Saturday, 6 February 2010

Saturday on call

0700:  Alarm goes off to wake me up for the day.  I push the snooze button one too many times.  Hard to motivate myself to get out of bed on a Saturday call day.

0815:  On my way to the hospital, a 5 minute walking commute from my house.

0830:  See babies in the nursery, which also serves as the NICU.  The little ones are growing :).  Baby of Maria has only seized once in the last 24 hours!  Thank you, Lord.

0845:  Make rounds on the mamas and babies on maternity ward... post c-section, retained placenta, post partum hemorrhage, endometritis, neonatal sepsis.  

0910:  One still-pregnant patient has prolonged rupture of membranes.  'Bout time this mama had her baby!  Start antibiotics and labor augmentation.

0950:  Somewhere in the middle of rounding on medical ward.  The patients I have seen have diagnosis including tuberculosis, congestive heart failure, cervical cancer, COPD, pneumonia, multiple myeloma, and gastroenteritis.  Just to name a few.

1135:  The ER is full to overflowing which is pretty typical for a Saturday.  I drain an abscess and admit the child for IV antibiotics.  See a patient who has had a stroke, probably secondary to a heart arrhythmia.  Who knows when the EKG will be done.  Admit her, too.

1220:  Take a 30 minute mandatory mental health break, a.k.a. lunch.

1300:  Back in the ER.  One of our staff has a fever.  Diagnose a kid with scabies and tropical splenomegaly syndrome.  Send him on his way with months of malaria treatment.  Admit a young woman with seizures.  I wonder why a patient with months of deafness decides to come to the ER on Saturday.  Write a referral letter for ENT specialist to see her for a perforated ear drum.  
Thankfully none of these patients needed oxygen, because the hospital has been out of O2 for a few days.

1530:  Stop by L&D.  Mama from this morning has delivered without too much trouble.  Another pregnant patient has just arrived.  She has a fever and probably chorioamnionitis.  Start antibiotics and induce labor.

1545:  Hey, not bad for a Saturday.  I am now at home and taking a nap on the couch.  My favorite Saturday afternoon past time.

1630:  Called back to ER to see a 4 year old kid who fell out of a tree and hit his face on something, I'm not sure what.  Looks like he will be OK.

1710:  Still not too bad for a Saturday.  At home again thinking of what I might want to have for dinner.

1755:  Waited to long for dinner.  Oops, that was a mistake.  Grab a couple of dinner rolls on my way out the door and back to the ER.  A young man twisted his left leg and fell while playing rugby.  The massive swelling of his knee and ankle suggest a fracture.  Order x-ray.  Evaluate another patient with an axe injury to his right foot.  A little deep, but missed most of the important stuff like tendons and arteries.  Wash and suture the wound.  Discharge home.

1920:  A group of men come into the ER dragging one of their buddies.  Some sort of fight down at the road bung.  The man has a chop chop to the forehead.  Nurses screen the patient and start an IV while I look him over from head to toe.  Other than being drunk, the laceration appears to be his only injury.  Clean and evaluate the wound.  There is an indentation in the skull bone from whatever weapon cut his head, but it does not appear to be a through and through fracture.  Tie off a couple of bleeders, close the laceration over a drain, and place a pressure bandage.  Patient is too intoxicated to even need anesthesia.  Admit to surgery ward for observation.

1945:  Still waiting for x-rays.  Rugby player requests not to be admitted.  The chop chop victim is from the Kuma tribe and was attacked by a member of the Sagang tribe.  The rugby player is Sagang and apparently fears retribution.  This rivalry runs deep in the Wahgi Valley.  Think West Side Story PNG style.  X-rays arrive and I find that the patient has both a patella and distal fibula fracture.  No more rugby for you for a while.  He does not have transportation and cannot walk on this injured leg.  Agrees to admission after a little convincing.  Knee immobilizer and ankle splint placed.  Will do a plaster splint or cast when the swelling goes down a bit.  Admit to surgery ward.

