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inmed · 7 years

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Obsgyn Hell in Pati

Would you fly in an airplane if you were told the pilots have been forced to work 32 hour non-stop shifts? No. You wouldn’t. Even a child can tell you that we need 8 hours of sleep in every 24 hour period. Common sense: skipping sleep immediately becomes evident as the senses dull, memory gets hazy, mood gets irritable, and decision-making ability goes down the hole. Do these symptoms sound familiar? Yeah, the same thing happens to people drunk on alcohol. A sleep-deprived pilot is no better than a drunk pilot. And nobody will be at ease in an airplane knowing the guy in the cockpit is drunk or sleep-deprived.

If we wouldn’t trust a sleep-deprived pilot, why do we trust sleep-deprived doctors? We can’t blame the passengers and we can’t blame the patients. They probably have no clue and they blindly place their trust in the hands of the professionals.

Sadly, the people who made the decisions to have doctors work 32-hour shifts are doctors themselves: the experts of human physiology! These are the very same professionals who prescribe rest more than any other medicine! Isn’t that ironic and amazingly stupid?

Well, whoever that decided that koas have to pull 32-hour shifts must have the IQ of a ping-pong ball who has failed at understanding the most basic physiological aspect of humans other than the need to breathe: the need to sleep. Not only should this person be stripped of their medical license, they should also be jailed for putting patient’s lives at risk. If I was the chief of an airline company and I demanded that my pilots shall work 32-hour shifts without sleep, and people found out: I would deserve to be jailed. Why should this practice be accepted in the hospital?

Okay, now that I’ve made my four paragraph preamble to set the mood for what’s to come, let me start my diary-like blog entry:

Obsgyn is my first big station. I had Forensic before this. Forensic was basically a load of paperwork and waiting 24/7 for the inevitable: a dead body in the hospital requiring an autopsy ASAP so the family can bury it in the morning. So even though there were just around 10 autopsies during the four week period, the constant stress was irritating: sleeping with the ringtone volume on max. There’s not much else to say about Forensics: it was stinky, we didn’t do much other than get strained wrists from writing endless reports.

Ok, back to Obsgyn. It is 10 weeks long. That’s two and a half times as long as a small department (such as ENT, Neurology, Forensics, etc.) The first couple of weeks we were in Sardjito. The following three weeks were spent in RSUD Sleman, my favorite hospital so far. Those three weeks were alright despite the 32-hour shifts thanks to the many opportunities to sleep in the comfortable koas room or just quietly escape the hospital. Still, 32 hours are 32 hours and it is absolutely exhausting. I would say “daily” but a day only has 24 hours. Our 32 hour shifts were “daily” in the sense that when one ended (at around 2pm), we’d go home and then be back the very next morning at 6am for the next 32-hour shift. There is no such thing as “weekends” or “holidays”. Let me give you a run-down of what one shift looks like:

