Yesterday I was on call again, and as expected it was an interesting call day.
Technically call starts at 4 pm after the rest of medical/surgical staff has left for the day. The "on-call" doctor is released from duty at 1pm to "rest" then to be available on call from 4pm until the next morning at 8am.
So, at 1 pm instead of "resting" I promptly rode my bike back to the NMB bank, Ndanda branch to ask why its been 10 weeks since depositing my predeparture allowance check and it hasn't cleared yet. The manager told me that the check has to be first sent to Standard Bank and from there a courier has to hand deliver the check with funds back to NMB. He told me he is certain that Standard Bank has received the check but wouldn't give me any details of when or who received the check. I asked him how he knew the check had been received. He said "you have to trust our system." I was so frustrated I typed out a letter requesting names and dates of the check arriving at Standard Bank but the manager refused to sign. I insisted on a name and number and, long story short, after 2 hours of debate I finally managed to get the name of his boss and number to NMB in Dar es Salaam. Luckily the manager spoke english and confirmed that my check arrived at Standard bank January 28th. Why it hasn't cleared yet is another story......
Back home by quarter to 4 just in time to get a call from Maternity Dep't to see a patient. Previous c/section due to failure to progress in active labor. In the midst of examining the patient I got a phone call from the hospital administrator (who is in Dar now buying equipment for the hospital including the doppler ultrasounds purchased back in December) informing me that the dopplers I thought were purchased are completely different than that expected and require a headset to operate!! After an unsettling conversation I went back to resume examining the laboring patient when another nurse came in to say that the theatre staff is waiting for me in the theatre to do the Ectopic pregnancy......."what ectopic pregnancy" i said. They said the patient for "emergency ectopic" is on the operating table now and they are waiting for you.......
I stopped my exam and headed towards the theatre when the maternity nurse said to me, "wait can you please examine this patient with placenta previa that came in bleeding?" "what previa?" I said. "The patient with a placenta previa who is bleeding" replied the nurse. I looked down at the patient's perineum didn't see any blood and made a decision to go to the operating room to do the "ectopic" as a priority.....
In the operating room, everyone was gowned and ready to start the operation. I looked at the patient who was about to be intubated and saw she was lying comfortably in no acute distress. Her abdomen was nondistended and nontender. There was a large keloid scar from a prior ectopic pregnancy. I looked at the anesthesiologist and said "who made the diagnosis of ectopic pregnancy?" He said "the patient". "The Patient!" I said??? I don't understand. Then I looked at the chart and the general surgeon had indeed examined the patient, scanned her and found an ectopic pregnancy and wrote plan for "emergency laparotomy at 4pm".......what a way to find out about a patient I thought!
I was reluctant to operate given her exam findings, however indeed there was an intact ectopic pregnancy that I removed, uncomplicated. why it was an emergency I don't know.......So, I rushed back to Maternity to find that the previa was infact bleeding, but not acutely hemorrhaging. So I made the decision to do immediate c-section for bleeding placenta previa at term. Emergency c-section again turned into a wait of almost half an hour. Long story short, the nursing students are expected to place lines and foley catheters and the student on call was having difficulty starting the IV and placing a foley catheter, so we had to sit around and wait..... Fortunately the baby did well with apgars 9,9 and mother was stable after the operation.......
Returned to maternity department where the patient with previous scar had delivered, but baby died - chronic asphyxia!
By the time the chaos had quieted down it was 7pm and I was back home. Hungry, tired and without much food to eat. I finished off the popcorn I saved from last month, made 2 scrambled eggs and drank some milk for dinner.
After a frustrating debate at the bank and then two operations I was a bit tired. I went to sleep early around 9, but woke up around 10 by a call from male surgical ward. This time a patient came in after a bicycle accident with wounds to his chin that required suturing. Back in the theatre suturing the wound and home again around 11. Fortunately this time slept through the night.
Uneventful day today......Tomorrow making another attempt at Mtwara for R&R while I have the weekend off.
Technically call starts at 4 pm after the rest of medical/surgical staff has left for the day. The "on-call" doctor is released from duty at 1pm to "rest" then to be available on call from 4pm until the next morning at 8am.
