Tuesday

1230 am: The pager goes off.  I wasn't sleeping anyway.  Sometimes when I am on call, I can't sleep.  I lay awake and wait for the pager to go off.  And it does.

The patient is pregnant - term with thick meconium and non-reassuring fetal heart tones.  Up the hill I go - primary c-section.

0200 am:  There is a patient with chronic hypertension, now 24 weeks, with blood pressures of 200/150.  Hydralazine and aldomet aren't working.  I take IV labetalol from the operating room (it is not stocked on labor ward) and I sit by her beside and push it IV.  Her pressures finally start to decrease.

0300am: asleep

0700am: Meeting for Physician Staff.  I love chai and mendazis (a fried Kenyan bread).  I don't remember what happened in the meeting.

0900am:  My first surgery of the day is an exploratory laparotomy for a right ovarian tumor (suspected dermoid).  This is per the ultrasound report.  But the patient is not in the operating room.  I go and find her, hang IVFs and take her to the operating room.

1000 am:  It's not an ovarian tumor.  It's miliary TB - all over her abdomen.  What was the mass?  A right psoas abscess.  Luckily, I have a general surgery resident on my service this month, so we closed her belly and then drained her hip abcess.  My first ortho case in Africa!

1100am:  The chronic hypertensive patient is not responding to the labetalol.  Her pressures are high and now she is complaining of a severe headache.  I decide to do a C section.  In the pre-op review, OtherDoc discovers no one has checked fetal heart tones during the 16 hours of her admission.  I do an ultrasound.  The baby is dead and it measures 16-17 weeks. 

I say bad words in three languages.  Then OtherDoc and I do a D&E to empty out the uterus. 

1245pm:  The OR says they are willing to work through lunch.  I try to find the next patient for surgery.  She is sitting on a bench in the labor ward.  She hasn't been prepped for the OR yet.

"Did you want to take her today?" the nurse asks.
I ask OtherDoc to write me a script for Haldol.

We get her to the operating room, but now anesthesia is gone.
I eat two Special K bars during the confusion.
The patient is 61years old and has complete prolapse of her uterus.  Everyone comes in to stare.
Finally, we start and I do my first Le Fort procedure in Africa.

300pm  I am tired.  My feet hurt.  I go to check on labor ward.  I try to make decisions but it is hard. 

430pm  Home at last.  I accidently close the door on Teddy's nose.  He cries.  I give him kitty treats and we go to bed.

630pm Am awoken to the sound of screaming outside my bedroom window.  I look outside.  A lady is sitting on the grass - sure enough  - outside my window.  Her baby is about 3 years old and he is screaming and running around.
I say,"I am sleeping.  Perhaps your baby can go somewhere else and cry?" 

Cranky white doctors.

I wish I had some haldol.

And that was Tuesday.