

'We'll check it together?' the nurse politely reaffirmed preparing the forms on the table waiting eagerly for Sheila to finish up. Each time she punctured through his skin he writhed in pain and it only discouraged retries. She knew not to get frustrated and more importantly not to frustrate the patient. She promised one last try and after letting him catch a hold of his breath, they decided to for another try.

'BINGO' she said excitedly, Mr Ahmed sighed in relief so loud that it made the nurse smile. 'She's a good doctor,' she said. 'Yes, yes she is,' he replied. Sheila replied with a bashful 'Thanks', took off her gloves and proceeded to help check the blood products and fill in the necessary forms before she moved on to the next patient. The nurse told to leave. 'I'll handle it,' she said and Sheila grabbed her shoulders and thanked her before moving on.

At 8am sharp, she realised she had no more urgent duties, so it was finally time to get back to patient reviews. She noticed her colleagues unceremoniously leave instead of doing their own work. 'Why?' she called out.

'Meeting! Dr Richard is demanding full attendance,'

That only meant Sheila had to go as well and if not for beeping of the cardiac monitor behind her, she would have. 'Desat! Desat!' the nurse cried her eyes transfixed at Sheila. For a brief second, the young girl was blank, not knowing what to do and if the training thought you one thing, it was how to snap right back. She threw her coat on a desk chair, gloved up and made haste. It was Mr Ahmed again, but now he was holding on to his chest.

'ECG?'

'He can't breathe,'

'Fine, O2 first, get him on high flow, and get an ABG, sublingual nitrates, then ECG.'

The nurses starred back at her. 'STAT' Sheila asserted.

'You'll have to do the ABG,' someone around commented.

'Yes, I am aware of that,' she replied without looking at whom. 'I'm sorry Mr Ahmed, I have to poke you again,' he nodded gasping for air while they brought him a ventilation mask to fasten.

**

'Everyone here?' Dr Richards surveyed the crowd who showed up to the small room in front of the ward. It was where they usually had little tutorial sessions whenever there was a little free time. The heads of department always stressed that teaching sessions had to be a part of regular practice. Despite specialists having varying opinions on houseman gatherings, meetings and tutorials, they still loved doing it.