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Today has been absolutely insane so far and I am on‐call tonight! It is almost 5pm here and I will be returning to the hospital at 730pm. So today, my second day of my surgical rotation, was supposed to be a day of endoscopies and colonoscopies. After the first endoscopy, the doctor took a phone call about an emergency in resuscitation. A Man came in with 8 Gunshot wounds (4 Shots but both entry and exit wounds). The Male German Intern asked if he and his fellow German Intern could go see the trauma; Larissa And I Saw and opportunity and followed them. When We got to resuscitation (no Idea what is the equivalent to a resuscitation ward in the US), The patient was in X-rays. We Got to see the images which showed that the heart was not damaged but the abdomen was more or less shredded. When The patient came out the doctor put in a rubber tube to drain the blood from the internal bleeds. Then, the patient’s heart stopped beating. CPR was started, three different people did CPR For twenty minutes (including two of the Germans), Then the defibrillator was brought out. The Doctors shocked the patient two times, then his heart started beating again. I was in absolute shock that after 20 minutes of CPR the heart started back up especially since a sister told us that the patient stood no chance and was already dead. The heartbeat was weak as was the blood pressure, but the head doctor made the decision that the patient had no chance without surgery. We more or less ran the patient to the operating theatre. By the time Larissa and I had changed into the OR Scrubs and booties, the number of doctors present had doubled. Before the patient was opened, he went back in to ventricle fibrillation and was resuscitated using the defibrillator twice. We stood and watched as the patient’s chest cavity was carved open with a scalpel then the ribcage was broken apart with a hammer. The Opening of the ribcage was much more violent than what we see in movies! The Incision on the patient was from above the sternum to below the belly button, in order to see, the patients stuffed a ton of towel sized gauze to soak up all the blood. The Rubber tube that was inserted initially had already drained over a gallon of blood. The Doctors went to work pulling out the large intestine, the colon, just looking for where each of the internal bleeds were coming from.
. Three Surgeons were trying to suture up the patients various internal wounds when the patient went back into ventricle fibrillation. For The next 45 minutes, doctors used their hands and manually pumped the patient’s heart and used the internal paddles of the defibrillator three different times. The Head doctor came in and told the team to call it; the doctor whom we shadow called time of death. The Whole time, Larissa And I Were never more than two meters away from the patient. A large part of why I Wanted to do this program with CFHI Was because I Wanted to see if I Could handle being around death and still maintain a rather optimistic personality. Today Was my first real test and honestly, as horrible as this might sound, I Really did not feel any emotions besides absolute amazement. Seeing A surgeon reach inside a man’s chest and keep him alive for 45 Minutes by manually pumping his heart or as he said, “squeezing a sponge,” was indescribably incredible. I Felt down that the man died, but I Was still in a shock and awe of how incredible medicine is; this patient managed to live an extra four hours when the four gunshots he received should have been more or less immediately fatal. Yes, Over four blood bags were used, but, by the end, over 1.25 Gallons of blood were drained from this man’s chest. After The surgery, the doctors kept saying how bad then ending was, but I Overheard two of the doctor’s conversation in which they analysed everything they did and found nothing wrong; this patient just could not be saved. In Three hours, I Will return to the hospital and observe what being on–‐call in a surgical ward is like, and I Imagine it will be quite busy! The Patient today took 3 surgeons, so all of the surgeries they were supposed to be doing did not get done.
(please excuse the poor spacing and things, weird format stuff!)