“Hello.”
“Hello doctor. How are you?”
“I am fine.”
“I am fine too. Doctor it is H ward. We have a patient who is gasping.” I pause. They might be dead. They might be sick. It is impossible to tell over the phone.
“I am coming.” I hop around the room, pulling off boxers, pulling on socks, pants, trousers and shirts. I walk briskly to the ward. Two nurses are standing over a patient. One commendably bagging and masking and the other doing chest compressions. I look at the notes. A young man with HIV and widespread TB. A quick examination reveals that he is not breathing and has no heart beat.
“We gave adrenaline doctor but it did not help.” I thank the nurse and we decide to stop. I look at the clock. It is 5:30am. 4 hours sleep. Pretty good.
H ward - although not at 5am
I saunter back to outpatients. They have saved me a few overnight: 4 ladies that were in a road accident in Swaziland 3 days ago and wanted to be checked out. One turns out to have a fractured wrist. Nothing was done about it.
Next I go to review a couple of patients the other docs asked to look at before they left on their Weekends of Fun. One is a lady who came in psychotic and confused. She has HIV and is on TB treatment but this is new. She was too agitated to do a lumbar puncture on yesterday. She is a little better today. Yet every time I touch her skin with the needle she squirms this was and that and makes to grab me. I start off patient. Then find I am getting annoyed.
“Tell her I have lots of other people who need my help and let me help them,” I grumble. The nurse looks at me.
“I have told her Doctor,” she says reproachfully. We try again and she twists and tries to hit me. I throw the needle to the floor in exasperation and turn away. The patient grabs my arm and says something. “She says she is sorry doctor and please will you try again.” I instantly feel a complete louse. We try another position and with 3 people holding her we finally get the needle in place and collect the fluid.
“Siyabonga Doctor!” says the lady as I label the tubes.
Next is a patient with TB meningitis who is in an increasing coma – probably as a result of hydrocephalus, a building up of fluid in the brain causing high pressure. They tried to arrange a CT scan for her yesterday but there was no transport available. The local hospital that does our scans does not run a weekend service. She is having seizures more or less continuously and is unrousable. A series of long phone calls later and I have arranged a scan in Durban with the neurosurgeons – if the scan confirms increasing hydrocephalus they will need to operate. I am slightly surprised they agreed to take her. Yet again there is no transport. The Emergency Service offers to send a helicopter but the hospital in Durban refuses – if they decide not to operate on her after the scan the helicopter will not be available to fly her back and she will sit in one of their valuable beds.
I am phoned 4 hours later by an apologetic operator. They will take her first thing tomorrow morning. It is now too late for road transport (she won’t get there until late in the evening now). Her conscious level is deteriorating and I take her to our High Care ward so I can intubate her. Her fitting does not stop despite her cocktail of strong anti-epileptics. I pull out my anaesthetic handbook and almost with the nurse pointing to the right part of the “How to do an emergency ventilation” paralyse and intubate the lady.
Next back to outpatients where the day doctor and I sedate and restrain a 4 year old too hysterical to allow me to suture him last night. He is still pretty hysterical and even after a hefty sedative a couple of us have to hold him so Dr Zulu can suture.
OPD is now pretty civilised – Dr Zulu has it under control. It is 3pm. I slip back to the flat, eat half a bar of Dairy Milk, watch an episode of Friends and lie on the bed. If there are any Caesarians or OPD gets crazy Dr Zulu will call me. This might be the only chance for sleep.