Medical mayhem: Our reporter's 24-hour shift at a Joburg hospital

Intern doctors are expected to work 26-hour shifts. Sunday Times reporter Shanthini Naidoo joined them on one — and left broken.

29 January 2017 - 00:00 By Shanthini Naidoo
Dr Kartik Naidoo - who has worked many hours without much rest - recalls walking 35km on a shift, stopping only for water at 10pm.
Dr Kartik Naidoo - who has worked many hours without much rest - recalls walking 35km on a shift, stopping only for water at 10pm.
Image: Shanthini Naidoo

Months after requesting  permission to join a group of junior doctors on a 24-hour call shift, I received an approval letter from Susan Jordaan, CEO of Rahima Moosa Mother & Child Hospital in Coronationville, Johannesburg, in mid-December. “Permission granted for a call shift at the neonatal unit, but without a photographer.”

DIARY

Mid-morning Saturday, December 10. 
A WhatsApp message from my allocated doctor reads: “Be cautious where you park, or Uber. Someone was shot over a parking space a few minutes ago, a man was bringing lunch to his wife, who is in labour.”

10am
I meet Dr Kartik Naidoo and fellow intern Jessica Wynburg*. This is their second year in medicine, they are in charge of the neonatal unit, overseen by a registrar who has five years experience and  is also managing the admissions ward with another intern.

Naidoo and his partner are sweaty, tired and pale. On call since 7am, they are fresh from simultaneously resuscitating two premature babies. 

One is infected with a superbug bacteria and was responding well to antibiotics for the last two months, but  started deteriorating  today. 

11am
We have all not rested well the night before. My nerves. Their regular, pre-call jitters.

We plan the day while they are busy with paperwork related to “the cases” or the 30-odd delicate lives of premature babies in their care. 

They are recording test results and sending blood samples for the tiny, tiny humans who are attached to all sorts of machinery to keep them warm, breathing and fed.  

12pm
The interns take me on ward rounds. We bump into the registrar, the most senior doctor on the day, who is overseeing the neonatal intensive care unit. 

She would have completed her two-year internship followed by community service, and two years of working and studying before graduating as a paediatrician. 

Then, she could get off-site consultation rights. 

Naidoo is to graduate to community service this year. 

The registrar  has been on shift for 12 hours and shows no signs of slowing down. Between the admissions ward and attending to 35 babies in the  neonatal intensive care unit, she doesn’t have time to stop. The interns and a team of nurses are her support staff. 

1pm-3pm
Ward rounds are quieter than usual. It has been raining, so there aren’t too many admissions  —  bad weather minimises non-emergencies. 

There are 35 incubators, but up to 70 babies are housed here on most days.  

The doctors check how well the babies are being oxygenated, if their gas readings are correct. Any unnoticed fluctuation can lead to brain damage. 

One prepares to assist the registrar with a lumbar puncture. Then they calculate feeds by weight. One wrong move can lead to  a fatal error, so they train their hands to be precise. At this time of the afternoon, they aren’t shaking from fatigue or hunger. That will come. 

“Once during surgery, I fell asleep standing up. I dreamt I was driving a racing car. When I woke up I was pouring water into an abdomen,” said Dr Naidoo. 

One of the wards at Rahima Moosa Mother & Child Hospital in Coronationville, Johannesburg.
One of the wards at Rahima Moosa Mother & Child Hospital in Coronationville, Johannesburg.
Image: Shanthini Naidoo

6pm 
I have lost count of the hours and it is not dark yet. We have seen more and more babies on ventilators and  in incubators. 

Some cry incessantly, like baby Wood, who is possibly hungry from the manner he puts his minute hand to his mouth (my non-medical, maternal opinion).

The nurses and doctors don’t seem to hear him. He has been fed, and he won’t get a top-up until scheduled feeding time. The doctors have to move on. They walk, walk and  walk. While nursing staff get scheduled hours, lunch and tea breaks, the doctors do not.

7.20pm
The baby who was resuscitated earlier is in distress. In his small, three-walled “isolation room” they try to resuscitate again, using four fingers to pump the baby’s  underdeveloped ribcage. 

This does not work, he has lost his fight. They discuss phoning his parents.  

8pm
The team pauses for a supper break, a rare occurrence. Most days, they might have a break to chug some water or eat an energy bar. 

8.30pm
I wonder out loud why the babies have funny hairstyles. 

They say it is from shaving their heads to get to veins for drips... Sometimes the arm veins are too small, or they collapse. 

Once during surgery, I fell asleep standing up. I dreamt I was driving a racing car. When I woke up I was pouring water into an abdomen
Dr Naidoo

9pm 
I don’t have the energy to walk anymore and wait in the small tea room as they are called to place a drip, something nurses would do in private care but here it is the interns’ task. 

