On Call
The time is 22h41 on Friday 16 January 2026. I am writing this from my quaint little abode in Hilton KwaZulu-Natal, trying to wind down before the cycle begins again tomorrow morning.
During a very complicated tutorial on how to set up the call rosters for the different rotations we were forewarned:
"You’re gonna be on call all the time for the rest of your lives." - Tom Jessop.
It felt like hyperbole then, but now it feels almost as fundamental as the first law of thermodynamics. Day bleeds into night and night into day and still you must work, taking patients' blood, giving patients blood, analysing the blood chemistry, objectively measuring the volume of blood loss at delivery, and arbitrarily assigning a volume of blood loss at Caesarean section. It's on my Dr Martens, and on my tourniquets, and on my gloved hands, and on the floor, and on the beds - Obstetrics and Gynaecology really is a bloody discipline.
After my first call, a full twenty-four-hour shift starting at 08h00 on Saturday, the third of January, I came home and collapsed. My dad visited me a couple of times during that first week and remarked that I looked a little bit shell shocked. It was a funny observation, but not inaccurate. The transition from student to doctor, from the amateur in training, to the young professional (admittedly still in training) thrown into the depths with an abstract knowledge of how to swim is not to be taken lightly. There is no gentle passage into the cold water; and the stunning sphenopalatine neuralgia is inevitable. I am very grateful at least for my training at Stellenbosch; the stereotype of us having relatively sound clinical and procedural skills, even if we lack the academic prowess and woke ethical nous of some of our counterparts, seems to be at least half true.
Amidst the hyperintense state of arousal and concentration in the operating theatre, and the gruelling monotony of seeing the entirety of the postnatal ward (neonatal total serum bilirubins are the bane of my existence), I have been most moved by the strange and jarring details of the administration of life and death.My first certification of death happened at 03h00. A young woman, middle-aged technically, but she looked young. Cancer of the cervix. I listened for the heartbeat for a full fifteen seconds. Silence. Her pupils were fixed and dilated; absent doll's eye reflex. By the time I arrived, she wasn't in quite in the state of rigor mortis yet, but she was stiff enough that it was a physical struggle to manoeuvre her arms to take the fingerprints required for the South African death notification form.
A 'natural' cause of death, but a profoundly unnatural experience to certify. At the end of it all, life boils down to a series of check-boxes? Name, Surname, ID number, smoking status, marital status, education level et cetera. Cause of death: fluid overload, renal failure, carcinoma of the cervix.
In the labour ward, there is no silence. The sound of continuous CTGs and the bleeping of monitors is so incessant that I hear them now, in the tranquil foggy night. It is delivery after delivery. A postpartum haemorrhage requiring a difficult resuscitation; a woman arriving unbooked and fully dilated in heart failure; the sheer, relentless volume of human biology requiring intervention.
At 04h00, about when the sky starts lightening with the onset of civil dawn, we trudged to the post natal to begin the morning ward round which was to take four hours. I was a little bit delirious, but having prescribed an antipsychotic, a benzodiazepine and soft restraints to a patient with post-partum psychosis, I was at least glad that I am not psychotic. At least not yet. What a strange and messy job.
Between the calls, I have tried to maintain some semblance of a life. I ran the Hilton Harriers half marathon last Sunday, which was a bit of a disaster of logistics and performance. I arrived late, forgot my license, and the altitude punished me. I conked at the 10km mark and struggled to the finish. On Tuesday, I played football with some other interns. To be honest I expected a gentle kick-around for about forty-five minutes; we played for ninety minutes and it was competitive. This exertion, in combination with a 24-hour shift the following day is probably the reason my liver enzymes and bilirubin were slightly raised on my occupational health visit .
I am most haunted by the case of a patient I saw awaiting induction of labour for intrauterine fetal growth restriction. She had undergone quite extensive investigation over the past three months for extrapulmonary tuberculosis due to a large neck mass. Communication was difficult, but she had ear pain. Referred otalgia is a sinister sign. I looked in her mouth and the cause was immediately clear: a large tongue tumour growing from the base of the tongue into the neck. That was the cause of the growth restriction and the raised ESR. We had been looking for the wrong Consumption. Will her child be healthy? How long will she be able to look after her child? Is she operable? How disfiguring will the surgery be? I will probably never know the answers to these questions. There is such a high turnover of patients, it is difficult to follow the clinical course of patients when not actively involved in their management.
I am working again tomorrow. I must once again don the scrubs, cut open abdomens, deliver babies, and interpret the arbitrary guidelines of the CTG. I don't think we are paid enough for this. But hey lots of people don't have jobs, and perhaps, in the chaos, I am making a very small difference.
P.S. 17.01.2026
Close call this morning.
I left Hilton on route to work in clear weather, but within two kilometres, the highway was swallowed by mist. I was in the middle lane, keeping a safe distance behind a white bakkie that was pushing the speed limit a bit too much for the visibility. We came around a bend to find the road blocked; two trucks and a grey VW Polo had stopped dead. The bakkie slammed into the back of the Polo, smashing its rear windscreen. I managed to stop in time, and put my hazards on. Then the impact came from behind; a silver Toyota Hilux ploughing into my back passenger door.
It was quite a pile-up. Remarkably, I was unscathed. The driver of the Hilux suggested we meet 1.5 kilometres down the road at the arrestor bed rather than waiting to be crushed by the next car coming through the fog. Before leaving, I got out to check on the car ahead; a mother and baby were inside. Fortunately they seemed to be physically okay. My car sustained some damage, but it was driveable. So I continued to the arrestor bed, exchanged details, and then, because I was on duty, I carried on to work.
I admit, my hands were a bit shaky putting in the first few of drips this morning. It’s not an ideal weekend; working both days and now facing the admin of insurance claims and police reports. But today I feel lucky to be alive.