A life in the day of....

When starting medical school I had no idea what doctors actually did with their time, particularly junior ones. I think I imagined being in charge of my own ward and walking around making important diagnoses or something even further from the truth. I had no idea I would value my pen for filling in forms over my stethoscope or what a vital skill it would be to be able to un-jam the photocopier.

So what does a typical day in the isolation unit in Freetown look like at the moment? It begins with a check of the white board to see if there are any empty beds, with the number usually corresponding to the number of overnight deaths listed separately. Next is the clamour for results; all patients will have blood results pending which is often the rate limiting factor. No results mean no patient movement and an uneventful shift. Alternatively almost every patient may have a result. There is joy for the negatives who are cleaned, given new clothes and discharged with a certificate.  For positive patients it means an ambulance trip to a treatment centre which can be anything from 1 to 5 hours drive away. This can be terrifying for many who often start to pray wildly when given the news.

Empty beds must be thoroughly cleaned and linen changed before new admissions arrive. As I have said previously, selecting patients from the waiting area can be harrowing but sometimes there is relief when you can take everyone. New patients enter on foot, by wheelchair or on a stretcher. All need documentation, medication and a blood draw as well as information about how to stay safe on the ward.

Once this is all done there might be time to see each patient individually. I ask them about their symptoms as we can treat pain, nausea and anxiety quite easily. I also make sure they have a good supply of Oral Rehydration Solution and encourage them to drink, I often hear myself saying “drinking will save your life” which sounds dramatic but is probably true. If there is time I try to offer intra-venous fluids to some patients, these are carefully selected to be compliant and the most in need due to vomiting or profuse diarrhoea.

Deaths can occur at any time, there are usually 2-4 per day. Bodies need to be cleaned with chlorine and placed in labelled body bags that are cleaned again. The burial team come daily to collect the corpses for safe burial.

There are always meetings to attend and office work to do but the cycle repeats itself daily and I will be back checking the white board the next morning, once again looking for the empty spaces.