I threw myself on my bed and woke up after 8 hours, cup of coffee was on the drawer nearby but it was cold not in a condition to be drunk.
By Dr. Mushtaq Soomro
While working in children’s emergency in Castlebar Ireland I learned a few things I never knew before.
On one evening parents and family friends brought a five-year-old boy who collapsed in the woods. While playing and running with a friend fell on dry old debris and got minor surface injuries.
On arrival at the Pediatric accident and emergency, he was drowsy, warm to the touch, and had impaired response to stimuli. Actually, the boy was part of a 10-member picnic group of two families. Kids were playing separately from adults at a short distance from the main camp. The boy passed out, after receiving minor injuries when he fell down on the ground. On examination had a few scratches from these and some blood was oozing. When he arrived at the hospital, his blood pressure was not coming up; he had a low-grade fever as well.
We discussed the patient among the team members who were managing him while resuscitative measures were being given. What could be the reason he went into shock? I discussed with a team member Dr. Collin, “I think he might have been bitten by a snake as symptoms are suggestive.” I gave my quick opinion.
“Dear there are no snakes in Ireland so we can rule out this possibility, with certainty”
“Long ago, St Patrick with his miracle threw all the snakes out of Ireland.” Replied Collin. Very surprising news for me. I did not know if Dr. Collin was believing this himself or telling me about a common myth but it was a fact that in the coming years of my stay in Ireland, I never came across any patient of snakebite and it was fact that in the whole Island of Ireland there was no snake.
The five-year-old boy had a severe infection, which got entry into his bloodstream, and gave symptoms similar to a snakebite. From my hometown, Castlebar, the nearest International airport was Knock West International, which I traveled through several times but wondered every time why the secluded place of county Mayo was selected for an airport.
My thoughts were seconded when I saw the title story of an aviation magazine, headlined, “What a place they built an airport.” Actually, Knock is a small village 12 miles from the international airport having a population of 972 people, well known for the Knock shrine pilgrimage site, a prominent place for Roman Catholics.
This small village became famous after an apparition occurred on 21st August 1879, and now some 1.5 million visitors from all over the world come every year. 15 people living in Knock village claimed that in the evening time they saw Mary, mother of Jesus Christ dressed in white, wearing a large crown appeared to be praying along with St Joseph and St John at Knock village, They saw them in the pouring rain, remained there for two hours.
Why was Knock Airport attractive to me? It was only 45 45-minute’ drive from my home in Castlebar, the main town of the beautiful Irish county of Mayo. Near the airport, there were a few small villages, but no big town or city and no large hotel near the international airport.
The drive to Knock is charming as going through lush green plains and hilly areas for some distance makes the short journey a memorable experience. From Knock, all the arriving and departing flights are scheduled in the daytime so during rush hours one can see hustle and bustle in the departure lounge where several restaurants are seen serving delicious cups of freshly brewed coffee along with tasty sandwiches, creating a relaxed and tranquil atmosphere.
The international airport of West Ireland becomes a deserted place when night falls; you can see only 15-20 cars in the huge dimly lit car park whose owners planned to remain out of the country for a few days or 1-2 weeks.
My flight was in the evening hours before sunset time from Knock Ireland to Manchester UK. I had several appointments in Manchester. I was planning to relocate to England so was nearly finishing the process of GMC registration (General Medical Council, which is the licensing authority for doctors in the UK). GMC had called me for a personal interview, which was scheduled the day after, at 9 AM.
After that, I had to read a paper at the Children’s Respiratory Conference.
In the late evening, there was a short visit to the Paediatric ward and after that, an overnight work shift in the Pediatrics ward as a locum (temporary doctor). Therefore, I took an afternoon flight from Knock to Manchester and stayed in a Bed and Breakfast, the day was busy so I slept well as another busy day and night was ahead. I had to work all night in the Paediatric assessment unit with a team of four nurses and one junior doctor along with supervising off-site consultant on call.
I woke up in the morning and prepared for my first appointment at the GMC office at 9AM, A multi-story building in the city center one full floor of that building was assigned to GMC. Everything necessary for my registration was complete except verification of personal ID documents and my picture, which all finished in less than 30 minutes and I was given the license to work in the UK as a doctor. I came out of the building, took a taxi, and in the next 10 minutes arrived at the venue of the Pediatric symposium, which had just started.
