Act first, think later.
Of all the different postings, casualty has to be the most unique one. It certainly sounds quite intimidating, but the nature of work there is surprisingly not the most difficult. I, like most of my batchmates was very much apprehensive and curious about this particular fortnight right since we got the timetables. And now that the time had finally come for us to join, I had enough butterflies in my stomach to fill a garden. Nearly four months had passed by since the start of our internship and this was the first rotation that involved a night shift. Naturally I was nervous.
There are three shifts in casualty posting, morning from 8 to 2, then afternoon from 2 to 8 and night shift from 8 pm to 8 am, and each day’s shift were allotted to us one day prior. As Trauma is an entirely separate and specialised unit here in GMC Nagpur, it meant that every day we could either be posted in Trauma or in EMS ( Emergency Medical Services ). My first day began with afternoon shift in EMS.
Casualty is like the gateway to the hospital, where any patient who has come in an emergency first presents. His basic history is taken and noted, vitals are checked and then the patient is referred to suitable department, mostly to medicine or surgery for definitive management. Promptness, swift decision and managing large and anxious crowd making is thus the necessary skillset. One or more CMO is always present though, and thus the major work for us interns is to take vitals of every patient who presents, and put in an intracath if it is anticipated that a patient would require fluids.
Needless to say, the casualty is always abuzz with swarm of patients and their numerous relatives. We had to be on our toes all the time, measuring BP of patients as quickly as possible, as well the pulse and O2 saturation. Casualty is one place where you see patients presenting with any and every type of ailment possible. Ranging from newborn babies with fever, to old and frail patients on wheelchair, women in labour, drunkards fallen from vehicles, patients with fever, dehydration, stroke, prisoners brought in by the police for checkup, minor road traffic accident to major polytrauma, patients brought dead or moribund – and countless other afflictions, you get to see them all. The protocol remains the same whoever the patient – note the history, check vitals and refer. Hence, act first and fast, then think about diagnosis later.
The wee bit of pre-shift anxiety that I would have every time before coming to the hospital, would soon be forgotten amidst all the work at hand and the frenzy of managing the casualty. When you successfully accomplish some task, could be even as little as measuring the BP precisely, the boost that it gives to your confidence is a high like no other. Putting in a difficult intracath has to be the pinnacle of self achievement. Having hardly done it before, I found putting intracath a very tedious and difficult task in the initial days but there is just something about the urgency of the situation and knowing that we have no choice but to do it, that actually helps you do it. By the end of casualty, I had become much better, if not perfect in putting intracaths.
My first ever night duty was in Trauma ICU, where even though patient flow is much less, the span of work is more extensive. The night dawdled initially and I found myself barely able to stay awake and checking the time every few minutes, but the night was still young. But as it so happened, it soon changed into a busy one a sudden flurry of patients coming in. Peculiarly enough, several patients had pneumothorax or hydrothorax so I got the chance of putting an Intercostal Chest Drain ( ICD ) right on my first ever night shift ! Time flies by much quicker when you remain busy and before I knew it, it was the break of dawn. Soon the sunlight streamed in through the windows and with that it brought a sense of relief and pride, that I had managed to pull off the night. Ofcourse later I slept the entire day.
My last day in Casualty was the graveyard shift in EMS, and even though it wasn’t an overwhelmingly busy night, patients still kept coming at regular interval. I eventually found myself enjoying the authoritative feeling that comes with directing and advising patients. The flipside of these two-week postings is that by the time you become familiar with and settle down in the work environment of the place, it’s time for it to conclude. Another factor that sets casualty posting apart is there are no residents to answer to, there is only the Medical Officers, so once the shift is over, there is no more hassle of calls. And since there are no patients getting admitted, blood sampling, tracing reports or other ward work is out of question.
Fifteen days right in the heart of the hospital certainly improved our clinical responsiveness and also tested our mettle. Even though the day sometimes seemed long and arduous, the fortnight passed by quick.