#oncall

On Call ft. my dawg Ty

Directed by ME and my homie NICK

So I had been feeling under the weather for the last couple of days. We are already short staffed at work due to the Covid pandemic so getting someone to switch calls with me was out of the question. I self medicated, went for a nasopharyngeal swab (one of the worst experiences of my life) and went on to do the call as I awaited my results.

You know things can only go downhill when your hospital is already full and you’re trying to get diversion to other health facilities cause already we were beyond capacity and bordering on being an unsafe facility. The queue of pregnant woman that still needed to be seen outside our already full admission ward was already a recipe for disasters to come.

So my call started off with both operating theatres being blocked with septic cases. The one had a difficult surgery and chorioamnionitis and blocked theatre for 5 hours, the other was blocked by a Gynae case. I already had more than 10 emergency cases on the board and had to prioritize which patients were more urgent. Instead of cutting from 17.00 I only managed to start my first case at 21.00. Everything seemed fine, as if we could get through this night…and that’s when the mayhem began.

At 20.00 another one of the tertiary institutions were on diversion, and I was informed that a patient with a retained placenta was coming from the clinic and she was unwell. When she came in she was in class 4 haemorrhagic shock. ph 7.1, Hb 5, lactate 14, BE-20, HCO 8. Low blood pressures and a tachycardia of 130. Rushed her to theatre as we were unable to manually remove the placenta, morbidly adherent despite no risk factors for it and she required a hysterectomy. Already from the transfer notes she had lost about 2000ml of blood and had continued haemorraging. Massive blood transfusion protocol was activated. At a point her pH dropped to 6.9 we eventually managed to normalize her pH and lactate, she was weaned her off inotropes but she blocked theatre as no high care beds or ICU beds were available at the time. After about 7 hours of being fluid resuscitated and correcting the correctables she was eventually extubated and transferred to HCA in a stable condition. No neurological deficit. Definitely a win for the books.Honestly it was the highlight of the night. Bringing someone back from the brink of death. You can’t put a price on that.

Then in between that madness, an abruptio placenta with a live baby. Both mom and baby are doing great. Then a woman day one post Caesarean section that had an intra-abdominal bleed that had dropped her Hb from 12 to 6.1. In between all this madness there were still the usual fetal distresses and previous Caesarean sections in labour and severe pre-eclamptics that needed to be managed. It was a night where you just prayed that anyone who could remain stable should do just that.

Honestly I worked with such an amazing team of nurses, my interns- Dr BM and Dr MM were amazing. The lovely Dr J who did the most with the PPH patient. Can’t forget Dr W who is absolutely amazing and such consultant goals and never fails to avail herself when she is needed

Honestly at a time where everyone is just flat out exhausted because of the strain COVID has placed on our healthcare system it really warmed my heart that everyone worked together like a well oiled machine. Yes one or two people were obstructive but the Lord still showed up and showed off that He is in control.

It was a night that reminded me why I want to be an obstetrician and gynaecologist. Why I want to save mother’s and their unborn babies. A reminder that I’m on the right track and though things may not always feel like they are coming together, somehow they actually are.

Ya pasaron 3/12 meses. Te acostumbras al ritmo del hospital. Te acostumbras a tu equipo de rotación. Te familiarizas con todo el ambiente. Entiendes que no puedes cambiar al sistema, pero puedes ser parte del cambio, tal vez alguien lo note.

Hasta el momento sé que no quiero ser especialista en urgencias.

Actualmente, estoy rotando por el departamento de epidemiología, un servicio muy light. La Dra a cargo es super amable y su equipo administrativo también. Tenemos nuestro dormitorio en condiciones dignas, nada del otro mundo. Hay mucho chance de dormir. Procuro usar mis horas sin trabajo para estudiar algún tema, a veces para ver alguna peli. Además apoyo en un departamento donde se encargan de referir pacientes a diferentes niveles de atención, lo cual me recuerda el punto principal de lo que les escribo hoy: la parte administrativa mantiene funcional al hospital.

Si, aunque usted no lo crea. El personal de salud es muy, muy relevante, pero la parte administrativa que se encarga de supervisar los indicadores de calidad de la atención hospitalaria (me lo acabo de inventar) y todas esas cosas que me resultan pesadas (papelería, tramites, oficios, etc) son los duendecillos -a veces prepotentes - parte fundamental del engranaje que es el sistema de salud. Y nadie te enseña eso, nadie te dice en la facultad como llenar una hoja de referencia para enviar pacientes ni que es necesario aprender a llenar un SIS/SINBA/SISPA y ni hablar de la “productividad” (mas hojas aburridas). 

De todos modos, tampoco me gustaría estar de lado administrativo... a menos que fuera alguna cosa como, no sé, jefa de servicio. Que lindo. Sueños guajiros de una mip.