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ER physician credits medical student for role in averting carbon monoxide tragedy

By Girard Hengen

Third-year medical student Eva Karki is now convinced she has chosen the right career path.

Her experience in the emergency department at Royal University Hospital on the night of Jan. 14 has reinforced in her mind that she wants to serve her community as a physician.

Karki was side-by-side with ER physician Dr. Mark Wahba when he alerted the fire department to a possible carbon monoxide leak in an apartment building after the two saw a patient at RUH. Fire crews confirmed high levels of carbon monoxide in the building and evacuated 50 people, with 29 taken to hospital. There were no fatalities. Dr. Wahba received an Award of Merit from the fire department and has been credited with saving many lives that night.

Dr. Wahba deflects credit to Karki, who he says played a vital role in coming up with the diagnosis of carbon monoxide poisoning in the patient. Karki, who is enrolled at the University of Saskatchewan, says she learned lot from the incident – about medicine, and about herself.

“It made me appreciate what life I have chosen because with medical students, burnout rates are high, we’re in a new environment, we’re mixing a lot of brainwork with emotional turmoil that happens in people’s lives,” Karki told the SMA. “That can really take a toll on us emotionally. Sometimes you question, ‘Is this the right decision that I made? I can’t do this for the rest of my life, I’m already so tired and emotionally exhausted all the time.’

“But then something like this happens and them you realize - there’s no way I could do anything else with my life. I’m so glad I’ve chosen this path and I’m able to serve people and do what I can to help my community.”

Something amiss with ER patient

Karki was near the end of a four-week clinical rotation at RUH’s emergency department on Jan. 14 when Dr. Wahba saw a patient who required a translator and had been waiting for hours to see a physician about a headache.

“Because I had a medical student with me I had to talk everything through, saying, ‘This is what I’m thinking,’ and, ‘What about this as a possibility? I had to teach Eva, which forced me to think of more possibilities,” said Dr. Wahba.

“Part of the teaching we talked about was that this patient had all kinds of cognitive bias stacked up, such as language and cultural barriers – we used a translator – to sitting in the waiting room for hours before being seen. There was a lot of bias in the case and the potential for error. As I was telling Eva this, we had to think through everything thoroughly,” said Dr. Wahba.

He originally thought the patient had a tension headache or migraine, or a headache from something as simple as wearing a mask all day – which he is seeing more and more. The patient’s vital signs were normal – yet something seemed amiss.

“He was searching for something more because doing the history was trickier,” Karki said. “There was the language barrier, and although we had a translator in the room, there is still something across languages and cultures that can be difficult to convey. As well, with the relationship between the translator and the patient, we don’t know how comfortable the patient was providing information, which was a big barrier.”

Karki said she drew upon her medical education to conduct a social history.

“I understood the value of a social history that day because I was just asking, ‘Do you have any supports at home?’ And that’s the patient brought up a child who was sick. When we went down that line of questioning with Dr. Wahba, I could see like a light switch turn on in him: ‘Oh we should see if this is a case of carbon monoxide poisoning.’ ”

“I called the fire department,” Dr. Wahba said. “I just asked, ‘I’m hoping you can do me a favour and check out a residence for carbon monoxide.’ ” He wasn’t certain, as blood work was not yet back from the lab.

“They called back about 10 minutes later. It was real, a real emergency. They had to evacuate the building, and then maybe half hour later there was an announcement of a Code Orange coming.”

'I'm really glad I had Dr. Wahba with me'

Karki recalls the surge of patients coming into the ER following the call of a Code Orange, or mass emergency. Patients were triaged; she heard people talking about numbers like parts per million of CO2, and although she didn’t know exactly what that meant, she was glad all was well in the end.

“It was one of those experiences where you’re just doing your thing, taking a history, doing a physical exam, and then happen to find a diagnosis that was beyond what you thought it would be,” she said. “I learned a lot and I’m really glad Dr. Wahba was with me. I think he exemplified the empathy and clinical decision-making skills that we all hope to get out of our medical education.

“It was really nice to see someone who was willing to take the time to try to understand what is happening with their patient, and I’m very humbled by the experience.”

Dr. Wahba received widespread praise from the community, the fire department and paramedics. "Paramedics would like to personally thank Dr. Wahba for his quick response that could have turned out much worse," Troy Davies, Medavie Health Service West spokesperson, said in a news release.

“There’s no doubt, many lives were saved,” said fire Chief Morgan Hackl. “This was a serious incident that could have turned out very differently. The Saskatoon Fire Department urges all residential homes and multi-unit residences to have carbon monoxide alarms. They save lives.” 

Physician turns advocate for carbon monoxide detectors

Dr. Wahba said he agreed to tell his story not for the recognition, but to advocate for a change in the building code that would mandate the use of carbon monoxide detectors, especially in high-density housing such as older apartment buildings. The apartment building did not have CO detectors because they were not required when it was built. Under the code, buildings constructed after 2009 require detectors.

“As a doctor you have to be an advocate sometimes for the general health of the public,” he said. “You have to put yourself in that position. I don’t really want to do media, but if it gets the story out that we need carbon monoxide detectors everywhere, then that helps saves lives – then that’s being a good doctor.”

The attention was “really humbling,” he added. “It’s a cliché but I think doctors would say I’m just doing my job. That’s how I feel. What I’m most glad about is there is attention now being drawn to the question why all buildings don’t have carbon monoxide detectors. I hope the media exposure highlights this problem. Why doesn’t every building have a carbon monoxide detector? Why doesn’t every home, every apartment?”

Dr. Wahba might get his wish. Saskatoon city council meeting on Jan. 25 agreed to start the process of getting a report from city staff on options to require CO detectors, a first step forward in preventing future tragedies.

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