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Tuesday, December 22, 2009

Ode to a Torturer....

For six months I've been at the mercy of a relentless tyrannical torturer.

Yes, you Dr MB.

I arrived at this secondary hospital in July, expecting to belong to a team of caring superiors who would teach me medical secrets at every corner.

Instead you educated me in how to most annoy your colleagues, how to brew evil pranks involving patient's bodily fluids and gave me a daily lesson in torture.

And in the way a victim comes to expect and almost have an affinity for their abuse, and in the way that a cat tortures it's pray before it kills it, you killed me today when you left to go back to that cold country of yours.

I'm taking comfort in the fact that I at least managed some sort of revenge over the last few months, and for this I'm very grateful.

So here's my thanks:


•Thank you for helping me save lives...and thank you for reminding me, every day, all shift that you are a hero, have a superior intellect, are the best doctor in the universe and furthermore are generally the alpha male in all situations blah blah blah blah blah.


Thank you for not letting the psych patients injure me while trying to sedate them...like when you unintentionally/intentionally eye-gouged a poor mentally ill music professor who wanted to make me his woman and tried to capture me.
FURTHERMORE - thank you for injuring me in resus and leaving massive bruises on both my person and my ego thus injuring me irreparably for which I will probably require a few years of therapy to recover from...and then...thank you again... for referring me to the psych department on my birthday for the aforementioned therapy.

Thank you for being a walking textbook of medical knowledge...thanks for adding extra chapters to my textbooks including such gems as “Dr S's Discharge Eponymous Syndrome: very smelly vagina, 99.9% fatality” Nice. Very nice.


Thank you for looking after me when I was going through my HIV needlestick issues, thanks for then stealing my patient stickers and placing one in the logbook next to a diagnosis of: retained foreign body, ?sex toy!
Thanks also for thus inspiring my revenge, with your very own diagnosis of: ?Haemaphrodite. Vaginal Bleeding, Grade IV prolapsed rectum and dysmorphic buried penis. ( Never mess with Dr S!)

Thank you for inspiring us to eat healthily and snack only on things like lettuce and nuts...thank you for being nuts and shoving a steel bucket on my head with plaster of paris leftovers after we had a lovely chat in the POP room and then claiming that it was a beautiful home-made hat and canning yourself stupid when the sister came in and found me lying on the stretcher with the damn thing covering not only my head but also my face and shoulders so that it looked like I was being RESTRAINED by the bucket NOT adorned by it .

Thanks for dribbling water on my head while I was resting my weary head on the desk...thank you for then standing still long enough for me to deposit an entire coke bottle full of God knows what on your person and smacking you on the head with the thing when it was empty. (HA HA! I win!)

Thank you for making me coffee at the end of a long shift...and thank you for suspending me upside down and threatening to drop me on my head after I stole your coffee jar which was totally justified because you made me a prank cup consisting only of hot water and milk purely to piss me off.


Thank you for letting me hide peanuts in your shoes...thanks for still eating them when you found them and thus not wasting food. (Weirdo!)
And on the subject of peanuts, thanks for throwing them at me across the doctor’s desk and making a massive mess on the floor. Thanks also, for NOT helping me clean it up when the head sister shoved the broom in my hand and forced me to start sweeping under threat of bodily harm.


Thanks so much for being thoroughly evil and waiting until I was in resus with a smelly patient who had made a moerse foul smelling kak, and then locking me in the bloody room with her so that I could die a death by noxious fume asphyxiation while you looked on smiling and waving through the glass doors!!!!!

You're going to be terribly bored in the UK. You'd only done one chest drain in three years before you got here, and in the 14 months that you've been here you've done over a hundred...When you arrive in England, with three feet of snow to welcome you...I'm going to lie on our beautiful world-class beaches in the hot Summer's sun and think about you and laugh because I finally got the upper hand over you...

Not really.

I'll be sad.

I'll be teribly sad that my adopted sibling is gone and that there's no-one left to play with at work...

Saturday, December 12, 2009

Back pain and Triple A

At the entrance to the front room there is an old steel trolley that rules my life. On it lies the patient log book: The book of life and death. Every patient that requires our team's attention is recorded in this cruel master of the shift...

She is a terrible slave-driver, relentless in her ass-whipping...doling out her punishments with cruelty and wicked irony - throwing out the sucker punches of end-stage cancer/HIV/TB at one moment, and then blasting you with the shotgun shells of stabbed hearts, cracked skulls and eviscerated bowel post knifing. And then, right at the end of your twelve hours overnight, she cackles, and slaps you in the face with a flat, blue, not breathing baby that has just been delivered at home on the floor of the mother's kitchen.

Sometimes her torture is just slow and painful...like when she sends you the patient logged as "back pain".

Argh - the worst, the worst of the worst. What a vague awful random non-emergency type of complaint. Yes, there are life-threatening conditions that can present with back pain:ruptured abdominal aortic aneurysm, peptic ulcer disease, pancreas issues.

But mostly, it's the complaint of the the overweight or old and arthritic - and not exactly something I'm ever in the mood to deal with at three in the morning inbetween the heart attacks and incomplete abortions.

