Another night in ED

Vinh Tran is a Canberra-born Vietnamese-Australian, currently working as a junior doctor at Canberra Hospital in Australia.

Image 4 - Dusica

Image: © Dušica Milutinović, 2016

It’s been over a year since I graduated medical school and started my journey as a doctor.  My first year as an intern was a huge learning curve, as I had to adapt to the long working hours, take responsibility for patients, and rapidly learn the hospital system.  It is now 2020, the world has come to a halt due to COVID-19, and I’m currently an Emergency Department (ED) Resident Medical Officer.  I have matured as a doctor, and with the new challenges I am facing every day, I am thankful that I have my cultural roots as an Australian-born Vietnamese.  Recently, that bicultural up-bringing, which helped me to develop the ability to speak Vietnamese, once again helped me in my professional sphere, this time contributing to saving a patient’s life.

On the evening I met this patient, I was on my third night of night shifts.  The next patient I was supposed to see was an elderly lady with flu-like symptoms.  However, I’d arrived early to work, so was asked to wait until my seniors arrived, and before I knew it, the patient was treated by another doctor.  The next patient on the list was a middle-aged Vietnamese gentleman who presented to ED with abdominal pain.  As I prepared to see him, I overheard him telling the nurses that his English was not great.  I guess it was fate that I happened to know Vietnamese.

Upon meeting the patient, I spoke some English to gauge his understanding.  His English was quite broken, so I decided to go with Vietnamese.  Although my Vietnamese is not as fluent as I would like it to be, I knew it would allow me to rapidly develop rapport with the patient and to get the information across quickly.  His brother-in-law was by his bedside; I remember hearing him say, “Oh – we are lucky to have a Vietnamese-speaking doctor!”  Hearing that put me at ease; there was a calmness acknowledging that we all shared the same language and culture.

As I spoke to and examined the patient, he was quite unsettled, and clearly in a lot of pain.  This made alarm bells go off in my head.  I made a list of possible causes: appendicitis (inflamed appendix), cholecystitis (inflamed gallbladder), diverticulitis (inflamed diverticula), renal calculi (kidney stone), gastroenteritis.  After seeing the patient, I discussed the case with my senior who performed a bedside abdominal ultrasound to further visualise his abdomen.  Surprisingly, the ultrasound was unable to identify his abdominal aorta (the main artery that supplies blood to organs within the abdomen).  We organised an abdominal CT scan; this would allow us to better visualise the abdominal cavity.  While we waited for the CT scan to be completed, our top suspicion was that it was kidney stones.  Little did I know that the results of the scan would actually be a matter of life or death.

After 30 minutes, my senior told me that the CT results had returned, and the results were not good.  After loading the image, I was in total shock.  The patient had a kidney cyst that had ruptured and was bleeding into his abdominal cavity so much that the blood had shifted all his intestines to the left.  This explained why the abdominal aorta couldn’t be visualised; it had been shifted entirely to his left side because of the sheer amount of blood in the cavity.  As luck would have it, while the CT was being reviewed, the urology registrar was sitting right next to us and overheard our conversation.  She recognised immediately that this was a life-threatening condition, and that things could go south very quickly.

As my seniors rushed to prepare the resus bay, I had to tell the patient about the results.  It was one of the hardest things I’ve had to do.  There was a lot of pressure; I worried about my vocabulary and whether I’d be able to explain the medical issue to the patient adequately.  After I told him, he was surprisingly calm.  I checked that he understood, and he confirmed that he understood what was going on.  This helped to settle my nerves; it meant I had been able to convey his condition in layperson terms, all in Vietnamese.  Even though on the surface this was a matter of translating between English and Vietnamese, there was another level of translation going on – medical terminology to regular speech.  I was relieved that I’d worked successfully on both those levels.

The next step was to assist the patient through the consent process for the interventional procedure to stop the bleed.  This was also scary because, again, we had to be sure he understood the procedure and all the potential risks.  I explained the major points to him in Vietnamese and, once again,  confirmed his understanding with a set of questions.  I was so glad that he responded well and I was reassured that he knew what was going on.  (I guess my Vietnamese isn’t so bad after all!)

Up until that point, I’d thought that telling the patient about his results was difficult enough, but next I had to call his wife and communicate the same information.  It was nearly 2:00 in the morning when I called.  I introduced myself and explained to her why her husband was in so much pain, then proceeded to tell her about the procedure we were about to perform.  Her first response was “Oh my God…” followed by a pause.  Hearing this was difficult because I was not physically with her to give her support (it’s surprising how physical contact can help calm a stressful situation).  There was silence on the phone, and so I apologised for delivering such difficult information, but also emphasised that time was crucial.  Thankfully, she held it together and asked to speak to her husband.  As I passed the phone back to the patient, I could overhear them talking.  The patient did a wonderful job keeping calm – it radiated out to his wife, and to me as well, to be honest.  I learned a valuable lesson from him about remaining calm even in really tough situations.

By 3am, the patient had been transferred to the operating room.  Over the course of the operation, the interventional radiologist had managed to identify the bleed and put a stop to it, and afterwards the patient was transferred to the wards for recovery.

In the end, what exactly happened to the patient?  Well, after 10 days in hospital, he managed to recover well enough to go home. I was relieved.

I often ask my seniors if they have ever experienced miracles in their profession, and they all have incredible stories to share.  After that experience, I now have a story of my own to tell.  I believe the patient wasn’t meant to die that night, and I’m so grateful that everything aligned as it did.  The patient I first thought I’d be treating was seen to by another doctor, so I ended up seeing this patient instead…  I was able to communicate with him in Vietnamese…  the CT scan could be performed rapidly that night…  the urology registrar and my seniors were both in ED when we got the results…  and the patient’s body managed to resist the strain and repair itself after we intervened.

While it may not always go this way in my career, it had this night, and I am so pleased.

© Vinh Tran, 2020