Sunday, June 4, 2017

Winds of change - 19


(This is the nineteenth part of a short story which is entirely a work of fiction.)

The next morning, Dr. Sampath came to the ICU by around 7. Vasudha was already up and was sitting beside Dr. Som. The plan was to put in a temporary catheter into the jugular vein to enable quick dialysis. A permanent access for dialysis called an Arteriovenous fistula takes about 4-5 weeks to mature and be usable. A temporary catheter is often used to enable the patient to get dialysis immediately.

Dr. Sampath had a nurse assist to him. He requested Vasudha to wait outside. Vasudha readily complied. He opened the catheterisation kit and the catheter. He told Dr. Som that he was giving a small injection which was  local anaesthetic which would numb the area and allow Dr. Sampath to put in the catheter comfortably. Dr. Som had done hundreds of such procedures himself. He felt it weird that it was he who was now at the sharp end of the needle!

Dr. Sampath had also done this procedure many, many times and tried hard to not feel any pressure and treat Dr. Som just as another of his patients. That way he would confidently complete the procedure in a few minutes. He inserted the catheter into the site and tried placing it into the right position. He felt some resistance to the catheter. He nudged a little. No luck. Dr. Som started getting anxious. But he did not want to say anything and disturb Dr. Sampath. He could not see what was happening. He had to surrender completely to Dr. Sampath at that time. He knew something was amiss. The catheters generally just go in without any problem.

Five minutes passed since Dr. Sampath tried to insert the catheter. He tried nudging and pushing. The catheter wouldn’t budge. Dr. Sampat became tense. He could feel droplets of sweat form on his forehead. At one point, his hands started shaking. He did not utter a word. After another few minutes, Dr. Sampath decided that he would give up and remove the catheter. He told Dr. Som, “Sir, there seems to be something blocking it. I am withdrawing.”

Dr. Som was surprised. “Ok”, he said.

Dr. Sampath began withdrawing the catheter. When he was gently pulling the catheter out, he felt something snip. As he pulled the catheter out, he realised to his horror, that the tip of the catheter had broken and the piece that broke was left inside. By looking at the catheter, Dr. Sampath figured that the tip that was left inside was about an inch long. He started shivering. His hand was on a thick piece of gauze that he had placed on the site to prevent bleeding. Dr. Som asked, “Why are you trembling Sampath?”

Dr. Sampath started sweating profusely. He had no clue what to say. He felt the floor slipping from under his feet.

“S…sir….. The t…t….tip of the c….c…..c…..catheter broke and is left inside.”

Dr. Som closed his eyes in disbelief. Dr. Sampath quickly fixed a plaster to the site tight to prevent bleeding and rushed out of the ICU to tell Vasudha and the other doctors. Within minutes, the senior doctors all assembled in the ICU.  They all had an eye on the vitals being thrown out on the monitor attached to Dr. Som. The worry was where the needle would go and what damage it would create. They had absolutely no control over this. They had to now do a CT scan to determine where the needle was and figure out a way to remove it.

Dr. Som could not utter a word. Vasudha was dazed. She pulled Dr. Murthy and Dr. Sampath aside and asked, “Should we shift him to Hyderabad?”

Dr. Sampath had regained composure by then. “Risky, ma’am. We should try to see where the piece is now. After that we can decide.” Dr. Murty nodded. “Let us do the CT and then decide.”

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