Day 41, Weekend On Call

Day 41, Mseleni is a pretty isolated place at the best of times but there’s a genuine sense of extended families with the doctors and therapists here which one feels most in their absence. Such is the feeling you get over a weekend when everyone takes off either collectively or individually to enjoy life away from here. Of course part of the deal of being here is I occasionally have to do some work and accordingly this has been my first weekend on call.

The on call essentially means that you start covering from a Friday and finish on Monday working 80 hours in a row, during the course of which you can be called at anytime and are required to look after the whole hospital. But of course having one person covering would be foolish for a hospital of 200 beds, maternity, paeds, medical, surgical and the emergency department; so they have two.

Nowhere have I felt more alone then when faced with a labouring woman. Being called at the wee hours of the morning to be asked by experienced midwives to help deliver a baby is not everyone’s idea of a nightmare, but it is certainly mine. During daylight hours at least there is support to help you through it. At night all I have to go on are the recesses of my knowledge trying to channel med school lectures from 5 years ago or the little books I carry around. I’m sure to an outsider it must look quite odd when I have to step out of the delivery room, have a quick leaf through my book and then return with some pearl of wisdom every few minutes!

Being cornered into making decisions isn’t always a bad thing as it means you are often bolder in your choices. This weekend I’ve so far had to decide to intubate a patient, drain a bartholin’s abscess, and put in an intraosseus line, all with minimal prior experience because push came to shove. The bottom line is that if I fail to even try then the patients really would have no hope so it is the best of a bad situation.

The fractious nights lead to my thinking becoming less analytical and more pragmatic. The nurses are fairly understanding and try not to call you for every little thing but even so you rarely get an undisturbed night. The colleague you are on call with will try not to wake you if they are called and courtesy is repaid as much as possible. However if an emergency happens then you are both there in the dead of night despite neither of you having decent sleep.

But on Sunday, almost at the end of the slog the extended family starts trickling back and the lonely atmosphere is replaced by the friendly faces. The very real sense of community was no more apparent when they brought me back a 6 piece of chicken from KFC from their weekend away. A little bit of junk food heaven, but the sentiment was perhaps more satisfying than even the colonel’s secret blend of herbs and spices. I may yet survive this adventure.

http://www.youtube.com/watch?v=HaVXfHZv50Y