all in a day's work

Nights on duty:

A year-old baby arrives at the hospital - a referral from another hospital. She is febrile and weak-looking. She is severely dehydrated and is breathing with difficulty. Pneumonia. Within the minute she arrives she goes into a seizure. Right away you consider meningitis and then cerebral malaria. You admit the patient immediately slightly piqued that the referring hospital did not call or send an SMS about transferring the patient. After admitting the patient and sending the ambulance away an SMS arrives regarding the referral. You conveniently forget to reply as you go on with your other admissions.

Two patients arrive almost at the same time. Both hypertensive with systolic blood pressures over 220 (normal systolic BP is 120 and below). Motor intact, sensory intact, no change in sensorium, oriented to person, place and time. Not stroke. One is congested, you start diuresis to rid of the fluid overload and bring down the blood pressure. One is diabetic and on insulin, blood sugar is in the high 200's. You give another shot of insulin. You monitor each patient closely the whole night.

A pregnant woman arrives complaining of lumbosacral pains. She has just gone into labor. A check reveals her baby is okay, fetal heart tones are okay. The woman's blood pressure, however, isn't. At 230/160 she is in preeclampsia. You start her on Hydralazine, load Magnesium Sulfate and inform her OB-Gyne. Her blood pressure goes down a little. In two hours time you are holding her baby. She had undergone an emergency Cesarian Section. They were okay.

Another pregnant woman arrives. She has been having uterine contractions since that morning. It was her sixth pregnancy. You do an internal examination which reveals that her cervix is fully dilated. You admit her directly to the delivery room. She delivers her baby within 15 minutes. The NA stands beside you to catch the baby. Both of you cringe as you notice a pinkish round noodle-like thing come out of her anus after the baby is delivered. A worm - Ascaris by the looks of it. You put a side note on the chart beside your post delivery orders and remind yourself to inform the OB resident to give the patient a purgative on follow-up.

You finally get some rest before 3 in the morning. You lie down and try to fall asleep knowing full well that the adrenaline coursing through your veins is going to keep you awake. Twenty minutes later just as your were about to doze off a knock on the call room door jolts you back into wakefulness. There is another patient in the ER. A mother has just brought her eight year old son. He has been vomiting and having loose bowel movement since the night before. He looks on innocently and smiles at me as he stands straight in his blue and white striped pajamas. You advise the mother to have labs done in the morning (the med tech had gone home for the day). Even though febrile, the patient showed no signs of dehydration. His clinical picture was that of a urinary tract infection - not viral gastroenteritis, not intestinal amoebiaisis*. You prescribed an oral rehydration solution, an antipyretic and an antibiotic, said goodbye to the kid and went back to sleep.

Two hours later you are awoken by another patient for admission.



*Labs done the following day did reveal a urinary tract infection.