The wake call began at 5.30am with the crazy grass cutters, who start working at the crack at dawn before it boils up during the day. I as whine as I try and close my eyes and catch another hours sleep as my paper thin caravan house walls absorb the sound of the rusty lawn mowers moans. Luckily, we had made a trip to the local cheetah sanctuary yesterday evening. I had two cheetahs sitting on me and one sucking my hand! Couldn't really begrudge the world too much for waking me today......
7.30: hospital begins with a grand ward round, its female medical today, the doctor presents his conundrum of bizarre and sick cases and we all tear him to pieces.
Then I realise that today half of the doctors (exempting myself) have been booked to go to circumcision camp so instead of 10 doctors in the hospital its 5, which means a very quick lunch for me.
After a quick whizz ward round of my antenatal women in various stages of pregnancy, doing a few dating scans, I take myself to the A&E to work on the pile of waiting patients. I am conscious I am oncall today and whoever isn't seen by 4pm is left for me.
TB, HIV, Mseleni joint disease aches and pains, Disability grant requests, remove a ?cockroach from the ear, Incise a purulent groin abscess, then it pick up the card for he paediatric assault case and my heart sinks. It sinks for two reasons, one; it is pretty traumatising for all involved including myself, two; it takes on average about two hours to do.
For those readers who are not familiar with rape assessments (much like myself before I started here), the victim makes the disclosure to the police initially and then they come attended by an officer with the rape 'kit'. The medical officer takes a relevant medical history and of the events for forensics as well as for after care i.e.. HIV prophylaxis, Hep B immunisation, Morning after pill. My 14 year old girl was barely tanners stage 2 and had been raped in the early hours of the morning by a man who was living in the family hut for the last few months. Her mother sat in the room, cradling the younger 6 year old who had cerebral palsy, whilst I took laborious samples from intricate places and hoped that there would be some fruit to this ordeal and the rapist was locked up for a long time.
I continued to see patients throughout the day, then got called by one of the doctors on paediatrics to get some help cannulating a baby with acute gastro secondary to traditional Zulu medication poisoning. The child was a floppy dehydrated mass, actively having runny diarrhoea. In these scenarios when intravenous has been tried almost everywhere, the last resort to rehydrate and save the child is to insert an intraosseous. After a little bit of a fight from the little one, I stuck the needle in and we pumped in fluid ASAP.
4pm; it was end of the day for the others doctors, but the start of my oncall, I had worked like a machine throughout the day and could look forward to a fairly civil evening. By six most people had been seen so I head down to my little park home for some dinner.
After dinner I went to check up on the babies, the poisoned kid had pulled out its IO line but luckily looked less like a dried prune so we compromised on aggressive oral fluids with mummy. Before I could move on the baby opposite, had its iv line fall out and before I knew it I was doing my second IO line of the day.
10pm; labour call and tell me about a pregnant lady who they cannot find the fetal heart. An intrauterine death is never a satisfying diagnosis. Being the bearer of this news is quite a sickening affair, this would be my duty this evening. She was actually in a terrible state, she had a hard rigid uterus and only one thing comes to mind - uterine abruption.
After resuscitation and analgesia, I grabbed the ultrasound, I could see no fetal heart but could see a large bleed behind the placenta. Management in cases like this is to rupture the membranes and allow delivery of the dead fetus per vagina. We just had to be cautious of a large post partum haemorrhage. She had a slow delivery and finally amount 7am the next day delivered. To my dismay we had no emergency units of blood at all and I arranged for her transfer out to our larger referral hospital ASAP.
After the placenta had delivered she had a massive bleed as expected and this seemed to subside but she had had a considerable bleed and repeat Hb was 5.5. I was getting anxious about when the emergency services were coming, but before I could worry too much, I realised she was re-bleeding! I called in a few more hands and one of them was used as bimanual compression whilst the other was blowing up a surgical glove to use as a balloon tamponade in the vagina to stop further bleeding. My patient who is a local Zulu woman, looked as white as ghost at this stage, all she needed was some blood the one thing we didn't have. 3 painful hours later a helicopter came and transported her up and out.
That was a long day and night, I was exhausted, once my patient was transferred sped through ward round and rushed to my HIV clinic, where I had my list of HIV patients ready and waiting from 7am that morning to be seen by the doctor.
That evening we went to the beach and luck would have i we saw a huge loggerhead turtle make its way out of the sea and slowly crawl up the beach to lay her eggs.
Life is not all that bad and now five days later I have my placental abruption lady back on the ward, looking the colour she should be.
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