A typical on call

Most of our life revolves around an 'on call'. Its a run -the-mill bread and butter of our lives. Life changing incidents take place during an on call, we are learning new things all the time and it conditions us for all kinds of emergencies and scenarios. Your innermost behaviour will surface during a busy on call; the hardworking solid guy n girl, the dumb ass, the talk-a-lot, the slow inefficient klutz, the uncaring bastard......they all come awake in us.

This was my typical call yesterday:

On arrival-big Nigerian guy with a gigantic slash wound on his back, lying on his stomach. There blood everywhere and he insist he just needs a couple of stitches and he will be on his way. Breath smells of alcohol, not the medical kind. Oh well, GA time! Slap in a a-line, turn him on his stomach and the surgeon gets to work. 4 pints of blood and two hours later, all is well.

Next case, stable patient coming from ICU for washout of his infected laparotomy wound. Simple washout and we are done. Its nearly noon.

SMO Hady and I converge in the team leaders desk to catch our breath and see whats next. In comes in a pregnant woman in labour who ruptured her uterus. Adeline shouts for help. Its a mad scramble to crash in on an operating theatre and we induce in less than 5 mins. Baby's out, surgeons do a good job and tragedy is averted.

Time to do a quick tracheostomy for a patient who is ventilator dependant. I help start the case, the ENT surgeons scrub in and its all left in my partners hands. She too has been having some difficult cases so far but still looks bright and cheer full.

We really need to get some rest but in comes a poor hungry child who has been fasted for some time. She has rhadomysarcoma and needs a CVL for chemo, bone marrow biopsies and lumbar punctures. Not a dying emergency but it needs to be done to expedite treatment, and the child can then break her pre-op fast.

Another couple of hours and the child can eat. I am hungry!

Hady kept himself busy doing a couple of nerve blocks of this nice gentleman who needs his leg to be amputated. He has such a sick heart, its barely beating. Hady and Wong did a good job, blocking the femoral and sciatic nerves. I throw my 50 cents worth by blocking the saphenous nerve!

While waiting for the block to work, we begin an ENT case on a patient with stridor, he had hypopharyngeal cancer and his trachea is stenosed. He can barely breath well and has a bad heart, needing bypass surgery at some point of time. An A-line, intravenous anaesthesia, jet ventilation and we are good to go. The surgeon dilates his trachea and we wake him up well.

I go to get food while Hady and Wong begin a laparotomy, a genltleman had a perforated duodenum after a difficult endoscopic procedure. 4 hours later and all is not well with him, operation done but I had been a bit liberal with fluid and now he's overloaded. Hady settles the problem with some Lasix and he pees buckets!

Next we start 100 kg lady who had ruptured an ovarion cycst. She looks ill and severely septic and my partner and I get get to work. Induction is smooth, the surgeons open up and there is about 200 mls of smelly pus in the abdomen. She is much better post op. And its also early in the morning.

I get a spinal anaesthesia going for a young forklift driver who wrecked his ankle. Nothing to it, pretty straight forward.

The neurosurgery team tells us to get a theatre ready, the have a little baby with head injury coming from Seremban and he needs an operation. I get my little drug book, check the doses, prepare the drugs, organise the theatre, machine, warmers and fluid, have a quick shower, a strong coffee and wait. And wait. And wait. Neuro surgery calls and says they will do him later.........

We just get in bed when the surgeon shouts for help. He's doing a gastroscope, the patient bleed half his total blood volume and needs resusitation. We get our half sleepy asses in the the theatre and begin work. An hour later, the surgeon found the bleeder and injected adrenaline. Patient stable for now. Anaesthetist are in good spirits, its morning and our call is over!