Five minutes of eternity...

Normal finding in an on call room: Owner-less toothbrushes....

There ends my last call of the month. Perhaps, no more PH calls for at least 4 weeks. Working for 24 hours straight is seriously inhumane, I tell you. Even when there are no cases, you can't sleep. Not properly anyway. At least, I wouldn't call 'tidur ayam' proper sleep. You keep waking up wondering if the phone had rang and you were too tired to hear it.

I am writing all these down, perhaps as a documentation of what had happened during my calls. Maybe for when something does decide to crop up later, y'know, as things usually do.

Labour room started busy early that day. Thin meconium liquor in a 43 y.o. gravida 5 I think. Eventually delivered rather uncomplicatedly but alas, her baby showed rather strong features of a Down Syndrome. It was left to me to inform her of her baby's condition, since he was to be admitted for observation anyway.

I was prepared for shock, I was prepared for unconditional acceptance - but I was not prepared for downright rejection. Was I being naive? Had I taken a mother's love for granted? She was shocked, alright but she was so shocked to the extent of refusing to hold her baby. Apart from his physical features, he was totally fine. But later, he developed hypoglycaemia and despite feeding, still required infusion of dextrose. I went to check on him later that night and he seems to be doing okay, despite the minor hiccup of a blocked intravenous access that had me in near tears.....frust, occccayyyy, kalau tak jumpa urat nie tau...:) in the end found one on the foot. Phew!

Then, a case of fall from height arrived. Ada apa tah kat tangki air kat rumah dia, that she had to check for herself....complaining of pain at the back but could move her legs okay. Xray showed a wedge fracture of the L2. Last I checked, she still didn't exhibit any neurological deficits, so I hope she'll be okay, at least until Mr S checks her out tomorrow.

Then I had two MVAs - siblings who both sustained fracture of the right femur. I don't know about other people, but I seriously have issues with underaged people who ride bikes as if they were racing in a GP. Serious. They are the worst in tiny, bendy kampung roads which only allow one car at a time. Seriously la, if they were to fall and the bike were to fall on them, serious tak larat nak angkat okay. and it's ALWAYS the car driver's fault. Tak percaya, gi tanya mana2 victim MVA yg bawak motor. I've never heard one admitting that it's their fault.

My weird case of the day came in form of a 19 y.o. chinese girl who, from what I gathered, had initially complaint of stiffness of the jaw, which progressed to numbness/cramps of both hands, SOB (shortness of breath) and then suddenly fainted. Her concerned mother and sister immediately came to the nearest hospital. Mother and sister claimed little sis had no medical problems, not on any medication apart from panadol for her gum pains but denied any possibility of overdosing. This had never happened before and there was no history of fall or family disagreement.

Her BP was normal, her oxygen sats were perfect and her blood sugar normal. There was no neck stiffness, no jerky movements, and her CNS were normal. I was totally stumped. There were no signs of infection, ECG was normal, her serum Calcium was normal and so was her renal funtion.

I rubbed on her sternum till my knuckles hurt and there was no response. Serious! and I rubbed extra hard some more but still nothing. Hish, kabar ke dok mek nih? She opened her eyes for a while but did not seem to register anything. I honestly admitted to her mother that I have no clue to what was wrong with her daughter and since she wanted her child to be admitted to a private hospital, she wanted us to send her.

We managed to send her eventually but I got temporarily pissed with a certain MA on call who was supposed to escort her. I clearly stated that he didn't need an attendant; he was supposed to come here and whoosh, go off. Tapi, on hearing that an attendant was not called, he PURPOSELY delayed leaving by, I dunno, pretending to check on resus kits and what nots until his 'best friend' magically turned up without any of us calling him. Why why why???? If he insisted on having a helper, he should have approached me or the other MAs on duty. If he sounded reasonable, I would have agreed. Nie tak, kau biar patient ngn mak dia yg already so flustered on the ambulance, pestering my driver who didn't know squat.

Then I had a young male with a history of rather uneventful asthma who suddenly had a bad episode of SOB and wheeze. He took about three hours of stabilisation before I could transfer him to ward. Seriously, I thought he was going to collapse on me. Young male with no history of ventilation before - major caution needed. This morning, I dropped by to check on him and he was fine.

Tapi, was my call ever going to be uneventful? Nooooo....of course it just had to end with a bang. and a Big Bang it was. Young mother of three, delivered 13 days ago came in with symptoms of shock. Pale as sheet and complaining of dizziness. BP registered at 77/33 with a heart rate of 80-90. Admitted to having PV bleeding since 7 pm the night before (she turned up at casualty at 5 am); lochia before this was already decreasing in amount and she denied history of fall, sexual intercourse (at 13 days post delivery? Ada ke?) or massage. Blood was literally pooling underneath her clothes. After pushing in fluids, BP picked up to 90/40. Vaginal examination revealed more and more and MORE blood. Abdomen had a mass of about 16 weeks pregnancy (when there shouldn't be at 2 weeks post delivery - uterus should have been impalpable) and scan revealed a bulky uterus. What was in there? A retained placenta?

Blood was ordered for transfusion in progress and I alerted the Gynae MO on call that I'm sending this patient. Now I need an escort. MO 2nd call was on call the night before and had OPD duty this morning. It was already half 6 in the morning. If I went, the ambulance could leave straight away. I know I had done all I could in my setting. She needs to get to HRPZ asap. Plus, MO 2nd call lived about 45 minutes away. Dilemma and decisions. On call money doesn't pay enough for dilemmas like these.

The ambulance journey took only half an hour, zooming through the morning mist which is occurring quite often nowadays, but it felt like ages. Five minutes were set between each BP readings and those five minutes felt like an eternity.

The patient still wasn't out of the woods when I left her. Her BP was still on the low and dangerous side. I prayed for her well being as I passed her case to the Casualty MO (all fresh and wangi and possibly wondering what she did to deserve a bad case of PPH so early in the shift..:))

Tied up all my loose ends, checked up on the patients I admitted last night and drove home. Ate my nasi pagi in silence and went to bed. Pukul 3 baru bangun balik. Which means, pasar malam dinner....hehe.

On a more cheerful note, Hooorayyy for sis who officially became a salary receiving staff with KKM last week. May you turn up for work with joy in your heart and always be at your table and not having never endings 'minum2' - dpt gaji jgn lupa belanja...hehe...