Doctor on Call- May 8

I am jolted awake by the loud and harsh vibration of my phone. I jump with a start sending papers flying all over. It hadn’t occurred to me just how harsh that vibration can be especially at the wee hours of the morning. It vibrates again. The caller ID reads “call room”. It is 3:36 am, twelve minutes since they last called. I had told them I would be in the ward in five minutes. I was just finishing off with the notes. I must have fallen asleep ….. I gather the papers and put them back in the file. My eyes land on the last sentences and I shrug and chuckle at the same time. Even I can’t read what I have written. The notes seem like they are ascending to heaven. The doses of the drugs are all mixed up. My phone starts vibrating once again. I thrust it in my pocket and dash to the changing room as I tear up the notes. In the changing room, I strip off my trouser scrubs leaving beneathmy pencil trouser change into my rubber shoes and run off.

It is business as usual in the maternity ward. All curtains are drawn. The lights are on. There is a nurse at the admission desk and a line of women seated with their legs apart, waiting for their turns. He lifts his head as I enter, I nod at him. He looks at me for a few seconds then continues writing in a yellow file. I walk towards the beds. Most beds are shared. Some women are sleeping on their sides, their backs against each other, bellies protruding before them, beyond the edges of the beds. Some are dancing on the spot, some standing with their fists at their hips. There is a nurse on the second bed, trying to get an IV access on a patient who looks like she should be soundly asleep in some dorm room, except for her bulging stomach that is threatening to rip her dress at the seams. The nurse is struggling. I move to her side. But she continues slapping the hand of the patient, a desperate attempt to make the veins more visible. she is obviously ignoring me. I walk away to the delivery room.

All three delivery beds are occupied. There is only one nurse standing on the foot of bed three. She is shouting commands to the three patients. “Bed one I said push only when there is pain!” “Bed three sleep on your left, and you in the middle can you open your thighs and then hold your legs! I know this nurse, all interns who have been through maternity call her Faya- she is fire, literally. I sigh, and then walk towards her! She sees me and turns to face me. I am prepared for whatever, so I look at her, eyeball to eyeball. She looks at me, shakes her head. Un-gloves, throws the gloves on a receiver attached to the delivery bed. I half expect her to walk away, or maybe slap me. But she just stands there unmoving, quiet, studying me from forehead to big toe. Then she speaks, ” nobody forced you to go study medicine young girl, here, people work”. Pause. “ We called almost thirty minutes ago. Thirty freaking minutes.” pause. “Explain to that patient what happened to her baby. I am not hearing the heartbeat.” I look at the patient and swallow as panic grips my whole being. “Hello,” I mumble. She doesn’t answer and I can understand. “What is your name? “ I ask, ‘”Grace Ngina,” she shouts, as a contraction starts. She sits down, forgetting she was supposed to be lying on her left side and starts rubbing her lower back furiously. I walk out to go and look for her file as she starts to invoke her mother’s name together with the names of all her female relatives.

She is a primigravida (pregnant for the first time). From the notes, her baby is in breech position! I walk back to her and coax her into an examination which she half heartedly accepts. Her fundal height is at term, the presenting part is the breech or buttocks if you may, aaand, there is a fetal heart, a very faint one. ” You are going in for a CS, “I inform her. She looks at me and shakes her head so vigorously that I move a step away from her involuntarily. “But there is a fetal heart. And your baby is in breech” I try an explanation. She will have none of it. I glance at my watch 4:02am. My phone vibrates, it is the call room. I am needed in the gyne ward, a ruptured ectopic with a hemoglobin level of four, bleeding. I summon Mrs Faya. By good luck she listens, agrees that the fetal heart is present. She talks Ngina into signing the consent forms. I drop the theatre list in theatre, and then run to the gyne ward before I get a second call from them.

It is a ruptured ectopic pregnancy, confirmed by an ultrasound. The lady is white from bleeding. I draw her blood samples and rush them to the lab, calling my senior on the way. In six and a half minutes, I am back in theatre, scrubbed. The patient is quietly lying on the operation table, under spinal anesthesia. With my assistant standing on the left side of the patient, we clean and drape her quietly. Everyone is lost in their own thoughts, or too sleepy for small talk. I pick the scalpel and make a bikini incision, fighting the fatigue in my eyes. Seven minutes later, the baby is out. She gives a fierce cry and I hear myself say; ‘that is an apgar score of ten, ten and ten”. I catch the smile on her mother’s face momentarily as I pull out the placenta and start repairing the uterus. Twenty three minutes later, she is wheeled to the recovery room, with her baby safely tucked between her legs. I yank off my gloves, throw my gown to the pile of gowns and drapes on the floor and run to the changing room once again and this time without even removing my scrub bottoms, rush to the lab. “Blood will be ready in ten minutes”, the lab tech tells me over her shoulder and continues scrolling on her phone. I collapse to the nearest seat and stare at her. She is angry for being awake doing a job she voluntarily trained for. My phone vibrates once again, and then goes off. Crap, it has been warning me constantly that the battery is low. I just got too engaged to even connect it to a charger!

I walk out of the lab for a sec and walk back in to find the three blood bags on the table. I sign off in the dispatch book and run back to theatre with the blood. Back in theatre, my senior greets me with a battery of questions, why is your phone off? Why is the patient not in theatre already? Have you found blood? ‘Yes, I answer to the last question, than run off. Back to the gyne ward. The patient is ready except there is no one to wheel her to theatre. I wheel her to theatre, stopping to catch my breath twice. Even I am shocked that I did it. The operation ends at six. My senior walks away. He will probably sleep away the whole morning. I switch on my phone and sit down to write all the notes on the last two patients.

At six fifteen, I walk back to the maternity ward. I finish my pre-round an hour later , rush to the doctor’s room wash my face, brush my air, empty my now threatening to burst bladder and rush back to the ward just in time for the daily ward round. I will have breakfast at eleven , maybe.

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That was a tough call doc.
But I love the narration and the triumph at last. Soon you will be the second on call and you will be more to reduce the exhaustion