So, at 1 pm instead of "resting" I promptly rode my bike back to the NMB bank, Ndanda branch to ask why its been 10 weeks since depositing my predeparture allowance check and it hasn't cleared yet. The manager told me that the check has to be first sent to Standard Bank and from there a courier has to hand deliver the check with funds back to NMB. He told me he is certain that Standard Bank has received the check but wouldn't give me any details of when or who received the check. I asked him how he knew the check had been received. He said "you have to trust our system." I was so frustrated I typed out a letter requesting names and dates of the check arriving at Standard Bank but the manager refused to sign. I insisted on a name and number and, long story short, after 2 hours of debate I finally managed to get the name of his boss and number to NMB in Dar es Salaam. Luckily the manager spoke english and confirmed that my check arrived at Standard bank January 28th. Why it hasn't cleared yet is another story......
Back home by quarter to 4 just in time to get a call from Maternity Dep't to see a patient. Previous c/section due to failure to progress in active labor. In the midst of examining the patient I got a phone call from the hospital administrator (who is in Dar now buying equipment for the hospital including the doppler ultrasounds purchased back in December) informing me that the dopplers I thought were purchased are completely different than that expected and require a headset to operate!! After an unsettling conversation I went back to resume examining the laboring patient when another nurse came in to say that the theatre staff is waiting for me in the theatre to do the Ectopic pregnancy......."what ectopic pregnancy" i said. They said the patient for "emergency ectopic" is on the operating table now and they are waiting for you.......
I stopped my exam and headed towards the theatre when the maternity nurse said to me, "wait can you please examine this patient with placenta previa that came in bleeding?" "what previa?" I said. "The patient with a placenta previa who is bleeding" replied the nurse. I looked down at the patient's perineum didn't see any blood and made a decision to go to the operating room to do the "ectopic" as a priority.....
In the operating room, everyone was gowned and ready to start the operation. I looked at the patient who was about to be intubated and saw she was lying comfortably in no acute distress. Her abdomen was nondistended and nontender. There was a large keloid scar from a prior ectopic pregnancy. I looked at the anesthesiologist and said "who made the diagnosis of ectopic pregnancy?" He said "the patient". "The Patient!" I said??? I don't understand. Then I looked at the chart and the general surgeon had indeed examined the patient, scanned her and found an ectopic pregnancy and wrote plan for "emergency laparotomy at 4pm".......what a way to find out about a patient I thought!
I was reluctant to operate given her exam findings, however indeed there was an intact ectopic pregnancy that I removed, uncomplicated. why it was an emergency I don't know.......So, I rushed back to Maternity to find that the previa was infact bleeding, but not acutely hemorrhaging. So I made the decision to do immediate c-section for bleeding placenta previa at term. Emergency c-section again turned into a wait of almost half an hour. Long story short, the nursing students are expected to place lines and foley catheters and the student on call was having difficulty starting the IV and placing a foley catheter, so we had to sit around and wait..... Fortunately the baby did well with apgars 9,9 and mother was stable after the operation.......
Returned to maternity department where the patient with previous scar had delivered, but baby died - chronic asphyxia!
By the time the chaos had quieted down it was 7pm and I was back home. Hungry, tired and without much food to eat. I finished off the popcorn I saved from last month, made 2 scrambled eggs and drank some milk for dinner.
After a frustrating debate at the bank and then two operations I was a bit tired. I went to sleep early around 9, but woke up around 10 by a call from male surgical ward. This time a patient came in after a bicycle accident with wounds to his chin that required suturing. Back in the theatre suturing the wound and home again around 11. Fortunately this time slept through the night.
Uneventful day today......Tomorrow making another attempt at Mtwara for R&R while I have the weekend off.
Picture above is a view out the window of the office in Maternity Ward. Its about 1pm and typical of most afternoons - the patients are sitting outside ward 6 - the female surgical ward. Most of the patients in this ward are post-op and spend most of the day time resting or visiting with their families and friends.....
1 comment:
when and where did you get a bike?!
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