Ward call

In an hour's time, i will be driving to the hospital to begin two weeks of overnight ward call. For those who are not familiar with term, ward call is basically a job where the on-call doctor is called upon to respond to all medical needs that may arise in the hospital when all the day doctors have left for home. The call can range from anything trivial (eg writing medication chart), to life-threatening emergencies (eg heart attack or pulmonary embolism).

Typically when i think of ward call, i have shivers down my spine because of the unpredictable nature of it. I remembered the first call i ever received was to see a mental health patient who was spiking temperature, aggressive in a semi-comatose way, and he had a needle found in his groin (he is a drug-addict). Was it drug intoxication? Was it sepsis (infection in the blood stream)?  Was it drug-induced psychosis? Those were my thoughts as i traipsed to the mental health ward.

Notwithstanding the fact that i had great difficulty getting a cannula into his vein (drug addicts have notoriously difficult veins because of all the times they have stabbed themselves), i also had no idea how to deal with someone extremely un-cooperative who has the potential to do harm to us if he is tipped off the wrong way.

That was indeed my cruel introduction to ward call.

Things did improve along the way. Slowly i learned how to deal with the common problems in the hospital, and to be a detective to investigate why is this person sick or presenting in this way at this point in time. Because this is the first time we are seeing the patients, we have no idea what they came to the hospital with, the past medical history, the progress in the hospital, the medications they are on etc. I would look thru past notes, pull up the lab results, glance thru their medication chart and vital signs etc, with the hope that i might be able to find out the reason for his or her current problem.

Thankfully, most of the jobs that came after this horrendous mental health call were trivial stuff. Later on, i was told that that mental heath call was more of a rare case rather than a norm. Ward call doctors usually go thru most nights without any major difficulty.

Whilst i hope this would be the case for tonight, at the same time i am looking forward to some challenge. I think immersing ourselves in difficult situations is the best way to learn. Yes knowledge plays an important role during this period, and all doctors should always be doing some form of reading up, but to be able to apply the knowledge when one is placed in a highly stressful environment is the quality that distinguishes ordinary doctors from extraordinary doctors.

In South Africa