Within a few minutes, Prof David William was called to deliver his presentation, a research paper on Difficult Asthma in Children and most latest treatment options were explained by the worthy professor. After that, I was invited to come and talk, I had done small research on children who had a history of recurrent croup and who developed asthma in the coming years, and presented with full data.
During the coffee break, I met with Prof. Williams, We had a brief chat about my registration with GMC and he said I was most welcome to visit his department that evening and to do some clinical work under his supervision.
I attended a few more lectures, came out, headed toward the city center, and had lunch in an Indian restaurant. Around 3.00 PM I went to a rather curved street in the city center which had branches of 5 British banks. I entered in all the banks one by one and requested to open my account as I was in the process of relocating. As I had no prior appointment, all four regretted and advised me to come in the next week, which was not possible for me.
The fifth one was the final remaining bank. It was now 3:30 PM, and the person at reception said to wait for a few minutes until he asked the relevant official. He came back in a few minutes and invited me to a small chamber where Mr. Jack was waiting for me. He glanced at his watch and said, “Yes we have one and a half hours, we can open the new account.”
Jack sat in front of his computer, opened up a long pro forma and after asking several questions told me about various options for current and savings accounts, then verified all the required documents and finalized my current account and handed over me some printed papers and advised that he should be sending my ATM card in the post soon. In the end, he gave me his business card; I thanked him and came out of the bank. And took a taxi for 5 miles away to reach the children’s hospital.
Went to my temporary accommodation in the hospital, took an hour’s nap then woke up took a quick shower took some snacks and a cup of tea and headed towards the Pediatric department. I met with Prof Williams, who was waiting for me in his office, he showed me various parts of his department introduced me to the staff, and left me in the Pediatric assessment unit, which was near to main accident and emergency section of the hospital.
I took over that assignment to work in the season in which cool days and nights were approaching although winter was not in full bloom. Most of the kids visiting the hospital had breathing issues so on that night out of six admitted patients two suffered from diarrhea, vomiting and abdominal pain remaining four were suffering from respiratory ailments like asthma, bronchiolitis and croup.
Fortunately, all patients were stable and nobody was sick although not ready for discharge home yet as most of them required some oxygen during sleep. After taking hand over quickly went through the current clinical status of all six kids, discussed their further management with nursing staff rescheduled inhalers and nebulizers, and did a quick phone talk with on on-call consultant.
Around midnight a 2-year-old boy was brought in quite sick status, The Child was looking pale and miserable his breathing was noisy and in drawing of lower part of his chest was clearly visible. His father who was looking panicked brought him; in the temperature of 65 Fahrenheit sweat drops were clearly visible on his forehead.
He looked at me as if I had met with him. I requested to inform the airway management team if the child needed their help and assured the father that the kid had Croup and the results of quick treatment were excellent in most cases.
The ambulance crew gave him a low dose of dexamethasone along with a bronchodilator (airway widening medicine) without a good response, despite receiving a large amount of oxygen his saturation was hovering between 91-92%. Child was given another dose of dexamethasone with some response as now his O2 saturation was normalizing so self-ventilating in room air.
I said to Dad,” Are you Mr. Jack working in the local bank” “Yes doctor, thanks for help, what has happened to my son?”
I told him briefly about the pathophysiology of Laryngotracheobronchitis/Stridor and Croup all things overlapping in this type of emergency/entity.
After about 30 minutes, the child’s throat was producing noisy breath sounds again with in drawing of the lower chest. He was breathing fast and his oxygen was dipping down again requiring some oxygen again.
It was time to take further action, the decision was made and the child was put in a high dependency room and a nebulizer of epinephrine was started which took about 12 minutes to finish the medicine. Soon he turned the corner, and the kid was now much comfortable.
In the coming two hours, I saw satisfaction on Jack’s face. Then two more patients with viral wheeze and shortness of breath came, and they responded quickly to medicine administered through inhalers. Heading to be discharged home in a couple of hours as per plan.
I was feeling tired, looked around at the faces of sick kids, and glanced at the plan for further management. I discussed this with the nursing staff, phoned to on-call consultant and looked at the big clock at the entrance of the unit; it was showing 7:30 AM.
