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Experience in Neuro-Surgery, DMCH

As a Internship rotation program I was placed as a Duty Doctor in Department of Neuro-Surgery in Dhaka Medical College Hospital (DMCH). The ward is 30. Probably the most busy and dangerous (!) ward in DMCH. All Head & spinal injury, unconscious, Road traffic accident (RTA), Injury followed by violence and assault, attempt to suicide, homicide etc patients are brought to the Ward 30. As DMCH is a public hospital, average 5 attendants with 1 patient will come here and charge (!) the duty doctor. Also police, RAB, and journalist from different media are always crowded here to make reports with or with out proper permission to the hospital authority. So I mentioned dangerous about ward 30.
Patients in the floor outside neurosurgery ward, DMCH

This is the only ward where there are some security guards to protect the duty doctors from any unusual occurrence. This is the most busy ward. all time patients are getting admitted and discharged. In my 7 day placement I received and discharged more than 150 patients. There are always 6-8 duty doctors at a time in a shift.

The fact is, Doctors are not only managed patients there but also managed all the patient’s attendant. Sometimes patient’s attendants are become aggressive to the doctors with no or silly reasons. According to them, Doctors are bound to manage all the attendants along with the patients.

I would like to share my experience here. One day I referred one of the patient to ICU. Patient party go to the ICU and refused because there are no bed available. They came to me and charged for not getting bed in the ICU. I told them that ICU is a different department and I have no control over them. But the party threat me that It was my fault and they will see me 🙁 I don’t know why.

Another day, a journalist from a TV media with her camera crew entered the duty doctors room and asked that patient party are complaining about not getting bed to the ward. another complained that no doctors visited his patients after getting admission. Reporter wants to know these reasons from us. Well. We go there and told her we cannot manage or rearrange the bed, all beds are already filled up with more than 1 patient per bed. At this moment patients have to be in the floor to get the management. Then we go to that patient and show the reporter that doctors attend the patient, give him proper order in the treatment sheet.

A poor looking patient along with 6 attendant came one day followed by RTA. Patient was unconscious. I attend that patient and examined the GCS. I told them that a CT scan is a must. CT scan of brain is charged TK. 2000 at DMCH (where outside is more than 4000). There is a option of free for poor patients here. I thought that patient party is poor and told them if they want I can manage them for free. Then one of them began to bargain with me with the price. I told them that it is the govt rate and I can’t reduce the price and of course it is under radiology department and not in my control. I can only request for free to the hospital director. One of the patient party then want to know my commission on this price. I am then shocked. I told them I could send them to outside laboratory If I had any intention about the commission. I wanted to help them but they misbehaved with me.

Another day, patient attendant come to me and said “Sir my patient is bleeding per urethra”. I went there and saw that there was a rupture of urethra as the catheter was forcefully removed by the patient. The patient was disoriented. One of my colleague who introduce the catheter to this patient, told the patient attendant to keep an eye on him so that he can’t forcefully removed the catheter. Patient attendant did not follow that. Patient himself removed the catheter and is now bleeding. I then managed the patient carefully, secured and bleeding and refer the patient to Urology.

Sometimes I was happy to manage the patient, sometimes I was shocked about the behavior of patient party, sometimes I was afraid off by the threat of patient party, sometimes I was sad for declaring the death of my patient. This is probably Neuro-Surgery.