Emergency Medicine – My Love, my passion & everything in between my Vows.

They say, “You have to be crazy to be a goalkeeper”. I say, “You have to be crazier to be an Emergency Physician!”

My interest in Emergency Medicine started very early, in the 2nd year of MBBS itself to be precise. The EMS & the Trauma centre at Sion hospital, Mumbai where it all started is among the best in the country, dealing with the entire spectrum of medical and surgical emergencies.

I still distinctly remember and smile, thinking about the time spent as a medical student / intern putting hundreds of IV lines, collecting blood samples, inserting Ryle’s tubes, Foley’s catheters, collecting ABGs, taking ECGs, accompanying trauma patients to CT scans, counseling patients, etc. Whenever I was free after daily lectures or while taking a break from the library, I would hang around in the EMS. I would look forward to the ‘Emerg-Double Emerg-and Triple Emerg’ where the unit in which you were posted had the call day for the weekend and the following weekday/s and you would end up continuously working 56-60 hours at a stretch in the EMS.

No matter how busy it got, the Doctors, nurses, the mamas and maushis, security continued to do their best – day after day.

Over time, I realized that being a government hospital, with the limited resources and the financial capability of most patients presenting there in the EMS, they were not being offered the best modality of treatment, nor was the treatment protocol based– Eg. There was no PAMI for an acute STEMI or thrombolysis for an Acute Stroke, no management of trauma patients as per ATLS protocol, procedural sedation, drug assisted intubation, etc.

At the same time, there was lack of communication skills, compassion, empathy & sympathy towards patients and their relatives by the resident doctors.

There were many instances during treatment by my peers which shook me and had a huge subconscious impact – seeing amputation of the hand being done under local anaesthesia with the patient howling in pain, pneumothorax while doing blind central lines, breaking multiple teeth while intubation, intubating awake patients with just a shot of Midazolam, patients requiring emergency surgery spending hours for an OT slot, etc to just name a few.

I had kind of made my mind then and there - the people deserve good Emergency care, which does not include only the medical aspect, but of the overall patient experience, satisfaction and quality in terms of ethical and affordable treatment, protocol based, supported by the latest equipment and cutting edge technology. I had vowed to practice ethically, not being money oriented, for the best interest of the people and provide them with the highest level of care. Not even once did I ever think of working abroad where it is possible to earn 4-5 times more money than in India, just because people here too deserve good emergency care.

Over the last 15 years, I have worked exclusively in the Emergency Departments of the top hospitals in the country, commissioned 4 Emergency Departments so far (seen them evolve over time into Centres of Excellence, and 2 of them receiving the coveted NABH Emergency certification), being actively involved in the teaching and training of young doctors, nurses and healthcare professionals. And the journey has been satisfying. More so because I have seen myself grow and learn, everyday.

Even to this day, I remain excited and enthusiastic about going to work. I look forward to the patients I would be seeing in my department. A well managed resuscitation, a smooth intubation, emergency procedures, STEMI, strokes, and everything in the Emergency – THE DRAMA, THE TRAGEDY, THE WORK PRESSURE, THE STRESS & THE URGENCY still excites me like it used to 19 years ago and keeps me going.

If ever I feel low, there are 2 feedbacks that reverberate in my ears. One was by my security guard who after seeing the many post CPR ROSCs said, “Sir, aap toh murda ko bhi zinda kar dete ho” and the other by another hospital staff, “Sir, God forbid, kabhi mujhe ya mere kisi family wale ko kuch ho gaya, I wish you are present on duty in the emergency”.

My current focus is on developing Emergency Medicine as a specialization, providing world class-quality care to my patients and to train healthcare professionals of tomorrow – of integrity, passion, honesty and discipline.

I now have confidence in my Emergency department, our current protocols and policies, the excellent team of Consultants and staff at our hospital, that in a life and death situation, if we can’t save a life, nobody else can!

Road to Success - Always Under Construction

A young 20 year old male patient was brought to our emergency with complaints of sudden onset chest pain, profuse sweating, hypotension (low BP), Hypoxia (low Oxygen concentration). ECG was suggestive of Sinus Tachycardia (a fast heart rate).

Based on his clinical evaluation, a quick bed side clinical diagnosis of a massive Pulmonary Embolism was made. Though I have only seen only 4 such cases in the last more than a decade of my practice in Emergency, I was 99 % sure that I would not be wrong, and did not write any other provisional / differential diagnosis on his emergency notes.

Knowing that Pulmonary Embolism is a life threatening Emergency where a patient can suddenly go into cardiac arrest and die, we needed to make quick clinical decisions and interventions.

The family was counselled regarding the seriousness and fatality of the illness, if not treated in time. His father and mother both started crying inconsolably; the patient was counselled regarding the possible diagnosis and he too started crying looking at his parents, with that feeling of impending doom of whether he will survive or not.

A quick CT Pulmonary Angiography was done, which confirmed the diagnosis of a Pulmonary Embolism. With our Emergency team which worked with clockwork precision, we were able to give him the definitive treatment in the Emergency itself, within 38 minutes of arrival, and by the time the medication infusion was over in 2 hours, he had stabilised completely - Chest pain gone, BP picked up, Oxygen levels up and he was much more comfortable.

His father stood by the bedside throughout the life-saving medication infusion. At the end of it, with tears in his eyes, the patient said, “Thank you doctor…” which made me emotional.

Hearing this, the father told him, “Ha doctor dev manus aahe, kahitar honar nahi tumhala (This doctor is God present in the form of a human, nothing will happen to you)…” and I was left speechless.

A reason why I wanted to write & document about this case was because it was one of the most well managed cases of my career, and highly satisfying considering the lifesaving interventions done in a timely manner.

The Head of the radiology department and the cardiologist (under whom the patient was admitted) were all praise for the quick diagnosis and treatment in the emergency, moments which make you feel good to be a part of a Team where we celebrate each other’s success. Also, it reminded me that I still get the same adrenaline rush and kick by saving someone’s life in emergency, like I used to since 2006 when I was a 2nd year medical student and first exposed to the EMS at Sion Hospital.

Over the last few weeks, we’ve had some really interesting and exciting cases wheeled in to our Emergency Department, and as a Head / Team leader, I really feel proud of the phenomenal work that my team is able to accomplish, and we’re growing together.