You wake up, disorientated, on the floor in the lounge, next to your phone.

Blearily you reached out for the phone, and answer its insistent call. Harsh, chirpy hold music plays, and then a nurse answers.

“Doctor, this is Labour ward”.

Communication is difficult – English is not her first language –  but the urgency in her voice is clear. There is a woman bleeding, and they are not sure why.

You end the call, and start casting around for clothes, a pen, a stethoscope. One moment, barely awake, the next, a clear focus, an adrenaline fueled calm.

Despite the need to get to the ward quickly –  women can lose literally litres of blood in minutes –  you frantically flick through your textbook of surgery, re-familiarising yourself with common causes and treatments. There’s no point in arriving in a flurry, but with no idea what to do.

Then you leave the house, walking with the same calm urgency, up the the hill. Not running, not walking; a purpose fuelled midnight march.

It only takes you 3 or 4 minutes, but that’s enough time to realise all the questions you need to answer:

  • What is her blood pressure?
  • Does she have good IV access?
  • Is there fluid running?
  • What was her haemoglobin before delivery?
  • Is the baby okay?
  • Is there a tear in the wall of the vagina?
  • How much blood has been lost so far?
  • Is the uterus well contracted?
  • Could there be a tear in the wall of the cervix?
  • Did the placenta deliver all in one piece, or could a piece still be inside?

All these (and more) need answers, all within the next few minutes. You’ve never done anything like this, but you are about to.

You’ve asked them to contact the other doctor to help: but you suspect they won’t have done it. So until help arrives, you are on your own…

I write this in the middle of my first night on call, here in Mseleni. My patient was fine, and the bleeding had slowed; I’m hoping the adrenaline soaked swabs will stop the bleeding, and I’ve asked the nurses to check for warning signs like more bleeding, or dropping blood pressure. The other doctor wasn’t called, but was very gracious when I rang him for advice (and woke him up).

It is exciting being on call, and terrifying, and nerve wracking, and tiring, and… exhilarating. Sure, rollercoasters, fast cars, jet skiing –  these might all be breathtaking, but none can compare to the satisfaction of lives being saved.

Every morning I am getting up and praying about purpose: Ridiculous as it is to say, but I think I need to accept that I already know what a big part of my purpose is.

I am a doctor.

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