Calls are like public toilets. You either open the lid and see a squeaky clean bowl or a sh*t show. There’s often nothing in between. I didn’t realise it when I had this thought, but it’s true.

I was in a situation where I witnessed 2 colleagues having a heated discussion. The argument was born out of which speciality a patient belonged to, at 3am. This is not uncommon for Casualty work. Often there are patients with a long grocery list of problems that overlap between specialities.

The patient was a 78 year old sweet lady, who reminded me of my own grandma who had diabetes, hypertension, atherosclerosis, previous myocardial infarction, a repaired hernia, cataracts, diabetic nephropathy, peripheral neuropathy, and now bloody and mucoid vaginal discharge.

She had been managed by internal medicine, cardiac ICU, general surgery, ophthalmology and nephrology. Just when gynecology had thought they had escaped, she came in with a problem down south that demanded attention. The irony made me laugh. (Not out loud).

The gynecology registrar was adamant that the patient be admitted to the medical wards as a primary medical patient and gynecology be consulted in the light of day.

“Listen doc, the patient has so many medical conditions, I don’t think this is primarily a gynecology issue. Plus I’ve examined her, everything is fine”, she said.

The internal medicine registrar looked at her blankly and sighed.

“Don’t take this personally, but what have you examined? The uterus and vagina could be infected or septic and no external examination would reveal that. Did you listen to her heart? When last have you ausculated heart sounds? What did you find? Is she in cardiac failure? Like, my question is, what am I admitting her for?!”

His voice escalated then stopped.

Crickets.

The gynae reg was stunned. But I could see she was trying to hide her embarrassment, for some reason.

I guess she did feel insulted in some way but he did say “don’t take it personally” so surely that counts for something? Right? She composed herself.

“I agree the uterus or pelvis could be septic but on my examination, theres nothing that warrants immediate gynae admission. But I’ll scan her uterus and pelvis, to be sure”.

The gynae reg hunted for the casualty sonar machine. I spotted it on the far side of the resus bay, in use by the EC doctor trying to look for a pneumothorax in a very corpse-like figure. She saw my gaze.

“Well, the sonar machine is being used so I’ll scan her in the ward.”

The internal medicine reg looked smug and victorious.

“Oh great, you can let me know how that goes”, knowing very well that won’t be his problem.

The gynae registrar gathered her paperwork and started the tedious task of admitting a new patient with 3 volumes of files to a new discipline. Her chronic script was endless and her past medical history was so extensive, I saw her pen fading.

I was busy with my own admission so I couldn’t offer a hand, but I did sympathize with her.

Saturday morning 3am admissions feel like a punishment. There exists a time and space on a Saturday morning between 3am and 5am that allows a person to rest, catch a breather and prepare for the real drag of a punishment, worse than the call itself…. Saturday morning rounds.

The weekend team must gather strength to see all the existing ward patients equivalent to a day’s work while being post a 24 hour shift. There’s no amount of coffee/caffeine that’s enough.

I looked at the time and I looked at the gynae registrar. We both sympathized with each other but knew we couldn’t help the situation.

She finished up and looked at the time, 4 30am. I could hear her drag her feet to the post call ward round with a huge sigh. As she left, I heard her phone ring and she muttered something about a new ectopic needing surgery and the lord having mercy on her.

I was finishing up my notes when I heard a faint voice behind the curtain.

“Doctor, I forgot to tell you something”

I went to the granny and explained to her that her doctor had already left.

“Oh no” she looked distressed.

I paused.
I shouldn’t have asked but , I did.

“The lady doctor said she wants to scan my tummy to have a look at my uterus and insides. Problem is…I had my uterus removed in 1989, i think so? she may not find anything there.”

Wow.

So she would essentially be admitting the granny for nothing, of which she already did the admin and paperwork, on a Saturday morning at 3am, post call, pre round and now probably pre emergency theatre.

All in a day’s work!