5 am: wake up. shower. call a GoCar by 5:30. 6 am: arrive at RSUD Sleman. Go up to the 3rd floor where the Obsgyn stuff is. Start going through all the patient’s medical records in both the ward and the “VK” (birthing room) and noting down the “SOAP” along with some other important info in my notebook. 7 am: the doctor arrives for a “visit”. Basically a walk through the ward and VK to see all his patients for up to a couple minutes each. We scuttle behind him and try to mumble out the patient’s information that we jotted down earlier. The doctor ignores most of this and asks us simple questions about the patient: “when was the last time hemoglobin was checked? how much is it?” - and usually we wouldn’t know the answer. 8 am: the doctor sits at the nurse station to write stuff in the medical records and the koas stand there waiting for questions. These questions tend to be more about theory and are quite difficult. 9 am: the doctor goes to the poly-clinic. Two of the koas who started their shift the day before follow him. I remain in the ward with one other koas. 10 am: we chat with the nurses and midwives about random things. 11 am: we walk down to the cafeteria and eat something. I buy some bottles of water. 12 noon: we try to nap in the koas room. there are two beds and it’s airconditioned. 1 pm: unable to sleep, I walk into the VK. I notice two women in labor. I sit down at the mini nurse station there and start chatting with the midwives. 1:30 pm: the midwives order me to do “DJJ” (fetal heart rate monitor) on all the patients. Now there’s four suddenly. 2 pm: Finished with the DJJ, I sit back down only for the resident doctor to walk in and ask me to set up the USG and wheel the patient in. 3 pm: My koas partner wakes up and walks into the VK. We sit together with the midwives, talking. 4 pm: One patient seems to be going into the active phase. The midwife orders me to do more DJJ. We start wondering who will assist with the delivery. 5 pm: Another patient is brought in. Suddenly the VK is full. 6 pm: Hungry. The cafeteria is way past closed. What to eat? I start flipping through the GoFood options when suddenly I hear loud noises from behind one of the separator curtains in the VK. I peer in and see that the midwife is already in position to help the patient deliver the baby. She looks at me and asks if I’m going to join or not. Of course I say yes and put gloves and apron on. I feel useless because the midwife is capable of doing everything herself and I’m just standing there watching. 7 pm: The baby is out and I take my gloves off. The gloves never really touched the baby. Instead, I was left to pull the placenta out. Boring. It’s all boring. And I’m quite hungry by now. Back to GoFood options. We walk to the ward’s large nurse station and sit down there, chatting with the midwives. It gets boring quickly. 8 pm: Food is on the way still. And we walk back to the VK. The midwife there tells us that a woman had already delivered while we were absent. We act surprised at how quick it was. A new patient is wheeled in. “God damn it, why do women have to give birth so much?” is written all over my face. I get told to do DJJ and take blood pressure. The GoFood has arrived at the lobby. I run down to get it. 9 pm: We finish eating in the koas room. I waste time on my laptop and my partner sleeps again. I wish I was good at falling asleep, but I’m not. 11 pm: I put my laptop away. I walk to the VK. 12 midnight: another woman starts giving birth. 1 am: the same lady is still giving birth. We all keep glancing at the clock because we know that the baby is stuck. The resident is woken up. I’m drowsy and want to sleep but of course, I can’t. I’m watching the midwives and the resident doctor try to encourage the woman. They start discussing the medications given to the woman. 2 am: the resident finally gives up and decides he will operate for SC (cesarean section). I’m ordered to follow the resident. 3 am: the operation finally begins. I get to help out a bit by holding the suction and passing some instruments to the doctor. I don’t feel sleepy but the core of my bones feel sore. 4 am: the operation ends. the resident is annoyed it took so long. there was bleeding. Small chat with the resident ensues and we walk back to the VK. 5 am: I lay down on the bed in the koas room. Exhausted. 6 am: My alarm rings and I walk over to the ward to go through the medical records again. 7 am: the doctor arrives for a “visit”. I’m wearing the same clothes as I did the last time (yesterday) when he came. He’s wearing fresh new clothes, hair still wet from his shower. 8 am: the doctor asks questions. 9 am: the two of us follow the doctor to the poly-clinic where we do anamnesis and watch how the doctor handles each patient. What was a sort of dull headache becomes a full fledged one: I’m trying to figure out if it’s due to low blood sugar levels or dehydration or because I only got like an hour of sleep. 12 Noon: the patients finally finish. The nurse makes small talk for a bit. We then walk upstairs towards the koas room. The midwives there make more small talk. 1 pm: My GoCar arrives. I feel lucky that the poly-clinic ended earlier than I hoped. 10 minutes later I arrive at home. I finally shower, shave, brush, and then eat (my maid’s cooking). 2 pm: My head touches the pillow and I fall asleep. 9 pm: I wake up. Most restaurants are closed. I can’t go out at this point. I guess I have to call GoFood again to order something from somewhere that’s open late. 10 pm: I eat and then wonder what to do. I can’t sleep again because I just woke up. I try to work on the PowerPoint to present for my Refkas (case reflection) tomorrow. 2 am: I fall asleep anyways. 5 am: Wake up. And the whole process repeats again.

So, this happened for a total of three weeks in RSUD Sleman. Then, about two weeks ago, I was sent here to RSUD Pati for a total of four weeks. The shift is the same length but the content of the shift is different. Here in Pati, we can’t just relax that much. We’re expected to do a lot more deliveries (by mostly ourselves), suturing episiotomies and ruptures, filling in medical records, doing loads of little tasks such as taking blood, installing IVs, installing IV pumps, and of course studying. After Pati, RSUD Sleman looks like a holiday.

It is midnight now. Tomorrow morning I have to be at the hospital for another day in hell. So I’m going to leave it there.

Hopefully I get time again to discuss Pati. It’s an interesting place with interesting hospital and I have a lot to say about it.

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