So where do I start… Let’s go with ‘What’s the worst, most hectic thing that could happen on a call?’ The absolute worst thing, in the medical admissions ward on yet another all-day, all-night call at my little hospital…?
My answer is always the same here. In my setting a diabetic ketoacidosis, the kind of patient I should be paying all my attention to but hec I can’t coz there’ll be 20, 30 odd other admissions over the whole 24 hours. Sure that’s tough, but it happens relatively often so to spice it up a bit I would add an unconscious patient, intubated with the vital signs monitor beeping away all night (infuriatingly!😠)
Three. I had to look after three DKAs on call last night!! We were sitting on two, and doing alright until… I don’t really have words to describe what went through my head when DKA numero tres was wheeled in through the door. Add to that four patients in heart failure, two of them severely distressed, unable to get off the face-mask oxygen. Next try a phone call from the lab at about 2.30am informing me that the blood results of one of the heart failure patients (think it was the third one I saw, 60something year old with dreadlocks, smoker…) showed his Troponin I levels were 1110 (now there’s an ‘oh s#1t’ moment if there ever was one!) That’s a really high number, some real damage done to the heart muscle there. Heart attack or to be physiologically correct, myocardial infarct. The textbooks say the patient feels like their chest is on fire while being squeezed really powerfully at the same time, you can’t breath, the room is closing in on you. A sense of doom. Dramatic much? 😰
I rushed off from admissions, upstairs to the male ward. “Bed 1” the night Nurse in Charge said as I got there (I had called ahead). A dose of morphine for the pain, an aspirin, and sublingual nitrates to dilate the vessels supplying the heart muscle with much needed blood, nutrients, and oxygen. Keep him on face-mask oxygen. Done, for now. See you the morning ward round buddy, I thought as I walked back down. Another patient in respiratory distress, possible pleural effusion based on my clinical findings, X-ray shows total white-out of the right lung. Poke that, get a sample of pleural fluid and send to the lab. Drain a whole lot more (no more than about a litre) he’ll breath a little easier, admit him to the ward, work him up for possible tuberculosis.
A one hour dose-off, awake again at about 6.25am. Casualty has sent across six new patients. Six!! Why do they do this?! 😩 No way we’ll see six patients by 8am. Some will have to be seen the new shift…
I have to admit that as stressful as it was I feel good about that call. Controlled chaos, is what was like. Thirty-four new admissions in all.
The consultant that was in charge of the post-intake round this morning is my favourite out of the four physicians in our department at Dora Nginza hospital. He’s a really intelligent guy, very well-read, meticulous. “Let’s talk about acute coronary syndrome” he says to the intern and I. “Sure Doc lets do that…” ‘Cause I haven’t been up all night working, I need to be stretched just a little bit more 🙂 In his thick Cuban accent “What are the contra-indications to percutaneous coronary intervention?” I return him a blank look, and the intern stares down at her shoes. “Read it, tell me on Monday,” he then says.
I will look it up, sometime this weekend, sometime in between everything else that happens in the next couple of days, I want to I do…
It’s late afternoon now, I still haven’t slept off that call. I’m finishing up on this blog post sitting at a backpacker’s in the Maboneng Precinct in Johannesburg. Got here from the airport just a few moments ago. Meryl will be here in a few minutes. She sounded really surprised on the phone a few minutes ago, she hadn’t known I was coming… 😉