I am currently home alone in a home not my own. The girls have gone somewhere else for the weekend while the dearie hubby is back in Clonmel, on call. We were on call as well on Friday but the strange system some hospitals have couples Friday calls with Sunday calls, which means no weekend for those involved. Thank God that is not the way it works for surgical interns in MWRH Limerick.

Alhamdulillah the Friday call was not too busy, to my surprise. I was always under the impression that Fridays are the days that people would want to leave work early, therefore they would have been more likely to leave unfinished jobs to the person on call in order for them to get to do that. Fortunately it didn't happen to me this week.

As usual 2 interns are on call on any day, and the night has to be divided into 2 to allow '4 protected hours' of sleep for each intern. One takes 12am to 4am and the other 4am to 8am. Considerate isn't it? The call starts at 5 when doctors not on call leave their workplace. We went to do rounds on the surgical wards and did the jobs listed for the intern on call at the nurses' station. We somehow found our own ways and got separated on different wards. After finding that there was no more job waiting to be completed I walked down to the doctor's residence (Res) to have a rest, as we don't know what awaits us as the night goes on. It could be calm and quiet initially then hectic and noisy later so better beware. 

I stepped my feet into my room, opened a book and began reading. An activity that is always so difficult for me to maintain for a long duration- because I easily doze off right after finishing only 2 lines like. Impressively I managed a few pages which I was quite proud of my achievement that night. Was reading hubby's "Kuasa KePEMIMPINan Al-Fateh" authored by Ustaz Muhammad Syaari Abdul Rahman- this year's PUISI's invited speaker! Am hoping to get to attend PUISI this year despite the tight working days and hours. Guess what, fell asleep anyway in the end for prolly less than an hour and woke up feeling bad and anxious if the other intern was busy doing jobs while I was in the Res, in bed!

Got up and darted to the wards to find the other intern browsing through a patient's chart. Phew. Then got a call from switch as to who goes to bed first. The other intern let me decide so given that I just had a quick nap, I suggested that I would stay up till four and he could go to bed first. Consensus achieved. 

I went on a tour repeatedly onto the wards to make sure that when I leave them for Res I won't get bleeped, at least not too soon. Just a few jobs to be done which were somewhat redundant. Apart from the IV lines to be sited, 2 patients for review had developed rashes and hot flushes following the administration of their medications. One tazocin and the other, query oxycontin. Obs were fine and no respiratory symptoms in particular, so I just prescribed Piriton 4mg TDS only as I didn't see the need for steroids. If anyone thinks otherwise please enlighten me okay. Saya budak baru belajar. Of course I reminded the nurse to keep an eye on the patients' obs and let me know of any deteriorations.

I legged down to the Res at about 1.30am with that wishful thinking that I wouldn't get called for any breaking issues till 4am, as I would be handing over my bleep to the other intern at 4. Just seconds after I entered the room and closed the door my bleep went off. A nurse from one of the wards asking for a patient to be charted painkiller. I was like, oh my God didn't I just go to each ward minutes ago to check?

N: I have a patient here who came in with ... . He is in an awful lot of pain but he is not charted for any painkillers.

D: Oh is it..?

N: He was once on (painkiller), (painkiller).. but they were crossed off. Why did they stop them doctor?

D: Err how would I know, nurse. He is not known to me! Emm.. (just following her flow)

N: Oh hang on doctor let me see, he is on (drug), (drug), .. oh yeah he has paracetamol charted in the PRN section. Sorry doctor!

D: Okay. Phew! 

So close to have to get dressed again and to have to walk over to the ward one more time. And you can't imagine how a long way it is to walk from the Res to the main hospital even though they are under the same roof. Plus, it was freezing cold! I jumped onto the bed and tried to sleep which I found hard. Not the usual me who would usually easily fall asleep sometimes at an inappropriate time eg in class, let alone after a long tiring day at work. I put it down to the thought of missing the significant other in Clonmel and the excitement of getting to meet him tomorrow. Probably yeah. 

