Saturday Call

I was on 24 hour call Saturday, and it was fun! The theme of my entire visit continued---learning, learning, learning.

When I take call here, as an internal medicine trained person, I am not trained in peds, OB, ortho, or trauma, so to bridge the gap there is always a back up person on with me. Yesterday that was Dr. Bill. As I intend to do many more of these types of trips in the future, I have tried not to be closed minded to learning these other specialties. However, I will say it's been fun doing new things and learning so much here, although my heart is still in IM.

The first great surprise of the day is that Dr. Bill showed up to rounds, which he did not have to do. Do you know what a sweet gift that is? How rounding works with the weekend is the Friday night person will see their whole ward and the surgeon sees their whole ward, which leaves me with the 2 wards left. In my case, it was the medicine ward (GREAT) and the OB ward (you want me to take care of pregnant people, are you crazy?!). I do want to learn, but have surprisingly not done too much OB here, so it was going to be a stretch to have me round there. As it turned out, the ER was packed when I arrived for call, and ultimately sweet Dr. Bill rounded on the entire OB ward for me!

The theme of the daylight hours was the ER. I admitted at least 10 patients, alot of kiddos and a few COPDers. What makes peds actually not that bad is these standard treatment books in PNG. It's a Sanford Guide sized book, that lists all the common illness in PNG, and standardized approved treatments. PLUS in the back, it lists all the common meds with doses by weight. Therefore, I haven't been doing any complicated math or calculating, I merely turn to the guide page and look on the table with the weight. I did end up with a really sick kid that we could not get IV access on, and ended up putting in my first IO (and later that night my second IO).

Sometime during the day, I got called that a first time mommy was in labor with TWINS! One baby was breech. Called Dr. Bill, and due to another sick kid, missed the first birth, but helped with the second. Just to make matters interesting, the OB ward ran out of OB trays, and had 2 other deliveries going on (the doctors only perform complicated deliveries here, the staff does the rest). So basically, Dr. Bill had to tell me what he needed, and I had to scour all over to find whatever he needed, mainly using supplies from a D&C kit. Mommy and twin baby boys are doing great! Dr. Bill walked me through sewing up tear in Mommy. There is a project in the US that sends these bundles for each delivery that includes an outfit and blanket, so you can see in the picture, the twins decked out in their new outfits.

Then in the evening, I got called for a penetrating stab wound to the back. When I arrived, it was exactly that, a man was drunk, and I believe got stabbed by his wife or girlfriend. When I walked, he had a BP of 60/40. I immediately realized that my finger could reach lung, and called Dr. Bill and then Dr. Kevin (our surgeon). It was a funny presentation, as I had no CXR or Hgb, you have to wait for security to find the X-ray tech at home to get that done. I did attempt U/S to look for a hemothorax, but Dr. Bill and I weren't successful in that endeavor. I asked Dr. Kevin, if he'd show me how to put a chest tube in, and he let me do it, which was fun! It was a hemo/pneumothorax. That is the top picture.

Simultaneously, another woman walks in with chops to her b/l cheeks and head. She was bloody, but really her injuries weren't too bad. And thankfully, the nursing staff can sew up lacerations here, so I could do the chest tube.

I got to sleep through the night, but then at 6 am this morning, I was called that another mother needed a C-section, so I ended my call assisting a C-section with Dr. Bill. We ended the day rounding on medicine ward together, and to leave a sweet present for Dr. Steph, we even conquered the peds ward (ok I saw like 3 patients, to his 20 or so on wards).

As my chief has always said, when your busy, you have plenty of learning opportunities (that's for you Sarah)! I am trying to take advantage, while I can!