On Call

Yesterday was my 2nd "On-Call" day here and it was quite an adventure. It started out with rounds on the OB service with one of the missionary doctors here. Monday was Easter Monday, so the clinic was closed down as it was a national holiday. The ER is always open and the on-call individual is responsible to see any patients the nurses aren't comfortable with. If my memory serves me correctly (which seems to be a big blur at the moment), I saw a kid with typhoid and a few others and then went home. Things worked out quite perfectly to give me a glimpse of what intern year will be like, because it seemed that whenever I was at home for any period of time, I would get a call to head back down to the hospital- be it for the medicine/OB/Surgery/ER services- or would have to answer questions to whose answer I was not completely confident of. Being a medical student still, I have staff that I can call for any questions that I have, or call them in if I am not confident of managing something. I felt that I used Dr. Bill quite a bit, but I guess that's the process of learning. Most of the fun and sad times started at like 10:30 at night. I got a call from the nurse telling me that a guy had come in after being in a fight, his ribs were sore but other than that he was fine she told me. Just some bruised ribs, she figured some ibuprofen and follow-up would be the right management. Well, I figured that was fine, but the patient didn't, he wanted seen by a Dr. So I went up to the hospital. Turns out his abdomen was distended, very tender and on ultrasound he had free fluid in his abdomen, presumably blood from a splenic injury or liver laceration. He was stable, surgeons were called, blood was typed and crossed, fluids started and Josh learned a valuable lesson about evaluating patients he gets calls about.

There were many other patients that I saw, but I want to share about one other. I got a call from the nurse in the ER that he needed me as a woman had been "chopped". One of the saddest parts of Papua New Guinea is the domestic violence. A woman was at home and her husband who for some unknown reason wanted to beat up his wife, but here it is much different that most domestic violence in the states. Here they use bush-knives, or as most of us know them as- machetes. I walked into the ER and her hands were wrapped up and there was blood all over her face/neck/clothes. Taking off the bandages on her hands her left pinky was gone and there was bone showing along with other lacerations, her Right hand had a huge cut in it as well and a large tendon was completely cut in half rendering much of her thumb useless. The back of her scalp had 4 deep bleeding lacerations that went down to the skull. Being in memphis I'm fortunate enough to have a great trauma rotation, but it's still weird when you're the one assessing someone and initiating management on a trauma patient. We worked of the next few hours to sew up the hands and scalp. Her tendons will be repaired sometime later this week by one of the surgeons. It might seem weird to some of you that the surgeons weren't called in initially, but this is such a common occurence that the on-call docs take care of most non-life threating injuries themselves saving the surgeon from being burned out as normally he doesn't have any back up. I asked about whether the husband would be prosecuted and Dr. Bill told me , "almost never". He would pay village violence fees and that would be it. Traditionally women were property and sadly this mentality continues to persist. Pray for the people of papua new guinea, that God would move in these tough and broken situations and bring a change of heart to these men who commit these acts and protect the women trapped in them.

Dr. Bill and I finished the night with two c-sections and found ourselves in bed by 6 am, to be up by 730. It was a tough night, but I wouldn't trade it for the world. It is definitely an introduction to intern year, but also a great introduction into working with needy and broken people who are dependent upon the missionaries here for for health care, but who also have a great deal to teach me about life.