2030:  Seeing the light at the end of the tunnel!  Must have been a mirage.  Suddenly there is commotion outside the ER door.  A truck has pulled up with three more chop chop victims, these from the Sagang side.  So much for going home.  Begin triaging the patients.  One was hit with a stone and has a deep laceration to the forehead.  He is semi-conscious and the most critical.  A teenage boy has been chopped across the forearm, all tendons severed.  A third man has been beaten and has a knife wound to his leg that has cut through his Achilles tendon.  Dr. Jim and some off duty nurses show up to help out.  We have such a great team!  They patch together the two patients with arm and leg lacerations.  I begin working on the guy with the forehead wound and discover that he also has a depressed skull fracture.  
Dr. Jim takes a look and helps with the repair.  Patient begins seizing.  Nurses give IV diazepam and the convulsion stops.  Finish wound care for all the patients and admit them to the other side of surgery ward.  Dr. Jim prays for peace.

2210:  Finally home.  Change out of my bloody scrubs.  Warm up some leftovers and sit on the couch to decompress.  Start to take a sip of my chai...

2225:  Call from maternity ward.  The patient with the fever has just delivered and has a deep laceration.  I am needed for the repair.  Lord, please give me strength.  I change into a clean pair of scrubs and head back to the hospital.  There is still blood on my mud shoes from the mayhem in the ER.  Make a mental note to wash that off later.

2350:  Laceration repair complete and clean up has commenced.  I am notified of another patient who has just arrived.  She delivered a stillborn baby in the village at 3PM today.  Placenta is still in.  She has lost a lot of blood and is pale and shocky.  Start second IV.  Order blood to be transfused ASAP.  Decide not to mess with the placenta until I am sure we have blood ready.  Go home.

0230:  Get a call from surgery ward.  The patient with the skull fracture woke up and is requesting to have his foley catheter removed.

0405:  Notified by maternity ward.  1st unit of blood has gone in and 2nd is ready.  I head back to the hospital.  We can't figure out how to get the stirrups on the bed.  Attempt to move the patient to another bed and she faints.  Nurse brings wheel chair for transfer.  We are finally ready.  I pray with the patient and give her IV sedation.  Procedure went well.  Thankfully I do not have to do a D&C.

0445:  Home again, home again.  Looking forward to a few hours of sleep, though interrupted by one or two phone calls from the wards.  

0700:  Alarm goes off.  I push the snooze about 5 too many times.  I hope those last few phone calls weren't too important.  I don't remember much when I wake up.

0810:  Back to nursery and maternity for post call rounds.  Baby of Maria is crying and responsive this morning.  Praise God!  This little one who was so critically ill is going to make it.  Mama with the deep laceration is feeling dizzy.  Check hemoglobin, she may need a transfusion.  Patient with retained placenta has received her second unit of blood and is looking much better.

0915:  Rounds finished.  Check out to Dr. Bill.  Hope your call is better than mine!  Now I get to go home and stay home.  
What a night.  Thanks, Lord, for your help.

0930:  zzzz...

"The Lord is my strength and my shield;
my heart trusts in him, and I am helped.
My heart leaps for joy
and I will give thanks to him in song.
~ Psalm 28:7


  1. Thanks for sharing what a PNG Dr REALLY goes thro in a day. I pray too for the Lord to renew your strength.

  2. Thanks for sharing. How often are you on call?

  3. Love you daughter....will just keep praying for you!

  4. Wow! After reading that, I am pretty much worn out! It is certainly God who is your strength. Do you get just frustrated at the chop chop patients?

  5. Good grief! I am already tired reading this! I'm hoping by the time you read this comment, you'll have had a few more hours of sleep. May God give you new strength and energy that you've never had before. ~Alison

  6. I am amazed. What a day. How in the world do you remember all that to be able to record it? Were you taking pictures with your cell phone that recorded date/time stamps? With that kind of a day, when I did finally wake up, I think it would all be gone :).