Unfortunately, I’m too sleepy and tired at the moment to write something eloquent!
My first on-call: It was on a Sunday and I was covering the Obstetrics ward meaning I stay to monitor the in-patinets’ conditions overnight and make sure that all new admissions are clerked and evaluated. I was assigned to the Labor and Delivery Unit at that time during my morning shift and it was a slow day so I had hope I’ll be seeing some action at night! However, the on-call night was running smoothly until 10 p.m. or so when my fellow on-call mate covering the L&D Unit decided to get us dinner. He brought mashawi, grilled goods, and immediately after the first bite I knew something was wrong! I had eaten a pine nut by mistake which they have used in the filling of the kebab! I’m allergic to all kinds of nuts and I tend to get even anaphylaxis which is the severest form of allergic reactions. I started vomiting right away and it was funny when I had to go to the obstetrics ward and tell the charge nurse there that their on-call doctor is heading to the ER to get some medications for himself! It was a crappy night in which I kept throwing up all night and feeling extremely unwell. Somehow, I managed to do my work too because in general, the wards aren’t very demanding.
My 2nd on-call: I was scheduled to cover the OB GYN ER service. The resident who was covering ER with me, Dr. Ibrahim, told me straight away: I’m jinxed and every on-call of mine turns out to be a disaster! We saw nearly 30 patients that night and I didn’t even enter the on-call room to rest except for once at 4:00 a.m. and I got paged at 4:05 exactly! Needless to say I only got to sleep around noon the next day! I’ve seen most of the OB GYN book that day!
We had ordered dinner and it was delivered at 10 p.m. but we couldn’t sit down to eat until midnight! Just before dawn at 5:00 a.m. there was only one patient left in the ER and we had some hope that finally we’ll get to rest. Dr. Ibrahim said, don’t get your hopes up! Dawn is the time when all the worst cases present! Just after he said those words we entered to see a patient who’s in labor. Abdominal examination indicated that the baby was in transverse lie. In PV examination we felt the baby’s fingers coming out from the vagina! We rushed her into the OR to perform emergency cesarean section. The last case of the day was of a patient coming in with PV bleeding and turned out to be a threatened abortion. I told the nurses that out of the kindness of my heart I will cover this case although officially I was off-duty!
It was a day to remember. Jaded as I was, I was also satisfied!
The 3rd on-call: It was a Thursday which is always worrying! This has proved that there is something wrong with me during on-calls that attracts all kinds of bad things! I was covering L&D Unit and during the time from 8 a.m. till 10 a.m. the next day there were 16 deliveries! 14 of which were normal spontaneous vaginal deliveries while two were of emergency c-sections. The 2nd c-section was due to cord prolapse in which the umbilical cord falls in advance of the baby’s head following rupture of the membranes which is an obstetric emergency. I was examining the patient’s abdomen when she said, I think my water broke! The nurse was cleaning her and did a PV exam after which she yelled, I can feel the cord! That was the quickest c-section I have ever seen. There was a case of shoulder dystocia of which the new resident handled really well . It’s when the baby’s shoulder gets stuck behind the symphysis pubis following delivery of the head. The baby made it out fine although he was severely cyanosed.
That was all nothing compared to the patient who was transferred to L&D just before dawn! She had severe pre-eclampsia (gestaional hypertension, a syndrome of complex pathophysiology unique to pregnancy) that resulted in placental abruption (premature separation of the placenta from the uterus) and lead to Intrauterine Fetal Death (IUFD) that got complicated by Disseminated Intravascular Coagulation (DIC). We transfused 10 units of cryoprecipitate, 6 units of Fresh Frozen Plasma and 2 units of Packed RBC’s. The patient required close monitoring and I was worried from such a responsibility. Alhamdillah the patient now is in a good condition.
There was a difficult moment around 6:oo a.m. when I had to tell the patient’s husband everything that had happened since he didn’t have a clue. IUFD is something that shouldn’t be experienced by anyone. The patient was crying and I admired how supportive the husband was although I could tell he was struggling with his own emotions too.
So what’s the point of this entry? I guess I just wanted to document those first on-calls. I know I’ll look back on them one day with a sense of nostalgia and I’ll have a smile on my face.
Hell, I’m even considering OB GYN as a future speciality now! I’m supposed to be on-call this upcoming Saturday covering L&D !
