The Medical Negligence

It was during my time as a House surgeon. I was posted in the Emergency Department. The ER was completely filled with Severe Covid-19 Patients. Some were on CPAP, some were on HFNO. I was in my PPE and had to do 8 hours of night duty in the ER [from 12:00 a.m. to 8:00 a.m.]. Along with me, a PG anaesthesiologist was Posted to the ER. But the PG didn't come. So, I had to manage the patients myself with 2 nurses. My duty was to monitor the patients timely and adjust the ventilatory settings if necessary. 

The ER was divided into 3 separate rooms and just outside the ER, Opposite to it there was a duty doctor's room where duty doctors and nurses would rest and chitchat. Even though we wore PPE, we tried to reduce exposure to the Covid by staying in duty doctors’ room and we used to come to the ER only for monitoring patients Half hourly once. This was common practice during the pandemic.

So, I had completed checking vitals and adjusting ventilatory settings by 12.15 a.m. Then the nurse asked me "sir, as we have completed monitoring all the patients, let's rest for half an hour in the duty doctor's room and then come back again". I asked her to go and told her that I would come within a few minutes, as I wanted to look through the new ventilator models which came a few days ago to the hospital. She said OK and she left. I was inspecting various ventilatory modes in the new model which was not yet connected to patients and was inside the ER in one of the 3 rooms. Then, 10 minutes later, I heard gasping sounds from a patient in another room and so, I rushed towards him. His CPAP mask was removed and he was gasping and trying to put it back. So, I immediately put his oxygen mask back and adjusted his mask and patient returned to normal within a few seconds. I asked him " how did the mask come out? ". He replied that he had taken the mask off to drink some water. [The patients on ventilators usually suffer from dry mouth and increased thirst due to prolonged mouth opening]. I asked the patient where his attender was. He said that his son went to bring biscuit packets a few minutes back and still didn't come. He couldn't tolerate the thirst and he couldn't wait till his son returned. So, he tried to drink water by himself. 

Now imagine if I wasn't there in the ER room and was resting in duty doctor's room, I couldn't have heard his gasping and I couldn't have helped him and he might have died with respiratory arrest. All the patients were sleeping, even then if the patients were awake, they were not in a state to come to duty doctor's room and ask for help. 

Here the main problem is that we should wear our PPE from the start to end of our duty hours. PPEs cause lots of suffocation. We sweat a lot, we cannot drink water or go to urine until our duty completes. In our hospital, duty hours for doctors were for 8 hours and for nurses it was for 12 hours at a time. So, it was more difficult for nurses than doctors. So, we can't make either doctors or nurses stay in the ER at a stretch for 8-12 hours with their PPEs on.

So, I immediately brought this to the notice of the medical superintendent and asked him to fix cameras in the ER with monitors in the duty doctor's room and nurse's station and asked him to provide each and every bed with nurse call systems, neither of which were there in our hospital at that time. Also, I asked him to reduce the duty hours of nurses to prevent such incidents from happening any further.

#crackmbbs