A different world: On call

We're out of oral flucloxacillin again - apparently it was a brief and glorious week of in-stock.  We're also out of cloxacillin and dicloxacillin.  A month ago, I don't think I even knew such drugs existed, let alone that you could sort of interchange them.  I know because I got called at 7:30 PM with this information.  "Are they already on Cipro?  Bactrim?  Oh, this is Surgery ward?  Call Dr. Taiye."  Jim told me not to take calls from D ward - that's Taiye's job, he's the resident.  It felt good, mostly because if you're already on Cipro, chloramphenicol, and Bactrim, then I don't know what else to substitute for flucloxacillin.

The ER nurse called me - baby with vomiting and diarrhea.  I gave him orders for IV, admission, and antibiotics.   Came up later on to see a woman with massive ascites from hepatorenal syndrome who'd just delivered a baby and had a hemoglobin of 6.  Nursing was concerned because she was short of breath, oh and, Doctor?  She refused to have any IV fluids.  Called Becky on that one, got Erin.  She approved of my plan A, which did not involve a paracentesis at 9pm.  Got hit with two more gastroenteritis babies and then a man who fainted after his wife's delivery (blood pressure 85/45, pulse 50, carried into ER).  I will note that the nurse told me to head on out, he could handle fainting.  They handle a lot of things here that in the States would require a physician.  It's quite nice.  I only get called when they need my specialized skills.  It took less getting used to than I would have thought; I know a lot of nurses back home who probably don't need me to tell them what to do 95% of the time, and I don't mind saying it.

Miriam requires Audio Adrenaline on the iPod now to go to sleep.  My little rock and roll baby.  She's been quite a handful at bedtimes these days, up and down a lot.  I think the different environment really gets to her.


Back over to B ward to see the lady with hepatorenal syndrome twice more last night - low blood pressures, worsening pain.  Wishing that there were a nephrologist or a GI doc or an ICU or something that I could punt to.  Finally, I called the lab guy in from home at 4 in the morning to give a unit of blood.  And they haven't called me back yet to tell me she died, so I guess it was the right thing to do.