Internist diary

It's a rather slow Monday morning. One of those you keep glancing at you watch, fidget on your phone compounded by yawning. I have been through a  busy 60 hour weekend call and I only got  to lay my head down for 15 minutes. I'm unproductive and highly irritable ,asking myself severally why internship had to be baptism by fire. Amidst my efforts to convince myself  I was still strong enough to take in some more  ,I remember I needed to prepare a theatre  list. It's our clinic day, and as usual patients are already lined up waiting patiently. It's only 7:49 am. I cursed between my breaths.My stomach is now rumbling. In the last 48 hours, I haven't had time to sit and eat well. I have been surviving on bread and soda, once in a while diversifying on the soda. While I'm still lost in my thoughts, two calls come for emergency reviews. Lately I have grown my hate for the phrase 'Daktari patient has changed condition and complicated, kuja review '.What is to change condition and complicate?. First of all this is a 92 year old with, hypertension, Dmr, heart failure  and COPD. If you know you know. Nimeachia hapo. The next patient is an acute intestinal obstruction. I get to the ward to find the  'complicating patient ' ,lying on bed just as they were admitted. She looks anxious, dehydrated and in pain.  Asking why the patient is not on fluids just broke my heart. 'Doc patient hana line? '.Did I mention I was already irritable? I didn't speak. I get an iv access, that took me close to 30 minutes. What else can you do when your veins are collapsed. I get in an NGT, catheter, take samples for  urgent lab works and request the nurse to put up fluids for her. I need to  get to the lab and get the results back before calling my seniors . Seniors are only called  when the  patient is  thirteen seconds from anaesthesia administration. It's 10:15 am I pass by theatre to let them know the emergency patient is  coming in. The theatre nurse asks  how it takes you  one hour to get the patient in theatre. To cut the long story short, the patient is finally in theatre at 10:40 am. At  11 am, I'm scrubbed in , on the left to be precise, armed with a retractor and  suction.once the abdomen is opened ,percussion begins. The surgeon points at structures drowned in blood and the famous question begins, 'what artery is this '.First of all my mind feels like it is under siege. I'm struggling to remember if oesophagus is the windpipe or vice versa. 4 hours later we are done  .Patients are still waiting for us in the clinic. It's 3:30pm ,I conclude  what doesn't kill you makes you stronger. Tomorrow is another day, we will live to fight again. At 6pm clinic is done and just as we are closing, an emergency is rushed in. It is an osteosarcoma of the skull. Bleeding profusely with maggots in and out of the skull.. I must admit I had never seen anything like it. I'm scared, the patient is calm, perhaps he is gotten used to this. This is my first time seeing maggots. You have to figure out how to have everything in control .It is called internshit.