Last Night on Call

You think you know what its like

It's day one, and by some horrible measure of anti-luck, I am on call. What that means is that when everyone else goes home at 4pm, I trudge down to the emergency centre (EC) and start an overnight shift, totaling 26 hours of work in a row. 

All of this in a hospital I have never been to before, in a new part of the country that I moved into a few days prior, working with a group of total strangers, with brand new elements to the healthcare system that I have never worked with before. I felt like a deer in the headlights, but most of one's time as a medical student feels a bit like that, so how different could this be?

I came to this hospital from a city with a wildly overburdened healthcare system. Heard of women giving both on the floor? I've seen it. Heard of someone coding in the CT machine? (coding means stops responding, essentially dying) I've seen it. Heard some someone going to the bathroom and almost bleeding to death while sitting on the bowl? Yup. 

I often felt as a final year medical student that I was putting in enough effort to understand what my years as a medical intern would be like. I got to go home at 10pm while the interns stayed overnight but hey, other than sleep, how different was it really? 

OH MY GOSH. I had NO IDEA. 

Here's a snapshot into my last rotation as a medical student: I was rotating through gynecology at a mother and children's hospital in a part of the city with too many women and children for such a small hospital. There were power cuts and water shortages.  Final years were treated as junior interns. We would come in around 7am and see our patients - what that means is that we would check their blood and radiology results, assess them to check on their condition, and make decisions based on what we found. 

Example: the patient is a 28 year old lady who presented with abnormal uterine bleeding. Upon workup, she was found to have an ectopic pregnancy (a pregnancy sitting outside the uterus, usually in the first part of the Fallopian tubes, threatening to burst that tube and cause life-threatening bleeding). She had an operation last night to remove the fetus. Today her hemoglobin (the part of blood carrying oxygen) is 5 (low) and she is experiencing dizziness, shortness of breath and loss of appetite. You assess her as having bled excessively before or after the operation, depending what the hemoglobin was before the procedure, causing a symptomatic anaemia. Your plan is to give her a blood transfusion, and perform an ultrasound to look for signs of intra-abdominal bleeding. 

But then the real doctor took over. No big deal if you were wrong about anything. 

Then we would go to clinic, where we would assess patients and come up with investigations and a plan. We would present that to the actual doctor, who would tell us where we were wrong, and we would take it from there. Until a prescription was required. Files would come in and pile up, and we would take them and work with people and diminish that workload. We would diagnose and come up with a plan. We would put probes on bellies and identify pregnancies and bleeds and masses; we would counsel crying mothers who had just lost yet another baby. We went home with amniotic fluid on our shoes. 

A full day was 7am to 4pm, after which we would go home and study. If "on call", ie just more working, we would stay until 1am. 

I felt like a part of the team, like I was pretty much there. Nurses called us doctor, and we didn't correct them - partly because it was too tiring to correct everyone and partly because we felt it sizzling there in our bones: almost. Almost doctor. Pretty-much doctor, right?

Oh boy, I was in for a surprise. 

Here is what my first call entailed, as a real doctor.