On Call in Africa

Last night my wife, who is a medical student (graduating May 15th!), had a tough night while on call. I thought that some who might not have received the email might find it interesting so I've pasted her email below. I'm glad I don't have call!


Dear friends,

I am writing this letter after a night of call... a long and difficult night of call. It's a very good experience for me as I am in charge of the entire hospital. I do have a back-up but it is expected that I will not call him unless a surgery needs to be done or a C-section. So, it's me and my books at night agonizing over the patients. All the admissions, all the patients doing poorly on the wards, all the lab results, all the non-urgent patients who stop in. It's very stressful, challenging, and a growing experience!

Last night's call was particularly busy, but perhaps you'd like to imagine what call means...
I start the evening by rounding in all the wards, signing all the results that have come back, seeing all the patients with problems. I review two newborns with spina bifida, a febrile child, a lady whose arm cast may be too tight. Then, I go home and wait for the knock at the door. It comes and sure enough there are the hospital night-watchman and the compound's night-watchman at my door to escort me to the hospital. Torches (i.e. flashlights) in hand, we make our way to the hospital. In the brilliant starlight, I pray during the ten minute walk, pray for wisdom, courage, knowledge, and clarity of mind. The first patient is a 37 year woman, "B.I.D." - Brought In Dead. The nurses are already gloving up to prepare the body to move to the mortuary as I check and double check for signs of life. I need to declare death and write an official note. I want to convey my sympathy to the family but cannot communicate beyond, "I'm sorry."

I walk home. I have just climbed into bed to close my eyes when the watchmen come again. "There is another patient." This patient is a patient that I have seen in outpatient clinic two days ago. She has unusual findings on pelvic ultrasound but that is not her complaint tonight. Tonight she complains of headache and she is hyperventilating. The nurse chases the entourage of people out of the room to talk to the patient. "She's the third wife. I wonder if they had an argument or something..." Good thinking because the patient's complaints do not measure up to a hospital admission but she is acting ill... Nervously admit her to women's ward wondering after a careful history and exam if I am missing something.

I don't leave the hospital this time, but move to men's ward where a man is very ill. I had signed his lab results earlier in the evening and noted that his bone marrow was not producing sufficient blood cells of any type, which leaves him open to infection and open to anemia and even bleeding. I do what I can, but none of the oxygen condensers are working, so we cannot place the man on supplemental oxygen even though he desperately needs it. He is in shock - getting an IV placed is difficult. I call other nurses (there is only one on each ward at night) to help us. They are cheerful and helpful and we have a sense of collaboration in the middle of the night. They laugh at how busy my night is. We do not have the medicines that he should be put on. We do not have immediate access to blood for transfusion.

We work on the patient for hours - I sit in the nurses' station talking with the students and finally send a note to my back-up doctor to confirm my actions and see if there is something I'm missing. The patient does not look well. A note comes back 45 minutes later reassuring me and stating that the patient's prognosis is guarded anyway, so my efforts are heroic. I am satisfied with my decisions and walk home. On my way home at 2:00am, I hear a truck on the road... I pause... then continue home but sit up reading waiting for the knock summoning me to the hospital. The knock does not come, so I go to bed. At 6:00 I am called and I learn as I evaluate the patient that the nurses were being kind and had decided to wait until morning to call me. The patient has a severe pneumonia and I suspect HIV. I have learned to identify HIV positive patients as they walk into the room.

I am relieved that there were no obstetric emergencies as I am inadequately prepared to handle those on my own. The children's ward was also quiet - another successful night of keeping everyone that I could alive. Now to work again (yes, even on Saturday!)- hopefully I can slip out early to come back home and sleep!

We are headed to Victoria Falls on Monday until Wednesday. I am ready for a vacation and we are excited to see THE falls!

Prayer:
Safety on the roads
Drought and hunger

Praise:
Easy renewal of visas in Choma
A good rain on Sunday