Postcall ramblings

It is half six in the morning, I am in front of the PC, sipping chilled coffee from last night and contemplating my call.

It was one of those heavy, almost bizarre ones.

The A&E was pretty quiet. I received two referrals from a local clinic, only to discharge both. One of them ended up being referred again later that night after he developed cramps after a bout of loose stools.

About half 8 a case was brought in, initially unconscious then she became disorientated. She was bleeding from the right nostril and later from both. According to the daughter, she fainted and then started to talk rubbish before vomiting blood. Her case was one of those when you know you can't keep her here but you don't really know where to refer her to. I hate cases like those. Fortunately, a mate was oncall on the medical team that night and accepted the case without actually listening to the full story. I hope she did not end up regretting that.

and just when I thought I could get some shut eye at about 1, a case of BID (brought in dead) arrived. Apparently pakcik became restless after taking his meds and did not survive the journey here. Luckily, because it is a BID case, I didn't have to do much.

The labour room was highly 'jonah' that night. It started with case of term pregnancy who was just discharged from the ward the day before. My staff nurses was setting up the CTG (a method of fetal monitoring) when they couldn't find the heart beat. A quick ultrasound revealed no heart activity. The baby was perfect, normal and of good weight. I would have been crushed.

Then the cases just could not stop coming. For once, ALL the labour room rooms were occupied. I only managed to snatch 15 minute naps here and there between checking babies, clerking new cases and waiting for the 24 weeker to expire.

I think one of the hardest things about my job is the so called 'conservative managements'. It wasn't so bad when I was the houseman; decisions like that were made by MOs or the specialists. Maybe I felt I wasn't involved; I was just following instructions but as I progress in my career, I am now making the decisions.

A few weeks ago I wrote about an infant with severe congenital malformations, the worst being cordis ectopia (heart in an abnormal position) - in this case my baby had his heart beating outside his chest wall. Apart from that he also had other malformations.

I knew what had to be done but it doesn't make it any easier. How do you tell parents that you, the doctor, is just going to let the baby die? We can scoot around and use ambiguous words but the reality is just that.

I had to do the same thing to the 24 weeker that was delivered at 0240 this morning. Seeing people die doesn't make it any easier, I can tell you that.

So, as much as I like my job, sometimes I can hate it too.