On Oncology...

ABG

“I think we shall let him do a few ABGs today, I’m sure he’ll enjoy it,” said Dr Janus, my polish Registrar in Oncology

“Enjoy? I don’t even know what an ABG is!!!!”, my thoughts threatened to scream out in panic. Shoot.

I kept calm throughout. As Dr Janus left for his clinic duty, Dr Thomas, my shadow intern for the day went to get a sandwich. I quickly flipped through the ‘medical bible’ for ABGs. Ah, just in time.

“So what does ABG stand for?” asked Dr Thomas (who wanted to be called Tom), with his mouth half filled with what looked like a ham sandwich. He was hungry apparently.

“Arterial Blood Gas,” I answered while giving my oxford handbook a loving caress.

“Brilliant, do you know how to do one?”

“Hmmm...not really”

An ABG is a procedure where one sticks a needle into the patient’s artery to obtain an arterial blood sample. The sample is measured for oxygen pressure, carbon dioxide, etc. Shall not go into the details.

Err..NEEDLE? BLOOD? PATIENT?...right. What a start to my 1^st day on oncology wards.

................

“This might hurt a bit, just hang in there,” words of encouragement to the patient (and myself), as I cleaned the targeted area with a swab.

“Just take your time and be confident that you’ve found the pulse. Be confident! Do not make a wild guess. Readjust your position. You’re a bit too far...”

Tom was giving instructions while I was looking for the pulse. The patient was wearing a CPAP (continuous positive airways pressure) mask. He looked nervous. He had the right to be.

“Bismillah,” and in went the needle. Missed the artery. Readjusted the needle. Nowhere to be found. There was no blood flow into the syringe. My heart sank. Bad start. The patient was already wincing in pain. I had to withdraw.

Tom took over. He didn’t do any better. 3 attempts hit a dead end. The patients vessels were very hard to find. He had gone through a series of chemotherapy treatments. That contributed to the weakness of the vessels.

Tom moved on to the other hand, frantically searching for an elusive artery. On what must’ve been the 5^th poke of the needle, blood came gushing out into the syringe. I could almost feel the relief Tom was feeling.

....

The Reality of Cancer

“He doesn’t have long. He’s going into respiratory failure. I took a good look at the ABG results. Tom was right. Even though the CPAP Oxygen was raised to 90%, from an initial 60%, our patient showed a drop in is pO2 levels. He wasn’t going to make it. Tom called for a meeting with the patient’s family...

Wiki Rules

“There are two types of bone metastases. Lytic and...What is the other one Tom?, asked Dr Janus.

“I’ll look it up for you,” replied Tom as he googled the answer. Wikipedia was his reference.

Conclusion : doctors are human.

ECG in A&E

“Get yourself down to A&E, I’ll be waiting for you there,” said Tom through the phone.

.............

“Alright, we’re going to do an ECG on Mrs X”, said Tom. I knew what he meant.

I was going to do an ECG.

It wasn’t that tough. The instructions were simple enough. She was an elderly patient who had a background of non small cell lung carcinoma. A very straightforward and uncomplicated process. I didn’t botch this one up.

As the reading for the ECG was being printed, Mrs X cast a look at me.

“Is everything alright Mrs X?” I asked.

“No, no, I’m grand. Is this your first day in the wards?” she asked with a twinkling smile.

Indeed it was....