Nightmares

The one thing I miss about the pre-doctor era is without a doubt, good, uninterrupted, peaceful sleep. During the very first few days of internship when i was still bright eyed amd bushy tailed, i would come back from a long day on my feet and collapse into a blissful slumber for hours at a time.

As the years progressed my sleep patterns deteriorated exponentially. I found myself unable to sleep at night yet too tired to do anything productive. I would often lay up at night and think about the intricacies of the day. Insomnia and I became the best of friends. I imagined the stories id have to tell my friends and family, the patients I’ve met, the doctors I’ve learned from. Those were indeed better times.

During My surgery rotation I began having grotesque nightmares about floating bowels and disheveled amputated limbs. I thought this was expected given the circumstances I was working under and as time went on it didnt bother me much. The nightmare plot was usually the same. Blood, organs, pus, urine, faeces, wounds. Just the basic bodily fluids. Day in and day out. Became a bit of a bore actually.

That was until one dreadful Friday-Sunday call in the latter part of 2017 during my obstetrics and gynecology rotation. Friday-Sunday calls were every intern(slave) ‘s monthly damper. As soon as the monthly call roster was out, we would huddle around one person’s call phone screen and moan about the upcoming fridaysunday call. The equivalent of a bandaid waiting to be ripped. Or a Marie biscuit floating on the top of your teacup. I hated fridaysunday calls with all the fibres in my being yet I remained hopeful.

I decided that my upcoming fridaysunday call would not be raining on my parade this month. I was determined to have a fruitful call enriched with educational experiences and other flowery thoughts. After all , I was going to be on call with The Colonel.

The Colonel was the anchor of the Department. Quick to make decisions. Logical and empathetic. First class patient care. Hardwork and experience under his belt, what could go wrong?

Everything.

Ironically before the call began, the colonel sat me down in the doctors room and leaned over with his hands resting on his knees. I distinctly remember his gold watch hanging off his left wrist. A watch I would see slide on and off during countless of Caesars that weekend. He looked down. Paused. And said these words

“Moosa today we are doing this call together. Me and you, we are a team. We will work together. When you cannot go on you tell me, you rest and I will man the fort. When I cannot go on, I will tell you and you will man the fort. There are mothers in this labour ward depending on us. And even more importantly there are unborn innocent lives in our hands. If I am busy or I close my eyes for a minute and you cannot make a decision, you come and fetch me. I will never be angry at you for disturbing me. But i will be angry at both of us if we have a bad outcome. No poor outcomes. No fetal deaths. And most importantly , no maternal deaths, None”

This PEP talk rerved my adrenal glands. YES I AM READY.

I definitely was not ready for the hell about to ensue.

The labour ward rang me. We had a young mother with fetal distress . the babys heart beat tracing was sketchy. The most common term to roll of my tongue in the coming 4 months- fetal compromise. I ran this by the colonel doing my level best to contain my excitement, a Caesarean section! I prepped and booked the patient and off we went.

Whilst in theatre I heard my phone vibrating next to the aneathetists collection of drugs drawn up neatly in various syringes. He looked up at me with a bored stare. I nodded. He answered. Mumbled a few words.

Theres 2 admissions to high care moosa. They’re looking for you. I looked up at colonel and he sharply probably sensing the beginning of the brewing storm and said ” help me close the uterus and go” . the baby was screaming and we were ofcourse relieved.

I arrived to high care and admitted to ladies with previous Caesars and pre-eclampsia. Their blood pressures were through the roof and yet they were calm as cucumbers. I drew bloods examined clerked and informed the colonel. He came to assess the situation and decided these two ladies need immediate delivery. The baby’s were not happy at all and their heart tracings showed it. The CTGs looked like a chaotic mess with more troughs than should be. Even i knew that at first glance.

Which was not the problem.

I called the anaethetist to book the emergency cases and he calmly ordered me to book the cases.” Oh theres a stabbed abdomen leaking faeces through 6 holes in his small bowel so we may be a while. ”

What? Its a fetal compromise I said with all the panic i could muster.

“I know moosa. We only have 1 theatre after hours. I’ll see what I can do to open a second one. The don is knee deep in bowel. He should be done soon”

My hero. I waited. I prayed. 2 fetal deaths. 2 maternal deaths. Hell to the damn no.

I informed the colonel and we began prepping the patients for OT optimistically.

I called the anaethetist 3 times hoping for a miracle. “Moosa where do you want me to put this damn man? On my flat forehead? ” i knew his hands were tied. Although the don had done damage control, the patient had lost so much of blood he could not be weaned off the extubator. So the anaethetist had to baby sit him until a second theatre was ready intermittently topping him up with muscle relaxants.

During the aforementioned commotion I admitted 2 more ladies in latent labour with abnormal CTGs.

