Call Day Notes

(Clearly I did not take this picture, but this is an aerial view of the station. The large cross shaped complex is the old hospital. The even large mass of rectangular buildings is the new hospital. Then if you follow the road that comes from the circle down to the bottom of the picture, I live just a few hundred feet out of view)

Another fun and interesting time on call, full of learning. Learning, learning, learning---this experience has been chock full of that! Of course, as per my usual in the US, all that learning came at the cost of little sleep last night.

• As some of you may know, I have a distaste for LPs (lumbar punctures, where you sample the CSF fluid). My distaste started in Africa, where I did my first LP late at night on a little baby, who seized in the middle of it. Ultimately I got it, after I shed some tears, mommy shed tears, and well baby seized (and likely cried before that). I have done this procedure a bunch of times, but just don't like it even though it is so simple. I walk into the ER in the middle of the night last night, to a toddler who needs an LP! I got it first try--and it was a CHAMPAGNE tap! (For nonmedical people, that is a good thing, it means I got no red blood cells during the tap, and tradition says that I get a bottle of champagne for doing it--which will be a tall glass of apple cider when I get home) Praise God! I was suspecting malaria vs meningitis (which can also be from malaria)
  
• I also had a fracture to cast last night, which I get some help with. BUT then today in OPD another fracture came in, and I thought I would spread my wings and cast it myself. I had Dr. Andy check on me, but I did it all myself. As you can see from the X-ray, that it was a tib-fib fracture, a kiddo fell out of a tree playing.
• I had 2 codes last night. Here a code is referred to as "going off." I find that kinda a cheeky phrase. Surprising to me, we actually do have code carts here, but really it is no where near the same as the US. Not to mention, that I have to await someone to call me, to know that it is going on. Frequently by the time I arrive, nursing staff may have been working on the patient for 10-20 minutes (imagining a code like we run in the US is the completely wrong imagery for a PNG code). What I have gathered is that my main job appears to be praying with the family.
  
• I still lack confidence with the ultrasound machine, but I am finding the more I force myself to use it, the better it is getting. Case in point, the surgeon and I needed to look at a patient's belly last night. It turns out I had more experience than him with ultrasound, and both us felt very confidence we were not missing any large fluid collections in the belly, which was what we were looking for.
• Ok my peds and ortho skills are improving, but OB is still a large void in my head. I am making some slow progress, wrote for oxytocin last night, and it worked.
• Finally, my driving on the other side of the road and this huge vehicle skills are also improving! To be fair, I really only drive like a 1/4 mile and am the only one on the road, there is a station rule that women cannot walk outside by themselves after dark. So when I am on call, I am given a station vehicle. I am still struggling with randomly hitting the horn, which is kind of annoying in the middle of the night! Opps! I haven't stalled the car once though.