This intern, who asked to remain anonymous, describes a typically brutal day at work on an exhausting shift lasting more than 24 hours. She is learning this profession is not without pain
I’m a first-year intern and I have been working for only a couple of months.
I work at a secondary hospital. One of the reasons I chose this hospital was to perfect my clinical skills.
On a typical day when I am on call, the following happens.
My alarm goes off at 7am, I press the snooze button and next thing I know it’s 7.30; I jump out of bed, take a shower and put on my scrubs and takkies – I need to be comfortable today as it is going to be a long day!
I get downstairs and it is now 7.50. I grab whatever leftovers are in the fridge and proceed to work. Fortunately, I don’t need to travel to get to work as I live on the hospital premises.
I get to the ward and see it's full. Every bed is occupied by a sick child. Where did all these babies come from overnight?
Oh well, they are here now and we need to help them get better so they can go home.
I start examining my patients and checking recent laboratory results.
Is there an infection? What medication is the child on? Is the child improving?
The sister calls me as there is a child who is not doing well.
Since our hospital is a regional hospital, some facilities are not available.
As four doctors and three nurses surround the patient, the doctor leading the resuscitation delegates roles.
“Intern, call the referring hospitals and ask for an intensive care unit (ICU) bed.”
As the obedient intern, I do as asked. However, before I start making calls, I need to repeat the blood gas of the patient as the doctors on the other side will want to know the current metabolic state of the child. I run downstairs as there is one blood-gas machine in the whole hospital. I wait a couple of minutes and hope that the results are improving.
I run back up to the ward to start calling the hospitals that can assist.
During my marathon to the first floor, the team is busy with the resuscitation. I call the first hospital; the ICU beds are all occupied. I try the second, the third, the fourth and the fifth – no luck. None of the doctors on the other side can help.
All I can do is pray that some child in ICU gets discharged so that a bed will be vacant. I let the team know and they say try again.
I have been on the phone for about two hours.
I try the first hospital again and they have just discharged a patient.
The ambulance is called and about two hours after the endless phone calls, the child is off to ICU. The team has spent about four hours on one very ill patient.
We now continue to see the rest of the patients. Each doctor sees about seven patients depending on how many doctors there are that day. It is 1.30pm and we have not started the ward round (where the team goes as a group and discusses the management and plan).
The ward round starts at 2pm. We go through all the children and finish at about 3. Some patients need investigations, for example, blood taken and lumbar work.
We work speedily.
I remember that I have not eaten the whole day and at 4pm I need to start my call in casualty. It is now 3.30 and I warm up my food and sit down probably for the first time today to have something to eat. As I finish, it is 3.55pm and I make my way to casualty.
As I enter the resuscitation area, there are three ambulances outside bringing patients involved in a car accident.
Everyone is crying and saying: “Doctor, doctor please help me.”
Fortunately, the patients have been sorted according to their critical states. We start examining and send those who need them for X-rays.
There is a patient with a head injury so he is drowsy and bleeding. There is no CT scan machine here, so this patient will need referral to an academic hospital to check there is no internal bleeding.
To transfer this one patient takes about an hour as the doctors on the receiving end want you to discuss the case with the radiology, trauma and neurosurgery departments before they can take the patient.
That patient is stable, so I need to start seeing the other patients. The time now is 6.45pm; I know this because the nursing staff shift is changing. The only break I have taken today was the 30 minutes to eat.
I reach out for my energy gums and start seeing the next patient.
This continues until 9.30pm when the post-natal ward calls and asks for one of the doctors to assess a newborn.
My senior colleague goes to the ward and tries to put an intravenous line in to the baby but fails. He asks me to assist.
This baby is so chubby, we don’t seem to be winning until we try an umbilical line. I run up and do a blood gas and I see this child is not getting enough oxygen to his lungs. He is slowly turning blue. My senior asks me to call around for ICU beds because he needs a ventilator.
I call, but nobody in the province has.
Right now, the child is looking dusky grey. His heart is still beating, which gives me hope and I am constantly looking at that saturation monitor, hoping the numbers go up.
One of the doctors from one of the hospitals calls back and says the child can come to his hospital: we’ve got a bed, it might be 50km away, but we’ve got it, he says.
The time is 1.30am. I can’t believe it flew by so quickly.
The paramedics come to transport the baby. They are reluctant to take him as he is not stable, the amount of oxygen in his blood keeps on dropping. After much convincing and them confirming with the receiving doctor, they agree. They leave at 4am.
I am tired and there are still patients in casualty to be seen.
All I am thinking is that I just want to sleep.
I see a patient whose complaints have been ongoing for three to four months; I am angry as I explain that casualty is for emergencies; it’s not a clinic.
When I ask why the patient never went to the clinic, I get no response. I know I should not be angry – after all, this is what I said I wanted to do with my life. I examine the patient and give appropriate medication.
The doctor who accepted the baby I referred calls and lets me know that the paramedics arrived but the baby died from heart failure en route.
My heart is shattered into pieces; I really hoped he would make it.
It is now 7am and the paramedics are back with the baby.
My consultant has come to help and tells the mother the outcome. Throughout the whole process, the mother knew what we were doing and what was going on.
“I can’t keep on going, I want to sleep,” is all I am thinking.
We finish the paper work and I ask if I can go home as I have been in hospital for about 26 hours without sleep or a decent break.
I’m hungry. I drive to the nearby McDonald's to get something to eat before I sleep. As I drive, I constantly remind myself I have to be vigilant. I make it back home safely, eat and go to bed.
However, through this whole time, I think about how the baby could have been saved. I don’t know how. All I know is, it is sad that a mother now has to bury her son.