It can take a minute or 45 minutes, depending on how steady their hands and eyes are. 

The tea room is clean but not tidy. It is basic, with a rickety small  table and mismatched chairs. It is equipped with a sink, kettle, microwave and a small fridge. There is also an empty water cooler and a pile of yellowing papers  stacked against a wall. 

This is an ironic space  for those tasked with saving lives, who are apparently esteemed members of the community. There is a reminder on the wall, next to consultants numbers, to pay for tea services.

9.20pm
They return, taking a few minutes to coo over a child with bright orange hair who was born today and to ponder whether they should disturb the consultant this late about a large facial abscess on a one year old. 

More paperwork, notes and readings — tomorrow a new team will take over. They don’t become accustomed to anyone, or anything. Internship means a few months in each medical unit, working trustingly with strangers.

9.45pm 
A nurse interrupts to say two mothers in labour are going into surgery. There are signs of foetal distress. The interns must scrub up.

10pm
I join the team in a state-of-the-art surgical theatre.

It feels like a day has passed and I am bleary eyed, the harsh surgery lights are making me twitch. 

The surgical interns prepare for a caesarian.

Nurses and assistants in green surround the table, the anaesthesiologist does his job, then watches a video on a tablet. 

It feels like a day has passed and I am bleary eyed, the harsh surgery lights are making me twitch. 

The neonatal interns must check the baby’s vitals. We watch as the c-section goes smoothly. 

They may be junior doctors but they are skilled and adept — they deliver. 

This baby is huge, I think. Actually, no, just normal-sized compared to the minute ones in neonates.

11.30pm
Meet, discuss, do ward rounds. The registrar is writing up her patient files and talks about time, not having babies of her own, moving to Gauteng from the Cape. How her life plan changed because of her work schedule. 

People don’t get it... friends and partners. Time to have babies and settle down? She barely has time to scarf down a date ball. 

They work five calls a month in addition to regular 12-hour days. They don’t seem to recover. “I always say I will shower and then have a regular Sunday, but that never happens. Your body just crashes.” 

Perhaps this is why doctors are on treatment for drug and alcohol abuse in both the private and the  public sector.

12.30am 
On a breather, it is quiet in the wards, the sisters turn off the lights and are napping in chairs at their station.

The interns discuss what it’s like to be a doctor and concern for the lives they hold in their hands.

“In stressful situations, you make mistakes. Things take longer because you are tired, you triple-check everything. Poor babies getting dripped might be jabbed more than they should.” They talk about miscalculating medicines and feeds.

Luckily, nurses are aware of tired doctors and double check.  

The sleeping quarters at Rahima Moosa Mother & Child Hospital in Coronationville, Johannesburg.
The sleeping quarters at Rahima Moosa Mother & Child Hospital in Coronationville, Johannesburg.
Image: Shanthini Naidoo

1.30am
The doctors debate a power nap ahead of the 3am blood test rounds. 

2am 
I am crashing. The rest rooms are labelled according to the area of work. They are ancient wooden dorms, with water-stained ceilings, falling curtain rails.

There is a small sink to maintain some hygienic dignity. 

There is a deafening “woosh” sound that comes from a pipe outside every 15 minutes, but they have learnt to live with it.

2.17am 
I hear a pop sound. Then a few more.

Gunshots, from Westbury next door. There is a gang war. 

I assume the doctors are all resting, and walk to the bathroom. On the stairs, in the chilly night, I bump into Naidoo, who's in scrubs again. He was called to assist with an emergency c-section. There goes any chance of rest. He prepares  to take the blood samples. I won’t join him. 

3am
I can’t bear to be at the hospital any longer; it is chilly and disturbingly quiet at this time. 

5.30am
I’m up, as are the doctors who managed to rest.

6am
I find the doctors making coffee, they discuss the gunshots. The registrar shows us her room, which looks like a budget hotel room —  it has floral bedding, a beautiful shower and an en-suite loo. She did not get to use it other than take half an hour to freshen up.

They must wait for the consultant, who has reached hallowed ground, working from home when on call and office hours in between. 

They look  alright, but the dark, purple circles under their eyes are a giveaway. 

Some patients are angry that they have to wait to be discharged. There are “well” babies who must be discharged. If they’re lucky they will leave by 9am, latest  midday. That would be 30 hours for the registrar.

The rule is to sleep after a shift, but they will want to go home, driving at 80km/h in a worse state than a drunk driver. 

They all know of someone who has had an accident, if they haven’t been in one themselves. They surmise it is the release of adrenaline that kept them going the night before. 

They risk their lives  saving others. 

And tomorrow, they will do it again.

*Name has been changed

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