tell me more.

tell us more about the hospital, you say.
well, fine, i will tell you about our morning on saturday.

on saturday, we came into the hospital to round on the patients. as friday was the team's admitting day, there were now about 60 patients on our team (one attending, one intern, one resident). in our ward , which we share with one other team, there were over 80. it was overflowing, and they had resorted to mats on the floors again. as we were waiting for the attending, an old woman came up to the other american student, who is indian, and dragged her over to an old man. we saw the intern and a nurse go over, too, and so we went. the man wasn't breathing and didn't seem to have much of a pulse, either, and the intern was doing chest compressions while waiting for the airway stuff to arrive. chest compressions are one thing we can do, so once he was intubated, us three students started to take turns doing compressions while the nurse attached the bag to the tube (you know, the giant bag you squeeze to give breaths). but the bag wasn't working. so we kept rotating compressions on this tiny man's startlingly compressible chest. finally, (minutes?) another bag arrived. the intern was gone at this point, and the nurse hands the bag to the man's son and leaves. so to recap, we have three foreign medical students and one family member running this resuscitation effort. at one point, i saw the nurse coming back with a syringe of something. oh, good. epinephrine, perhaps? actually, it was meds for our patient's neighbor. then she left. so there we are, perched on this little rickety bed, compressing away with the son. there was an emergency kit, but it seemed not to contain much more than glucose.

once, as we were switching off (those compressions are tiring!) i looked up and saw that despite their meager efforts to pull a screen across the bed, we had the rapt attention of the whole ward. after a few minutes, the intern returned and decided this was futile, but what happened next remains a little unclear to me. as best i understand, we stopped chest compressions but left the son with the bag, giving respirations, because the family would need more time to process what was going on, and we would just tell them we needed time to see if he would respond. so we went to start rounds and left the son bagging.

incidentally, the first patient we went to round on was also lying in bed, deceased. 0 for 2, good start to the morning.
so, some time later, having rounded on the other 58 or so patients, we returned, and someone finally told the family that their continued efforts were futile, and, of course, they did not take it well. then, with the patients in neighboring beds each about a foot away, he stayed there until the morgue folks came up, and with the same futile attempt at screening and same rapt audience, stuffed his nose and mouth with cotton and wheeled him off. at least they wheeled this one. the other patient's family had to wheel his body to the morgue.

so that is what the hospital is like sometimes. it isn't that the doctors aren't smart, or that they don't care. it's just that they're overwhelmed and if two of your patients die, well, there are still 58 more that need your attention so they don't. so i guess sometimes you just have to accept your losses.