First night on call

Ok, here is the story of my first call. Things to keep in mind, this is my first call here, I have to do everything in spanish, I am now the attending, which means it is all my responsibility (I have been the attending for OB patients before, but not for medicine patients). So I have several obstacles to overcome.
Call starts at 8 am. Nothing happened until 10 am. This guy comes in to the ER (we are the ER, there are no ER docs) sweating, dizzy, weak, hasn't eaten much in 2 days and his blood sugar is 22. Now, last week, he had a heart attack and was sent to our hospital in Quito for treatment. They told him he needs bypass surgery for his heart, but he has no money. So he is essentially a ticking time bomb, and now he is in my ER. So we treat his blood sugar, and get him under control. He is doing better. Then I get a 26 day old with fever, this one is straight forward, run some tests, give antibiotics, wait for the results. So, now it is lunch time and I decide to go out with a couple other ladies to a cafe 5 min walk from the hospital. I didn't take an umbrella with me for the first time since I got here. We just finished lunch and my friend gets a call on her cell phone looking for me at the exact time we hear the helicopter and it starts down pouring. So there are 2 patients in the helicopter, a guy with a snake bite and a lady in labor who they tell me has placenta previa and is bleeding (placenta previa is something that requires a c-section and if the pt is in labor, it becomes an emergency). So I get a plastic bag to put on my head and take off running to the hospital. When I get there, I find out she does not have placenta previa, but she is indeed in labor. This is her 6th child so it should not take that long, she is already 7 cm. So we start taking care of the snake bite guy. Snake bites is something I know nothing about so one of the other docs stayed and helped me (that was super nice of him). We thought this guy might have compartment syndrome (that is pressure in a specific part of an arm or leg that puts pressure on the blood vessels and nerves, after that you can have permanent damage to the extremity), if he indeed had compartment syndrome, he needed surgery but 2 problems, 1) the surgeon was in the OR doing surgery on someone else, 2) he got bit by a poisonous snake that causes your blood not to clot so if we cut him open, he could bleed to death. So I go in the OR, talk to the surgeon, we get his pain under control with morphine and I go to check the OB patient. She is fine, moving slowly, but now she is 8 cm. Then I get called to the ER again for a kid with burns all over him. I call in the surgeon and go look at the kid. Apparently the dad was putting a mixture of gasoline and diesel into a diesel lamp and it exploded yesterday. They had taken the kid to the free clinic and got some bandages, but nothing else. So now this kid is very dehydrated. The anesthesiologist came in and sedated him so we could clean him up. He had burns all over his face, his front, his back, his arms. This was the first time during this call that I almost started crying. We got him all taken care of and I went to check on the OB patient again. She is not doing anything, her contractions stink and she is stuck at 7 cm. While I am evaluating her, the nurse walks in the room and has a smile on her face. She tells me that MAF just called (those are the pilots that bring sick people in from the jungle), they have a child in serious condition. The nurse starts laughing because she knows that has been the day from hell so far. She says it sounds like pneumonia and many times when the pilots say something is serious, it is not. So, ok, she sent the ambulance to the air strip to get the child. I decide to start medicine on the pregnant lady to get her moving along. I go back to the ER as the ambulance arrives with the very sick kid. They were right, he was very serious. He was breathing about 75 times a minute, his oxygen saturation (which should be >93%) was 60%. It was very possible this kid was going to stop breathing. This was the 2nd time during this call that I almost started crying. So we called in the people to do an x-ray and the anesthesiologist (in case we needed to intubate him), gave him oxygen, medicine for his lungs, antibiotics for the pneumonia he had, steroids to help him breathe better. After an hour, the anesthesiologist still had not come, so I called him myself (then I found out they had never called him). Then I go to check the pregnant lady. The resident had just checked her 20 min prior and she was 7 cm. So I was going to check her again to see if she was doing anything, otherwise, we were going to do a c-section. I asked her how she was doing, she said she was the same, She got a contraction so I said I would check her after the contraction. She held her breath, so I decided to look under the sheet and there was the baby. Of course, this was my first delivery here, I don't know where anything is, and I am in the room alone with the door closed. So I finish delivering the baby, with one glove on, of course, then I open the door and yell for help. Everything turned out ok, and I learned another lesson, women here don't make any noise when they have babies, and they know they can do it without my help, so if I am not in the room, they don't care. We finished up with her and went back to the kid who was not breathing well. The anesthesiologist came in, got the ventilator ready in case, but we all decided he was doing a bit better and we would wait longer before intubating him. At this point it was only 8:30 pm. I could only imagine this keeping up all night long. But right now the ER was empty so I went home to eat, shower and relax some. I called the hospital at 10:30 pm, still nothing, so I went to bed. I slept all night (except the 4 or 5 times I woke up thinking I had slept through my phone) and got called at 7 am this morning for another delivery.

So even though the call sucked big time, I did sleep all night and everyone was still alive this morning. And the kid with pneumonia is still very sick, but is doing better. They have promised me that all my calls won't be like this one and it can only get better from here.