The Last Call

“You, medical student, come here!’’

I was in the wards, as usual exhibiting non-purposeful movements in, out, and around the wards when suddenly that deep voice came from behind. I turned around. The voice belongs to a specialist consultant. ‘Oh shit’, I thought. ‘He either wants to scold me for lying around the wards without purpose or wants me to run somewhere and fetch him some blood’. I came towards him anyway

“You, undergraduate student right? Come here and auscultate (listen to) the patient’s lung. Tell me what you find!’’

Dang, breath sounds. I wasn’t prepared for this, but hoped to get it right this time. The curtain around the patient’s bed was closed. Without hesitation, I went in. Inside, there were nurses around the bed, must be 4 to 5 of them, because I remembered I felt like drowning in there. Judging by the looks, the patient must be in a critical condition. I took out a navy blue stethoscope from my white coat, wrapped one end around my neck, and adjusted the round shaped object we call ‘diaphragm’ at the other end. I put the cheap plastic piece on my ear, the diaphragm on the patient’s chest, and started listening.

Perhaps there was too much noise. The nurses around me were talking loudly to each other. What are they doing here anyway? I got irritated. I couldn’t hear a thing with them in here! I pressed the earpiece harder towards my ear. I listened again. Still, there’s nothing. I rechecked the diaphragm, twisting the cord clock and counter-clock wise again. There’s nothing wrong with it. By that time the nurses had stopped talking and started giggling. I decided to get some hints and ask one of the nurses.

“Uh, nurse, what does this patient have’’ I asked

“What does he have? Hmm…well, I’m not really sure’’. She had a sinister smile, then the other nurses giggled harder.

I was in an awkward situation. Then, the curtains open abruptly. It was the consultant.

“Hear anything?” he said

I had read the patient’s note before. It said that the patient has ‘bibasal crepitations’, crackling breath sounds you hear in your stethoscope when auscultating patients with certain lung disease. I had an impulse to say it, but I decided to be honest, and glad I did:

“I couldn’t really appreciate the sounds, doctor’’. He had a similar sinister smile as the nurse before.

‘’Do you know what’s a last call?’’

‘’Last call?’’ I asked

‘’Yes, last call, you know how to do it?’’

Then it came into my mind. Last call. I heard of it in TV series. That was when everything fell into place. The noisy nurses, the inaudible breath sounds, the eerily silent chest, the closed curtain. How couldn’t I realize earlier, that there was a resuscitation cart next to the bed? How couldn’t I notice the chest wasn’t moving? Or there’s not a heart sound along with the breath sound? No wonder the nurses were all over. Perhaps I was too nervous by the specialist suddenly asking me to examine the patient, or perhaps his instructions to ‘hear the patient’s lung’ confused me, or the nurses overwhelmed me. Of course I couldn’t hear the breath sounds...

I was auscultating a dead patient!

Having understood the specialist was playing tricks on me to make me learn a valuable lesson, I confirmed the patient’s unresponsive pupil with my pen-torch, confirmed the pulseless carotid on the neck, confirmed the inaudible breath had heart sounds, and made the last call. It sounds something like this:

‘This patient, Mr Y, announced dead at 3.45 PM, 23rd of December, 2010”

I learned a great lesson that day. Do you know that in the midst of the stormy disaster, the most tranquil place to be is in the eye of the hurricane? That's where I want to be in the midst of a disaster. To remain calm, controlled, careful, focused and observant, even when the world is in a storm.