Beep beep. 2.30am. After I finally managed to rest myself under the duvet I got bleeped again. 

N: This is ward .. and we need blood cultures to be done.

D: What's the problem with the patient?

N: The patient came in with ... and he needs 3 sets of blood cultures.

D: Is the patient spiking temperatures?

N: No but the team wants blood cultures for him.

D: Sorry why do they need to be done now? (at 2.30am!)

N: Because we just went through his chart there.

D: For God's sake.. We normally would do blood cultures if a patient spikes temperature.

N: I know.

D: Yah so if he is not and it is just routine blood cultures I'd say we can just do it tomorrow morning ya (should have said in the morning when I get up). Phew.

Zzz. Beep beep. 3am. 

D: Surgical intern?

N: Ya we have a patient here who is in pain post osteotomy. He is a young boy and he needs painkillers. He is on... (didn't pay full attention. What is osteotomy by the way, what ward is this, ENT, eye?).

D: Would you mind giving him paracetamol I'll chart it in the morning.

N: Oh come on, he is post osteotomy. (This must be coming from an experienced nurse, I was supposing. Er what is osteotomy?! Why is a young boy placed not on the paeds ward? ).

I was so not impressed with that nurse-on-the-phone's tone that angry thoughts blossomed in my mind. If the patient is deep asleep I'm going to question her how did she know he was in pain, the devil was actively playing its part onto me. Two nurses were at the counter, one looked friendlier than the other (she even asked if I were engaged after catching a glimpse of my ring I guess. I was thinking why didn't she ask if I were married, probably I look too young for a married girl lol).

The patient was not too young, I thought she meant like 11 years old boy or something. It's 22. A maxillofacial (Maxfax) patient. Sitting up, not asleep. So osteotomy in this case must mean something to do with bones in the face or jaw. I see. New knowledge everyday isn't it. He can't tolerate oral meds so was thinking of pethidine IM/IV but resorted to Difene PR instead. I am on colorectal/general surgery so Difene PR is kind of common for bowel stuff. I asked the nurse what do ye usually give for facial pain as such. She wasn't too sure herself. Oh well.

Did a quick round following that just to make sure to not get bleeped again even though it was already  3.20 in the morning. Roughly half an hour before the handover. But I can help to ease the job of the other intern can't I? After doing the jobs I headed down the Res again. Another bleep went off as I turned off the light. What?

N: This is ... ward. We have a patient who came in with ... . His urine output is zero would you mind to come and review this patient?

D: How long has it been like that err did you see me when I went to your ward?

N: Emm the patient wasn't here at that time.. it's been zero for the past 2 hours.

D: How was it before that?

N: It was 7mls per hour.

D: How's the obs.

N: The BP is low but the patient is on fluids.

D: The O2 sats are fine ya? 

N: Yes.

D: Is the patient on frusemide or anything? Any renal disease?

N: No the team doesn't want the patient to be put on frusemide and they will come to see him in the morning.

D: There you go, bingo! So the patient is well except for the urine output, O2 sats are fine (respiratory symptoms/fluid overload) the team doesn't want him to be on frusemide and he will be reviewed tomorrow morning. There's not much that I can do at this point isn't it...? Em I'd say just monitor the obs and let me know of any worsening okay?

That marks the end of the bleeps I received during the last call. Finished the call at 12pm to see darling hubby already arrived in front of my apartment. Yay! 

Shared with him my experience and the anger that developed throughout the call upon getting 'trivial' calls. He on the other hand was looking at a different angle and advised me to avoid releasing 'negative energy' by emitting fury and animosity to my environment. For that will in some way allure negativity to develop in my mind, nourishing me to become a person full of revenge or a person difficult to ask for help whilst not denying the need for rationalisation. Hmm did I get it right? Deep thinking of the thinkers ya. A successful product of an adamant self-help book reader, I thought. Hehe. Thanks for the reminder.

See ye in Akademi Al-Fateh, insyaAllah.

Wallahua'lam.