KB Mall Freak Accident: Another Vintage Point

9 12 2009

Quoted from subtlefortitude.wordpress.com


KB Mall 6 Dis ‘09 : Before the Memory fades from my old temporal lobe and life returns the Usual.

The sales person handed me the change for my wife’s new Sony Ericcson. I quickly put the clamshell into my left pocket ….”Translate: Better not lose it if I needed my hands busy”. Made my way through the crowd less than 1 minute after the booommm. Went stupidly close to the upturned car to take pictures with my handphone (fortunately the car didn’t explode). Through my phone’s screen, I saw a figure lying in a nurse’s uniform in left lateral position 10 feet in front of Watson’s. Nobody was within 5 feet of her.

I hurried to her left and squatted. Saw some movement of her head. Helped by a lady (later found out to be a seasoned clinic nurse) to turn her supine …. I tried maintaining relative immobility of her head. (later realized forgotten the proper way).

The moment I touched her, the same old thought crossed the mind “You are my patient … Allah has intended it to be so for reasons only He knows”

“So much blood from her mouth !!! What to do? In hospital simply suction then intubate” There’s obvious neck muscle movements but nothing else moves. “There must be a pulse coz she’s moving. But how to give her oxygen?”.
Tried opening her mouth. Crackling sensation accompanied . Her maxillary bone was fractured.

Looking at her chest … she appeared the “normal figure” with uniform on. “Should I expose her?? Naah … better not. Can get beaten for indecent behaviour. This is Kelantan”. Tried to pull her tudung to clear the blood of her face and out her mouth. But her head was on her tudung … could’t do it without moving her head.

“Ya Allah … the clock is ticking. I need to do something. Eeemm ..Why not try chest compression. If no cracking sensation and good recoil, her rib cage should be intact” Gave few short ones … felt okay. Then gave her the full blown 100/min in 30s … though may have overdone it to 150/min following my own adrenaline-rushed heart rate.

“Kain!Kain !Kain!! (meaning cloth)” I blurted it out continuously.”Please la, someone hand me something to wipe out all this blood from her mouth”. (Surprised to hear myself later on youtube shouting “kain,kain”). Pop … a pair of white sport socks dropped onto my lap. Well ..better then nothing.

Wiped the blood of her lips. Felt her maxillary bone fragments crackling again. No point asking anyone to do the jaw thrust. “Emmm .. my 7half-size-glove left hand may just stretch enough for my index finger and thumb to hold both her jaw angles”. Tried it. “Alhamdulillah, this may just work”. And the concavity of my left hand’s first web space held her fragmented maxilla good enough for her lip to move apart.

“Direct mouth to mouth?…. Better not. I’d vomit if swallowed her blood. And again this is Kelantan”. “HIV,Hepatitis B,C ….no worry. All student nurses are screened. . I do their RMEs all the time.”
Placed the blood stained sock on her opened lip and gave her the first rescue breath. ‘No can do .”. The air just dissipated through the thick sport socks. No chest rise.

“Kain .. kain …kain!!”. Again I blurted out. Pop … a white kain tudung dropped onto her face. “This is better..Surely I can breathe better thru it compared to the thick socks”.

And so I gave her rescue breaths, realizing only 1 in every 2-3 breaths was followed by a chest rise. Continuously adjusting my left hand grip on her jaws and at the same time feeling her right carotid pulse with my left ring and little finger. Frequently reapplying and folding the kain tudung to breath thru to her until it became fully blood soaked. Occasionally having to spit out my blood stained saliva or wiping my face with my shirt … occasionally having to hold back the strong urge to vomit.

On off pausing to see any spontaneous breathing. She was still trying to catch her own breathe … but to no avail.
Noticed few others coming to help me .. though didn’t have the time to look at their faces. A guy kneeled and whispered “LailahaillAllah” continuously to her right ear. Indeed, his voice was helping her in the most important way … much more than what my blood stained hands and lips could.

Another came to try persuade me to turn her to the left lateral position. I resisted. “Should I tell everyone that I’m a doctor??…”. My low self esteem kicked into gear … so I didn’t and kept quiet. Some other guy who probably had some old school CPR training gave 5 chest compressions every time I paused from my rescue breaths. No point reminding him that it’s unnecessary when there’s patient movement and a pulse. Detrimental to her? Not too sure myself. Perhaps she could do with the adrenaline surge from his chest compressions. “Let him be, he’s trying his best to help. Just don’t stop to long from my rescue breaths or he’ll start pressing again”

It felt like the longest wait for the ambulance. The constant recitation of “LailahaillAllah” kept reminding me that none of us has any power unless what Allah lends to us. None of us could do anything to change what He had decreed for the girl.

”What more can I do ??? Primary and secondary survey perhaps, then cardiac monitoring. What about running intravenous fluids and packed cells?”. “Hey, is there an ultrasound machine on sale here in KB mall I can use for a FAST … my patient sure is turning pale!!” I would be kidding myself to have had such thoughts. Between my rescue breaths , feeling of helplessness ever grows.
The pool of her blood began seeping through my wet pants to my knees. She was bleeding … and it’s not from her mouth. “Clinically cervical injury with comminuted maxillary bone fracture”. Even a 1st year meds school student knows that diagnoses usually comes after “Severe Head Injury”, not before it.
As her pupils began to react sluggishly and dilate, her carotid pulse brady and weak .. I began to wonder whether I’m torturing her and delaying the inevitable. Should I have just watched her from the sideline from the beginning. A pakcik wearing a kopiah tapped my right shoulder and asked me to let her go. “What should I do??” Am I her doctor to pronounce her DIL (Death in line) in public.? Or am I just a bystander who should continue doing the basic until proper help arrives??


“Thinking about it now .. I didn’t delay the inevitable. Allah has taken her the very second she was written to be .. in a place where no one would aspect to be in an MVA (motorvehicle accident). Looking back at it now … I was helping the other man as long as he can to remind her of Allah’s oneness LailahaillAllah. She barely moved, but I hope she was listening … and her heart accepting.
As she became very pale , I began giving chest compressions. Her blood pressure must be very low .. she’s gasping but I hardly felt her pulse. “Pushing blood to the brain” was how we crudely relate about chest compression at the casualty unit … sometimes joking about it.

I could hear sirens wailing for minutes. As the guys on my left and right began stepping back out of my hindsight, I was left alone again with the dying girl. And as the paramedics placed their emergency bag on the floor, I requested an oropharyngeal airway. They obliged. Placed it in her mouth, and gave her 2 good rescue breaths. Requested the laryngoscope and an endotracheal tube ETT. Gave more rescue breaths and attempted intubation. The ETT without an introducer stylet wouldn’t bend upward thru her cords. Sure took a while for the paramedic to find the introducer.

Post intubation, an honorable fellow doctor helped to ascertain air entry and cervical collar placement. Again the public lend in their hands for a perfect supine lift of her onto the stretcher.

After a few words with the paramedic, I quickly made my way through the crowd as I’ve given the Sony Ericsson box to a bystander. I gave her one last look across my shoulder and realized I have forgotten one last important thing.

I walked back to her …. took the fully blood stained kain tudung which had been the lifeline between me and her, and placed it onto her exposed neck and upper chest. She was a Muslim .. so let me leave her as one. That night I learned from TV3 news she passed away on the way to hospital.

Al-Fatihah … may Allah accept her as a Muslim and a Mukmin. Amin.




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