Ambulances blaring, monitors beeping, the distinct smell of disinfectants mixed with despair in the air – this is the everyday scene at Dr Ankush Garg's workplace. A 12-hour overnight shift at Vardhman Mahavir Medical College & Safdarjung Hospital, one of the busiest hospitals in the capital, starts at 8 PM and ends at 8 AM.
Between these hours, it’s up to Dr Garg, Senior Resident, Department of Anaesthesia and Intensive Care, to manage the patients that come into the red zone. We catch him on a night off after his overnight duty, and he takes us through his shift from the previous day.
(As told to Anoushka Rajesh. His account has been edited for length and clarity.)
First, let me explain the setup. The emergency department is divided into zones. When a patient comes into the ER, triaging is done to better manage the inflow.
Triaging is basically classifying patients according to their symptoms and the treatment they require. The red zone is where a patient requires immediate, acute, and life-saving intervention.
We give them fluids, blood, medication (whatever we need to stabilise them), and then send them to different departments as per the requirement – Orthopaedic, Surgical, ICU (Intensive Care Unit), OT (Operation Theatre).
8 PM-10 PM: 'It's Never Not Interesting'
At 8 pm, I reported for my duty. It started with a routine briefing – I take a detailed handover from the team that is completing their shift about how many patients came in, what interventions were required, where they were shifted to, etc.
At around 8:30 pm, just as we were getting done with our team huddle, a roughly 40-year-old man was brought in. He was clearly inebriated, but more pressingly, he had multiple stab wounds in his abdomen.
As soon as we received him, we hooked him to the monitor and took his vitals. We started an IV line, gave him fluids, and tried to resuscitate him, so that he wouldn't collapse.
I later found out that he was a victim of an attempted robbery. Apparently, he was walking on the road when a man on a motorcycle tried to rob him, and when he resisted, stabbed him three to four times before fleeing.
Upon inspection, we found that his wounds were not that deep, and that no internal organ had been damaged. So we did a primary treatment, patched him up, arranged blood for him, and sent him to the OT for observation, in case he needed an emergency surgery.
All through the process, he was conscious and aware of what was happening. He wasn’t feeling any pain because of the alcohol, I suppose.
He was perhaps the calmest stab-wound patient we have ever gotten. All this while, he just sat there, letting us do our thing.
But not all stab wound patients are so lucky. I remember one time we had a patient who came in with a rod impaled through him, much like that one episode of Grey's Anatomy. But even then, by some miracle, the rod had managed to miss his major organs, and we were able to save him. So yes, there's never a dull moment.
10 PM-11 PM: 'You Won't Die'
After that, a lady in her late 40s came in wailing loudly, clutching her daughter's hand, and nearly hyperventilating with panic. She had a scorpion bite.
The thing is, in over 90 percent of the cases, scorpion bites are harmless. They're just extremely painful. But the hysteria around it, on top of the pain itself, can make a patient panic which can worsen their condition.
I began by trying to calm her down by reassuring her that she was going to be okay. We treated the wound and gave her pain medicine.
We got a road traffic accident case shortly after. These are perhaps the most common cases we get in the emergency at night.
Sometimes they have minor injuries, and sometimes they are so badly hurt that we can't save them. This time it was a young motorcyclist in his 20s who was hit by a truck. His hand was bleeding. We got a medico-legal certificate made and left him with the junior residents.
11:30 PM-12:30 AM: 'Break Time'
I took my first break of the night at around 11:30 pm. We’re a team of six people posted in the red zone at once. I, along with one more senior resident, head the team made up of postgraduate students and junior residents.
There is no set time for a dinner break. We just discuss it amongst ourselves and take it one at a time.
How long a dinner break can go is left to the discretion of the one heading the team. I took a 20-minute break – went to the cafeteria, had my dinner, and scrolled through my phone for a bit.
Younger doctors sometimes use this time to go meet up with people – friends, partners – and stretch it to an hour. We generally let it slide unless there’s an emergency or in case we need them.
1 AM-3 AM: 'Difficult Decisions'
Things get quieter after midnight. We spend a few hours checking on the patients and tending to them.
We had an elderly patient struggling with the last stage of terminal cancer. The family was told that her chances of surviving it are next to none, but they insisted on putting her on the ventilator.
We counselled them against going for invasive treatment, to consider taking her home instead and providing her with end-of-life care – easing the pain, making her comfortable, keeping her nourished, and just being with her.
In such situations, family members are not always easy to reason with, and you can't really blame them either.
They want their loved ones to survive, to know that they did everything in their power to help them.
We need to be empathetic and explain to them that sometimes doing nothing is the best thing we can do for the patient.
In this case, they wouldn't budge, and sadly, as we were putting her on the ventilator, she had a cardiac arrest and passed away.
3 AM-5 AM: 'Mind Over Matter'
Just a few days ago, we had three cases of attempted suicides brought to the ER in a single night. As grim as it sounds, there is usually a rise in such cases after the NEET (National Eligibility cum Entrance Test, for Medicine) and the class 12 board exam results are declared.
I went to check on them. These were all kids aged 17 and 18 years.
At this hospital, we only get critical cases referred from other hospitals that aren’t equipped to handle them, so I can only imagine how many more they would have had that night.
We gave a report to the forensic team about the details of the case — what kind of attempt it was, the nature of the injuries, and then we involve the concerned departments for further treatment.
Such cases also hit closer home for me because I've been a student like them and I know what it's like to be in their shoes. But, at the time, my sole focus is to make sure that the patient survives.
If I start thinking too deeply about it all, then I’ll just fall through a rabbit hole and it’ll be difficult to pull myself out of it.
This has actually happened with me once. I was posted in the ICU. This young man had terminal surgery, after which his condition got worse. The patient's wife came on to me, begging me to save him. "If he doesn't survive, his family won't spare me," she said.
I suppose it was also because I was younger then, and I got emotionally invested. Ultimately when we couldn't save the guy, I wasn't able to get over it for a few days or function right.
5 AM-6 AM: 'Challenging, But Rewarding'
We don't get time to take naps during the shift like they show on TV, but we do get to take short 10-minute breaks from time to time. We usually go for a walk, drink some coffee, and then we get back.
Managing emergency cases involves quick decisions, quick action, and keeping your wits about you when you're stressed and sleep-deprived. It's not everyone's cup of tea, but I find it exhilarating.
You constantly see how your immediate intervention was able to save someone's life. When people constantly look up to you as a saviour, somewhere you start believing it, and shouldering the responsibility that comes with it.
I find the best way to cope is to tell myself that I'm doing my best, I was trained for this, and the rest is up to fate.
8 AM: 'Rest And Repeat'
It took me an hour to get home, beating rush hour traffic of people making their way to work. I ate a heavy breakfast and went to bed. We get 24 hours off after a night shift, and then it's back to the grind.