Yesterday at 9:00, I enter Puvi hospital
I start doing rounds on the department. It’s a quiet morning, i know the patients well.
I assess a few new patients during the afternoon.
I receive a call for the transfer of a young man in respiratory distress from a village. I accept the transfer but the plane is unavailable because a colleague of mine has to go rescue a baby in critical condition in another village. Prioritizing is something we must do all the time. So i wait for my patient. After finishing everything at work i go home at 18:30. I make myself dinner. I get a call at 19:45 to assess a psychiatric patient in distress. I come back home at 21:30. I get another phone call at 23:15 and i go back to assess a patient with abdominal pain. When i leave the hospital around 0:15 i tell the security guard, see you later. He smiles. I have no news of the patient in respiratory distress but i know he will arrive during the night. So i try to go to bed but how do i find sleep when i know someone in critical condition is waiting for transport somewhere in a remote village of the great north? After much turning in my bed, when sleep finally comes, the phone rings again 2:00, another abdominal pain. Take a deep breath… patience is inversely proportional to lack of sleep. When one is conscious of this, one can keep his calm, most of the time. This case is resolved by phone. Ok, let’s try again to sleep… shiit! my mind is in active mode, it’s trying to predict every possible outcome i will face with my upcoming patient… breathe in, breathe out… after much turning in my bed, when sleep finally comes, the phone rings again. It’s 5:15 he is here. Run to the hospital. A critical patient with shortness of breath, i assess his condition, find and confirm the right diagnosis, administer the right treatment, stabilize him, organize transfer and wait for another plane to pick him up. By the time i am done, it’s time for breakfast. I eat quickly and i run to my bed to catch an hour of sleep before the day starts again. I get 3 other phone calls just with enough time between them that i don’t fall asleep. Doctors and head nurse in intensive care in Montreal want an update on my patient’s condition. I understand their need and i talk with them. I get up at 9:15 late for the morning meeting. Four of my patients need to be reassessed before lunch time so they can return to their village if i authorize their discharge. So i might as well see them. By the time i am finished, more things come up and i just can’t say no. I leave the hospital at 12h00 for a well deserved 2 hour nap.
I go back to reassess my patient who is waiting for his transfer to Montreal. I work on a few things for the rest of the day.
It’s 17:30, i just handed out the phone, someone else’s turn to be on call.
These last 32h, i might have gotten 4 hours of interrupted sleep.
I have so much respect and admiration for the local doctors. I am just here for a week. They follow this crazy call schedule every second or third day, every week, all year. The big challenge we face is how do we give competent care when the system is supported by obligatory sleep deprivation and self-sacrifice?
I feel we should offer more support and more resources to our local doctors working in remote areas of our province. Plane and truck drivers have laws that enforce the obligation to rest after a certain number of hours. Doctors and nurses don’t drive or fly, they care about people lives at every moment….
There are extraordinary compassionate and competent individuals here but there is a reason why most of them are under 35… Nobody survives more than a decade under such pressure…
Original post Facebook, October 2018
Martin Pham Dinh 