Two call nights ago, after I got home at 9:20pm, I received no further calls all night. Last night was a another kind of night:
22:30 - go to sleep.
23:47 - the phone rings. Walk through the fog to the hospital to see a patient with a tender abdomen and discuss the case with the junior doctor. Order an abdominal Xray (we have no CT scan).
Get called to see two other patients.
Look at the film on a lightbox.
Film shows dilated bowel loops everywhere. Clinical impression before was probably ileus (temporarily paralyzed intestines after surgery), Xray is consistent. Discuss why repeating the exam hourly is better than having a CT scanner - you feel the change in abdominal tension and sense whether the pain is increasing or decreasing: "Your hands are better than a CT."
Walk home through the fog at 01:17. Lay down under the net, but sleep is taking a while...
02:30 - ...nope. Eyes closed, but no sleep. Phone rings. 35 year old with very low oxygen levels despite administering more oxygen.
Run while zipping up jacket.
02:37 - teach junior doctor how to intubate (put a breathing tube in the windpipe). Impressed: junior manages it first try! Patient extremely ill - frothy pink secretions are bubbling up the tube: Diffuse Alveolar Hemorrhage (DAH) likely. Requires constant suctioning to keep clear.
02:45 - a little more story, apparently was drinking some homemade rice alcohol. Quite a lot of it. suspect it was adulterated with other chemicals - some pesticides cause DAH.
02:50 - troubleshoot suction machine.
03:12 - one of the guards looks in to see what the excitement is. Stays to watch a few minutes.
03:30 - patient temporarily stabilized. Bedside ultrasound confirms it's not the heart, so DAH it is.
03:52 - check on guy with the tender belly. Improving.
04:00 - DAH again. Trouble with secretions clogging the tube. Attempt re-intubation with larger bore tube - won't fit, revert to original tube. more suctioning.
05:00 - eventful hour. Patient quite unstable - now on IV pressors to keep blood pressure up. Having trouble maintaining saturation even with ventilation. This bodes ill.
05:15 - realize two patients on the ward can see through the door into the ER and have been watching us work the last few hours. They appear fascinated.
05:32 - we can do no more than we're doing. As I head home to sleep for an hour or so, I hear the mosque turn on it's PA system and begin the 5:30 Azan (call to prayer).
08:00 - patient with chest pain rolls in, swallow the last of my coffee...
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