Friday, October 17, 2008

In the still of the night...

i've been oncall pretty often here in Labuan. Yes, i have to admit that the 'physical workload' is much much less compared to my 'houseman' days. i do get more than 5 minutes sleep (so far) and my phone is not constantly ringing (most of the time). But the mental and emotional stress is way higher, only because the responsibility is so so much more.

To put it crudely, this time my decisions matter. They really matter. i've got no 'medical officer' above me to hide behind and take the heat for stuff anymore. i am fully responsible. And although my specialist is there (when their around) to be that overlooking guide... but on ground zero it's me that faces the brunt of the issues and problems and the (many a time) life-depending decisions that come with it.

Anyway, that's not what i want to highlight.

i've noticed... well, it may be a sweeping statement but i think most doctors would agree with me... that most problems happen when you're oncall.

Most patients somehow take a turn for the worse, or even die either late through the night or during the wee hours of the morning.

i've had patients that were in critical state to the point that there's no 'point' anymore to actively resuscitate the patient should the patient 'go'. And the patient will be in the ward all through the morning and right through the evening with not much change in their status only to breathe their last at 3 in the morning the next day (oncall hours).
And, i've had patient who were perfectly fine and recovering well all through the day... some times for days on end only to all of a sudden (almost out of the blue) develop complications one 'fine' night.

Patients seem to get upper gastrointestinal bleeds at night.

Miscarriages seem to come in at night.

Postpartum haemorrhages (bleeding after delivery) seem to always occur at night.

Accidents and motor vehicle collisions go without say.

in short, all the problems (well, most at least) seem to occur 'in the still of the night'.

Hmmmn... foreboding isn't it?

Makes you wonder if the devil (the Prince of Darkness) starts playing his tricks and having his way with those vulnerable all the more when it's 'his time'. When it's all dark? When it's the dead of night? (pun intended)


Well, just an observation i've made.

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