Yucks..

Misti commented on the Durian post regarding "you cannot eat liulian during the day or before you go to work. or else burp habis!" , and this reminds me of this particular incidence again.. Hahhaha.. although the event took place 7 years back (in year 2000), I can still remember it clearly. Although I shared this 2 years back, it's worth sharing it back again, since Misti waited eagerly for the story (under the table summore!)

That night, i had a young Malay patient with suffered compound, comminuted fracture of the femur for surgery. He had MVA (motor vehicle accident) at 4:30 pm in the evening, and he took durian half an hour prior to accident. ( i normally will ask the patient when was their last meal and what they took, as stomach emptying under normal condition will take 6 hours. This is important to prevent aspiration of gastric contents into the lungs (hence aspiration pneumonitis) once patient was under general anaesthesia). I called the case around 10 pm at night (6 hours after his last meal). I intubated him with cuffed ETT with cricoid pressure applied, and he was put under general anaesthesia.

The surgery itself took approximately 4 hours and finished around 2 am in the early morning. I reversed the patient from all the anaesthetic drugs and inhalational agents. Upon awakening, the patient vomited out large amount of partially digested durian (almost one bowl), and stink the whole operation theatre. My assistant (GA nurse) couldn't stand the smell and vomited, hence leaving poor me handling the patient alone. The surgeon had left much earlier on (as usual). The circulating nurse was no where to be seen. The scrub nurse was busy cleaning the surgical instruments in the other room. The hospital attendant hadn't arrived yet despite being called earlier on. I had to clean up the "mess"- sucking the remaining durian debris from the mouth, wiping and cleaning his face etc. I really had to hold my breath while doing that. I had to make sure there was no more residual vomitus left inside the mouth and the patient was fully conscious prior to extubation. (Stomach emptying normally takes 4 to 6 hours but the process may be impaired by certain factors, such as major trauma/accidents which might cause gastric stasis. This was well proven in this case, as the food particles stay intact in the stomach even though 10 hours had passed since his last meal).

Luckily there were no other emergency cases following that and I can close the operating theatre. The partially digested durian really stunk, and the smell remained inside the fully air-conditioned operation theatre for several hours. I had encountered with several more disgusting episodes in the past, whereby patients vomited on my clothes, and to make the matter worse, I cannot leave and clean myself or change my clothes immediately coz I have to attend to the patient first, or else they might aspirate their own vomitus or fell down from the operating table. (Some will struggle in the merge of waking up), Some of the patients are aggressive and we have to be alert. Else, might kena pukul buta-buta anytime. Who says being a doctor is glamorous ???