Last on- call

Last Wednesday i completed what was probably my last on-call ever! Do you get the feeling that you're going to miss something just because you might never have the chance to do it again? Even if that something is something that you used to dread as a houseman? On-calls are a bittersweet thing. When the call is approching you feel dread as to what cases might come. So you make sure you have enough sleep and try to bathe in 'air bunga' to rid of  all bad luck. But during the call you realize extra sleep is not necessary after all as the adrenaline rush keeps you wide awake  during the call. And when the call is over, and like me you work in a hospital where you get pm off after the call (off after 1pm), you suddenly feel a sense of happiness, and many would describe it as post-call euphoria.

I will definitely miss being on-call. How much exactly, i will not know till later after i have started my new life as a pathology MO (please God  let me love microscopes).

So, for future reference, here i chart my last weekday call.

As a Wednesday is a non clinic day, we could take our own sweet time doing ward rounds. I'm in charge of the Special Care Nursery and our mini Neonatal Intensive Care Unit together with Zuraida a new colleague. We also have one houseman who is lazy, defensive and s-l-o-w.

My other parter in crime, Inthira is in charge of doing the ward rounds in the general paediatric ward. Mind you she is all alone there and post call as two of our colleagues, Zara and Tahirah are at the Advanced Life Support Course held in our hospital.

Rounds were plesant as always. It has been plesant since the day our darling amazingly good and nice paediatrician came a few months ago.

We extubated an orang asli baby with complex cyanotic heart disease called Yok successfully and prayed that IJN will see the baby as soon as possible. Before that of course, we first have to pray the social welfare department lady will hurry up and come back from her  course to pen a support letter for financial aid.

The rest of the day was pretty uneventful.

As always, patients (or rather their parents) prefer to come after everyone in the hospital has gone home after five.

I was rudely called to the operation theatre (OT). Well actually not rudely but politely, but what irked me was that no O&G doctor bothered to inform me of the case. Rather they made their nurse who does not necessarily know fully the case to give me a call.

Went to OT, gave the O&G MO my two cents worth, stood by for the case - baby is well- felt more happy- clerked the case and left OT.

Received a call from KK Tanjung Malim (district clinic).

Case: 2 year old orang asli girl, fitted at home for 30 minutes according to mother. Continued fitting for 5 minutes in the clinic and aborted with per rectal diazepam. However baby has yet to regain consciousness. No other history obtained. Advised to prepare IV phenytoin and iV diazepam in case child fits again. No phenytoin in KK Tanjung Malim. Shit! Asked the reffering doctor to prepare IV diazepam on standby during transport and send the child to my hospital fast! The doctor seemed very concerned.

Child arrives within 20 minutes of the call accompanied by a Medical Assistant (MA) and a nurse. Wait a minute, where is the doctor!!?? Too lazy to inquire.

Child still unconscious and having tonic movements of both upper and lower limbs that lasted 1 minute. It happened twice and aborted without any medication. Vital signs were all stable. MA set a second line and took blood investigations ordered. I love competent MA's!

Obtained history from disraught orang asli mother. Baby was born at home. No midwive on standy. Baby did not cry post delivery. In fact did not cry the whole day. Brought to private clinic the next day and only given immunizations. At 2 months noted to have congenital cataract. Development very delayed.

This is not a normal child.

Sigh, most likely not meningitis. Nevertheless did  a lumbar puncture and started on antibiotics.No more seizures therafter.

Three more cases waiting in casualty onces i completed the lumbar puncture.

Shit, it's 9pm and i forgot about dinner. JH was equally busy so no time to eat either.

See the 3 cases in casualty. All complained of fever, cough, and flu.

Discharged one. Planned to admit the other two. One of the mothers were not keen for admission. Then why do you bring your child late at night to the EMERGENCY DEPARTMENT of a hospital!! Do x-ray to convince the mother her child has pneumonia and that's why his fever persisted for one week.

Finally at 11pm went for dinner.

Halfway called by MA. Another orang asli girl came in very tachypnoeic.

Saw the child. Still active but very very breathless.

Sent to the ward. Lung findings do not tally with severity of tachypnoea. Lungs were fairly clear with occasional ronchi. Nebulized child continuosly with salbutamol and one dose of ipratropium bromide for one hour.

Took the time to sleep.Reassesed after one hour.Less tachypnoeic. Both lungs were filled with ronchi. Great got my diagnosis. Gave IV hydrocortisone and reduced the nebulized salbutamol to hourly.

Finally could go to bed at 3 am. Bliss.

Called at 6.30am by O&G houseman. Thats a slight improvement. Informed of a case with moderate meconium stained liquor currently with an os of 5 cm. Asked to call again when os is 10cm.

At 7.30am mother is already bearing down with os fully. Seriously who does these vaginal examinations?! Suspicious.

Stood by. Baby delivered well. Admitted for observation.

Started my morning rounds. We are fully staffed today, except for one who had to take leave.

After morning rounds, started clinic. Resolved more orang asli social problems. Seriously what are the Jabatan Orang Asli doing? Review babies and enjoy seeing their growth and smarts.

Finish clinic at 1pm. Go for drug talk. Get free pen. JH post call but still alert enough to win something at drug talk. Eat pizza for lunch. Go to ward. Scold houseman for not giving adequate medication to patient who is planned for discharge.Mother had to come all the way up from pharmacy for a prescribtion slip for medication she should have been prescribed from the start. Should have asked the irresponsible houseman to run down to pharmacy himself. Receive many thanks from patients.

I think i'm going to miss scolding housemen and ordering them around, teaching and guiding housemen.(Don't get me wrong i only scold stupid/irresponsible/slow housemen)

Most of all i'm going to miss seeing the babies and children's happy smiling faces when they make good recovery.

Pathology please give me as much fulfilment as paediatrics!

Disclaimer: This is considered a fairly good and chill call as many doctors in tertiary centres or district hospitals with no specialists have much more work to do.