By now i knew for sure my motivation was tapering. Raw fear set in. 4 possible fetal deaths waiting to happen with 1 stabbed abdomen blocking theatre.

The colonel had managed to keep the .2 New fetal compromises at bay with some conservative measures yet we still had 2 with no improvement.

Thats when his phone began to ring in his pocket. A nearby district hospital was sending over a confirmed ruptured ectopic pregnancy who was hemodynamically unstable and

An abruptio placenta with a live fetus.

Almost every obstetric and gynaecological emergency was breathing down our neck.

The Colonel sat down on the floor in the hallway. I followed suit. He took out a small piece of paper and began writing down the pending cases in order of urgency.

“Moosa remember what I told you. We are a team. Close your eyes and find the strength. We have to do our best and cover all patients”

At that specific moment, almost as if Murphy himself was mocking us with a thick sly grin over his face, the colonels phone rang.

The casualty officer informed us of a suspected ruptured ectopic pregnancy in casualty. A completely different one.

Our game plan was mapped out on the piece of paper. First we take the fetal compromises to OT and get the babies out ASAP. While the colonel delivers them I rush down to casualty and confirm and prep the patient for an exploratory laparotomy for a ruptured ectopic pregnancy.

Once the theatre is free, we push the ectopic in and await the abrutio and second ectopic from the district. The Colonel called on the labour ward staff and sat us all down. He gave yet another powerful PEP talk which we all needed.

“No one will die in this ward today. The grim reaper will leave EMPTY HANDED”. I wasn’t so sure.

The plan was going smoothly until my phone rang a ghastly ring. Labour ward informing me of a PPH- post partum hemorrhage due to a perineul tear who is actively bleeding out and her BPs are in the boots thanks to old chap Murphy.

I ran like a life depended on it. I found the patient in a pool of blood and birth products. I immediately jumped on the abdomen and performed aortic compression until the blood trickled down her leg like the sweat off my forehead.

I switched places with a nurse and dove into unfamiliar territory. I knew the colonel was busy delivering the babies solo which was hard enough so I attempted to localize the tear and ligate the bleeding vessels.

The cervix looked like a vortex of a million black holes in outter space all condensed into 1 portal. I knew i had to do something. I may not have been the best or most experienced person who could help her but I was definitely the only one.

After searching for what seemed like an eternity, success. My fingers were numb. My knees were weak. My head was spinning. But the bleeding had stopped. I watched in awe as the cervix turned rosy and blood filled. I had done something right. I packed the vagina and left to resume my duties to the ectopic in casualty.

I met the colonel outside theatre and he gave me a pat on the back. He assured me he would assess the patient and inform me if any formal wound suturing would need to be done.

I gave him a thumbs up as i stepped into the elevator and pressed -1 to go to casualty. As the door closed I noticed the unusual slowness in which it paired with the frame. I slammed the open button but it was too late. The elevator door was stuck.

I slumped down onto the rubbery filthy floor and pushed the emergency button continuously to no avail. The entire lift was dead silent. I looked at my cellphone to ofcourse find no reception.

I banged on the door for 10 minutes straight until my voice went hoarse. The elevator was stuck between floors so all I could see was a black thick wall when I peered through. I screamed for colonel but he ofcourse was busy popping the babies out in theatre.

I felt my pockets for any gadgets or devices but all i found was a week old mentos deep in my scrub pockets. I ate it absentmindedly. I thought about the lady in casualty in excrucuating pain whom i promised to go back for.

I imagined the abruptio had arrived and the colonel thinking I had abandoned ship. Probably cursing me and indulging In my irresponsibility. I imagined the guilt id feel if anyone had died because I was stuck in an elevator.

Then I had an idea. A small stupid one but an idea non the less. I pulled out a piece of paper and I jotted down I was stuck in the elevator. I folded it carefully and wrote READ ME NOW in capitals in case someone had mistaken it for litter.

I popped it between the centimetre of open space and waited.

I put my head down between my knees and prayed a silent prayer.

After what seemed like 5 minutes a crackle and pop startled me and the emergency button went off. I frantically pressed it and started talking.

The security on the other side assured me maintenance was working on it and the time lapsed was only 20 minutes.

The longest of my life.

The moment i got out I ran to casualty to make sure the patient hadn’t died and was relieved to find her breathing.

I called the colonel and explained my situation. Before laughing uncontrollably, he snorted and mentioned how I really was not having the best of days.

The call seemed to never end and it went on for another 36 hours in this fashion. Emergencies poured in while we fought the reaper.

I was relieved to know that no one had died and all the mothers and babies were safe and sound. Yet the veracity of the call had changed something in me forever.

I had continuous nightmares in which I was stuck in a time lapse of this call reliving each emergency over and over again. I would wake up sweating and tachycardic, feeling like a truck had drove over my face.

The nightmare eventually ended and was replaced by another. But that’s a story for another day…