Medical Mishap

‘Shut up! Shut up! I know!’ Panic washed over Abby as she futilely attempted to staunch the unrelenting flow of blood with surgical sponges, then suction devices. The bright red colour of the blood meant she must have nicked an artery somewhere, but with so much blood flooding his chest cavity, it was hard to identify the exact location of the leak. ‘Shit, shit, shit!’ Abby’s hands shook violently. Her confidence had misled her into believing this surgery would be a breeze. Disregarding Callie’s warning, she had taken matters into her own hands, operating without proper authorisation. And now, everything had spiralled out of control. Not only had she violated the hospital’s rules, but she had also caused a medical mishap. To make matters worse, the patient lying before her was a soldier. What if he died on the operating table? The weight of the consequences pressed upon her, leaving her paralysed with fear. Her trembling hands failed to halt the bleeding, rendering her helpless. Wendy, though just as flustered, knew she couldn’t afford to panic. She tried to keep her voice steady as she admonished Abby, ‘Dr Colman, this is not the time to freeze. The patient’s going to bleed to death if you don’t do something!’ ‘I... I...’ Abby’s voice wavered, her distress seeping through her words. ‘I... I don’t know. What should I do?’ Wendy swore under her breath and fought the urge to shake some sense into the young woman. Abby was the doctor here, even if she was just a first-year resident. If she didn’t know what to do, what hope was there for a nurse like Wendy? But Abby was clearly incapable of acting right now. Wendy shoved her aside, used suction devices to remove excess blood and fluid from the patient’s chest cavity and tried to locate the bleeding source. But there was simply too much blood. And even if she did find it, she’d need a surgeon to help stop the bleeding. Abby stood by the side, watching helplessly. Wendy shot her a glare of frustration before hurrying off to Operating Theatre Two. She shouted into the intercom. ‘Dr Hawthorne! We need you in Theatre Three!’ Callie was drenched in sweat, having just closed the patient’s pericardium with absorbable sutures and the chest incision with surgical staples. She was about to place drains to evacuate any fluid or blood that may accumulate postoperatively. Continuing her work and without looking up, she asked, ‘What?’ ‘Dr Colman performed the emergency thoracotomy alone. Midway through the operation, the patient started haemorrhaging profusely. He’s in tachycardia, and none of his vital signs looks promising.’ Callie’s movements momentarily faltered, but within seconds, she recovered and picked up her pace. ‘Wendy, prepare for a blood transfusion immediately. I’ll be there in three minutes.’ ‘Dr Colman, that’s the other problem! The patient is blood type A, MNSSU. We don’t have that in our blood bank. And compatibility test with blood types A or O takes time.’ Wendy’s voice was hoarse from shouting. ‘As far as I know, you’re the only one in this hospital with that exact blood type.’ Callie bit her lip, her grip tightening around the chest drain tube. ‘Is Dr Moncrieff available?’ ‘No. I looked into Theatre One. He’s just getting started on patient Number Two.’ Which meant Callie had to do both: treat the patient and donate blood. There was a flicker of unwavering resolve in her almond-shaped eyes as she repeated herself, ‘Wendy, I’ll be there in three minutes. Set up the transfusion pump. As soon as I find and close the bleeding site, we’ll do the transfusion.’ ‘But Dr Hawthorne—’ ‘Go. Now!’ With that, she shut out Wendy’s protests, diving back into her patient’s care. Abby’s disregard for her instructions and unauthorised surgery had caught Callie off guard. But this was no time for pointing fingers. That would come later. Callie picked up her pace once more, closed the incision site, then left instructions for the surgical nurse to apply sterile dressing before darting out of Operating Theatre Two into the adjacent Theatre Three. She scrubbed up and stormed into the theatre. ‘Is the blood pump ready?’ she asked Wendy, not sparing a glance at Abby, who stood frozen to the spot. ‘All set.’ With Wendy’s help, Callie examined the patient’s chest cavity, gently manipulating the surrounding tissues and structures to identify the injured artery. It took her about twenty seconds to find the bleeding spot. With a pair of vascular clamps, she clamped down on the artery until there was no more blood seeping out. Then she sutured the artery with a curved surgical needle. Once haemostasis was achieved, she relaxed slightly. She turned to Wendy. ‘Let’s do the transfusion.’ She sat on a stool and rolled up her sleeve. ‘Let’s do 300cc first.’ ‘Got it.’ Wendy drew Callie’s blood with practised ease, collected it into a sterile canister, then processed it in the blood salvage machine to separate the red blood cells from other fluids. Once separated, the red blood cells were washed with a sterile solution to remove any contaminants, then filtered to get rid of any remaining impurities or clots. Finally, it was transferred to a blood bag and immediately administered to the patient with a transfusion line and a blood filter. Throughout the process, Callie kept her eyes on the monitor, observing the patient’s vital stats. They had stabilised somewhat, but his systolic blood pressure and oxygen saturation level were still dangerously low. ‘Draw another 500cc,’ she said to Wendy, who did as told. ‘Another 300cc,’ Callie said after the second transfusion was done. ‘His oxygen saturation level is still below ninety per cent.’ The nurse sighed when she noted Callie’s increasingly pallid face, but she carried out the order without protest. It wasn’t until the patient’s oxygen saturation level was brought back up to a healthy 98% that Callie finally stopped. She rose to her feet, swayed and saw black dots swimming in front of her eyes.