The anxious on-call intern

Madhava Sai Sivapuram

Final Year

Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation


Little did I know that my duty as a causality intern was going to become a night to remember my entire life. I was looking at my phone and chatting with my girlfriend about how I am missing her and is it possible to meet her tomorrow? With the increasing cold, my half-asleep eyes and completely tired body thought of going towards the chaiwala to have a cup of tea. Using all the energy I have, transferring it into my legs, and finally progressing to the 1st step towards the chaiwala, but suddenly I am halted by the ambulance sounds rings.A 22-year male, a Road traffic accident case having severe bleeding from the head is accompanied by his friend. On the further evaluation, it is revealed that he was coming from his birthday party on a newly brought bike gifted by his parents. As soon as the patient arrived, the interns on call had taken started giving the first aid under the guidance of chief medical officer. The patient has been unconscious and saline has been injected into the body. I myself injected the saline. I thanked God that the cannula has been inserted into the vein in one go. An X-ray and CT scan had to be done. During the whole process, the friend who accompanied him was requested to inform his parents or relatives to come as quickly as possible. Meanwhile; we contacted our Internal medicine department postgraduates for further evaluation of the case. The X-ray has shown a fracture in the skull and also the CT scan revealed an acute subdural hematoma. This was the first case of subdural hematoma I was part of.

As the consultant Neuro-surgeon of our hospital was not available with us for further assistance, we informed the attendant about the situation and the need for immediate further referral. We provided the referral hospital addresses to him and an ambulance was arranged. Despite this, he was consistent not to leave and repeatedly yelled that the patients family members are coming and they are going to take care of him.  Ultimately, we had no choice but to wait for the family members.

Finally, the family members arrived. As soon as they arrived, they began shouting at their son’s friend without any further thought. Our chief doctor tried to explain the situation to them, but instead of listening to the chief doctor, they started asking why did the scan was done unnecessarily and started questioning us and finally blaming the chief about making unnecessary tests and claims. The chief tried his best to stay calm and explain the crisis situation, but ultimately had no option but to shout at them and explain the need for immediate treatment in a better care facility to save their son. Alas, again it was like speaking to a wall! Instead of listening to him, they started accusing him of doing this for a commission. I was awestruck at the discussion and how the patient’s life was in danger due to the same. With the conversation headed for nowhere, I stepped a little back (I tried to hide literally due to the fear this conversation may turn violent).

Finally, they left the hospital but without any assurance of taking their son to the referral centre and were cursing us at the same time. They all gave us a darn look while leaving, a look well embedded in my cerebral cortex as a terrible look to subject the hospital staff to. I was left with a very poor self-subjective image of mine, which I never had previously.

After an hour, I maintained my composure and tried to reassess the situation, asking myself – what happened and why was I afraid? I was afraid of them, hence I stepped back. I thought they may harm me since the conversation was at a wit’s end.  I was not able to manage the situation and tried to run away from it. Instead of standing at the front end and leading a way I stepped back. I asked my chief how he managed it, leading to a good piece of advice for me to deal with relatives of the patient. Exactly two days later, the same relative who used brash words, comes to the ER with a box of sweets and asks about the doctor. The nurse takes him to the room, they have a discussion for 10 minutes and finally while leaving, he comes towards me and apologizes. I nod and recall back on my anxiety and self-doubt, with the realization that I can handle such cases with a better approach in the future.

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