Baptism by fire....

I promise that I will never, never, winge about being on call in Christchurch again! It started with a prayer, which is the custom here before any procedure in the OR. This teenager had an acute abdomen and we were after his appendix. I was performing my first GA in a long time and did quietly wonder if the Zulu prayer reflected this. Anaesthetics is a simple affair here with Ketamine the backbone, and as he dozed off I felt grateful that I was at least familiar with this drug. Sux, ETT down and then crank up the Halothane and Nitrous and keep him still with a vial of Vec. It all went smoothly and I felt a sense of smug satisfaction as I gazed over the green drapes at Johan digging around McBurney’s. He wasn’t having as much fun. His Babcocks anxiously suspended an open section of bowel which he sadly had plunged into, it being adherent to the fascia above. The appendix mass was an impossible proposition and he repaired the bowel and closed up. I was relieved to wind down the gases, reverse his paralysis and whip out the tube, but this was by no means a slick affair and Johan was long gone by the time I left theatre. Then I made a quick stop on the ward to review my pale yellow patient, who had RVD with a CD4 count of about 100 and both renal and liver failure. I wasn’t surprised to find his Hb was 2.4 and managed to secure the last 2 units of blood in the hospital, to at least give him some symptomatic relief.

At about 01.00 the fun started. “Hello Doctor; this is sister on Labour ward; can you come? The baby is not coming…..”. I ran up past the Mango trees in the dark hoping like mad that a Mamba wasn’t out for an evening slither and sprinted around the hospital trying to remember where Labour Ward was. What greeted me would have been comical had I not been so terrified; an elderly multip suspended in stirrups, fetal head on view, tired and annoyed midwives looking at me expectantly……I gazed hopefully at the ragged CTG, fetal decelerations obvious and remembered something about vacuums….a quick call to the faithful Johan confirmed my attack…”you’re allowed 3 pulls and if it doesn’t come then go for Caesar”. I found some gloves, a scruffy mask and visor (yes, RVD+) and set about connecting the vacuum. Suction was variable but somehow we got it going and with a bit of prompting from the midwives about ‘rocking’ the head, out it popped. The cord was wrapped tightly around the neck and we divided it and then with a bit of a wriggle delivered the body, limp and quiet. Thankfully with a bit of bagging, some oxygen and a bit of rubbing the little critter gave a howl and never looked back.
The drama in LW continued with the birth of a macerated still birth and then another who came in with her tiny dead baby covered in sand and the cord tied with a pathetic little bit of blue wool. A hypertensive mother, reportedly without a fetal heart, turned out to have one and her BP responded nicely to some Nifedipine. Her labour was augmented with some Pitocin, but not before I combed the handbook reminding myself of all the perils of CPD and eclampsia. We ruptured her membranes (ok if she has had her ARV’s at least 4 hours before) and she delivered a healthy boy.

It was now getting light and it was time to tidy up in “OPD”. A policeman with a gunshot thigh was interesting for the lack of an exit wound, “a ricochet” he thought, but was lucky to have normal neurology and sensation and the femur appeared ok, but I was unable to confirm this because the radiographer was away for the week-end. The next chap, with a stab wound to the left costal margin in the midline, also seemed in pretty good shape but again a lack of x-rays frustrated me. I was keen to observe him on my ward but was advised to send him 2 hours down to our referral hospital. The rest was a blur of fevers, ARV’s, TB and abscesses but one did stand out; an 8yo boy with a neck like a Springbok rugby player. It may have been an abscess but lymphoma was also a possibility, so we elected to put him on the ward for a biopsy the next morning. I wouldn’t like to have to manage his airway.

So as the day dawned I reflected on my first night on call and smiled as I thought about my consultant call in Christchurch. Hopefully I had made a difference but perhaps a ripple in a pond. I wandered off to do my ward rounds.