Went to the nearby coffee shop, which was open round the clock for hospital staff and attendants of patients. Took a cup of coffee and carrot cake and relaxed for a few minutes there.
The night staff of the hospital was preparing to go home after a whole night’s busy and tiring shift and day staff was coming in, initially nursing staff then doctors.
Around half eight my reliever Dr. Daniel came in. I handed over to him all the patients under my treatment last night in stable condition. Before finishing the shift I did an eyeball look on all patients under my care last night. In the corner bed last night, the child, son of the banker was much more comfortable and the dad Mr. Jack was also looking relaxed. He thanked me again for looking after his son. I said bye to him and came out of children’s department.
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Came to the hospital’s main reception and called a taxi for Manchester airport. Weather was getting cold and dark clouds were merging and mingling, in the next 25 minutes reached the departure lounge and rushed towards the gate of the Knock flight. The flight was late for 45 minutes so new time of departure was 1200 mid-day, quite tired but hustle and bustle of the busy departure lounge in which several flight delays were announced and new times were told, I could take only 10-12 minutes of a nap while sitting on the chair which was not comfortable at all.
Took a cup of coffee, which kept me awake for 45 more minutes but again was feeling, extremely tired and sleepy till heard my knock flight announcement now departing at 12.45pm.
The usual flight duration between England and Ireland is around one hour so I was painting the mind picture, expecting to come out of the arrival lounge of Knock airport around 13.50 hours, take a large cup of coffee, and sit on the seat of my car toward Castlebar and reach home around 15.00 hours, all well.
We were now in the air right over knock area West of Ireland, What was happening? The plane was circling around. The second time and then the third time but could not land even not attempt to land because thick fog, was not allowed by the air controller to land, so the pilot decided to divert to another airport Shannon International. In the next 10-15 minutes plane landed at Shannon, It was getting cold and I was tired and sleepy.
After getting our luggage which came with a delay of 30 minutes all the people who came out of the lounge were told to stay outside as some buses had been hired and they would arrive in the next 30 minutes or so, and passengers were instructed to arrange themselves in three queues. It was really chaotic as three buses came after one hour wait then all luggage and people were checked again embarked on the buses and the fleet moved to the west of Ireland.
During chaotic activities could not find a peaceful corner of the coffee shop to boost my energy. Distance from Shannon to knock was not a short one, 95 miles and requiring a duration of 1 hour 45 minutes to reach. The fog was in the weather so the bus was running a bit slow at last reached in two hours.
It was dark outside, with only few lights in the airport building as this airport is not meant to be used after sunset. All the restaurants and coffee shops were closed even though there was no coffee machine there.
In the moderately cool weather came out of the bus and proceeded to the dimly lit parking area in some drizzling rushed to my rather cold, moist car. Collected my energies and started the journey to my hometown Castlebar. Came through Claremorris a town from which two roads emerged one to Castlebar and the other to Galway.
Instead of taking the road to Castlebar, I took Galway Road without any conscious effort as if I were going to home Castlebar. After the distance of 5 miles when I went through the small village, Bellindine saw a petrol station and adjacent Papa John Pizza, and suddenly realized that I was heading to Galway, not to Castlebar.
My eyes were wide open able to see immediate danger but I was unable to decide quickly so I slipped to the wrong road 10-12 minutes after seeing the petrol station and Papa John Then memory revived that whenever I used to go Galway I passed through that spot.
So after about 6 miles on Galway road a spot came in which construction of road /repair was being carried out so in night-time there was a small vacant area in which the car can be diverted, so I got the correct road and widely opened my eyes and in next 25 minutes reached home.
My wife was waiting for me for several hours, dinner was getting cold, I told her,” Darling I could not find coffee for many hours, can you please prepare one cup.” She went to prepare coffee and I threw myself on my bed and woke up after 8 hours, cup of coffee was on the drawer nearby but it was cold not in a condition to be drunk.
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Dr. Mushtaq Soomro, hailing from Sindh, Pakistan, is a UK-based medical doctor and freelance writer of Sindhi, Urdu and English languages. His works were published in various dailies including Hilal e Pakistan, Jang, Dawn, Daily Times, The Frontier Post, Kawish and Ibrat. His short story was published in Ibrat magazine. This is his first short story in English. He can be accessed at e-mail: mushtaqsoomro@gmail.com