So what happens is that the back pain patient gets skipped over...and after sorting out one patient and approaching the book of life and death for my next beating, I purposefuly bypass the back pain for something I think is more worthy of my early morning attention. I know my colleagues are doing the same, and we are each secretly hoping that someone else will be the better doctor and go and sort that patient out, but are not willing to take the plunge ourselves.

We had exactly such a patient one day - and because she presented near the end of the shift she unfortunately was not seen by the time the handover round started. That morning, the consultant in charge of the handover was none other than the Godfather of medicine in the Western Cape, a legendary figure whose initials, Triple A,are both his nickname and the medical abbreviation for Abdominal Aortic Aneurysm...and he is just as deadly.

Triple A is renowned for his spot diagnosis and unparalleled clinical skill - having the uncanny and inspiring ability to diagnose a patient's condition from the end of the bed - sometimes by just looking at them, not even one question asked.

Not only is he an astute medical genius, but he is also a staunch atheist, a lover of incrediby rude jokes and also wholeheartedly committed to the poor patients accessing state health care.

The stories that circulate about him are the stuff of legend. One of them being that one morning on the hand-over ward round he developed chest pain, and went to lie down on the floor next to a plug on the wall.
When people asked him what was happening he replied that he was probably having a heart attack, and since the ECG machine was situated on the other side of the front room and that he knew there were no extension cords, he decided to lie next to a plug, thus could someone please go and fetch the damn thing and check him out. The poor intern did the honours, trembling all the while, not believing that he was bent over his grand master, and then exclaimed while reading the ECG that there were no classical ST elevatory changes to indicate a myocardial infarction.

Triple A, lying on the floor had a slug's-eye upside down view of the ECG and promptly exclaimed, "Fuck you, man, there's an R-wave in lead V1, I'm having an inferior infarction, get the streptokinase!". He then refused to be moved to another hospital, exclaiming that if he didn't have faith in his own place of work, then how could he expect his patients to do the same.

When we arrived at the bedside of the old, overweight lady with back pain, we presented her as an arthritis. But we might have been talking to the walls - Triple A wasn't listening. Ignoring us, he asked her to describe her pain, where it radiated to and what time she felt it during the day. That was all. And then he looked at us and proclaimed: "This woman has cancer of her pancreas". He hadn't laid a finger on her. We all balked. And there were mutterings that perhaps the senile dementia had finally got to him...But he insisted, she was sent for an ultrasound, and the report came back that there was a mass in her pancreas, most likely a malignancy.

We all felt like fools. Like shits. Like we knew nothing about anything worthwhile. Like we were mere amoebae in the presence of this medical guru.

Needless to say, I've changed my behaviour towards the back pain patient...and when the book of life and death throws that one at me, I'll accept the punishment gladly to try and atone for my previously wicked behaviour!

Wednesday, November 25, 2009

Retarded referrals (2): Surfer Doc

Matthew McConaughey is working as a doctor at one of the primary care centres that refer patients to our front room.


This pic is for the ladies...a quick little perv. opportunity before I carry on with the narrative.
Satisfied?
Ok, let's continue...


Seriously.
I'm convinced it's him.
And I'm convinced it's a specific type of him, the one from that totally self-indulgent movie, "Surfer, Dude!"

It's either the real him or a very good imposter.

He calls every few weeks with a telephonic referral reminiscent of a stoned surfer's philosophical conversation with his board than an actual medical referral.

Quote, unquote:

Telephone: "tring tring!"

Dr S: "________Casualty Unit, Good-evening, doctor speaking."

Surfer Doc:" Howsit, hey...Look here man...I've like, got this dude here...and like his hand, man, it's like totally fucked, dude!"

Dr S: "Um...What?"

Surfer Doc: "Ja it's like been stabbed, his hand, it's totally fucked hey! Can I send him through to you guys?"

Dr S: (trying to suppress the giggles and sound professional)" Well, I guess if his hand is that fucked then he most certainly needs to come through to us, dude!"

I had no freaking idea what was wrong with that patient, and accepted him purely on the basis that that the poor patient at least warranted an assessment by somebody who was not, like, totally fucked on marijuana!



P.S. Matt McConaughey: If it is you - Pop round to our casualty unit, preferrably topless. Give up this doctor gig you're trying out...it's not really your thing, thinking and all that. When you get here, don't bother talking, just pose. Flick your hair a little, and flex your muscles while flashing me a heart-stopping knee-quivering smile.Be a thing of beauty in this hell hole of a unit and give me a reason to rush to work every day!

Saturday, November 21, 2009

Macho man versus the Needle.

CHEST DRAINS!

SNORE!

I've done tons of them over the last three years.

Sticking in chest drains to relieve a pneumothorax/haemothorax post stabbing by knife/bicycle spoke/pen...Oh God I'm soooo bored by them now.

This procedure frightened the living bejeezus out of me as a student...yet three years post qualification I feel like I could do them in my sleep.

Yes, yes..ok...I know it's a pretty gruesome and barbaric procedure...slicing through skin, using blunt scissors to dissect through fat and muscle, and then popping the pleural cavity and shoving a big fat drain 23 cm around your lung while being careful enough not to puncture your heart.

But honestly - when you're guaranteed at least three every weekend shift...it gets pretty tedious.

Which is why I'm totally blah blah blahzaay about it.


Except that on one occasion it provided me with an amount of hilarity I'm not used to experiencing while slicing through someones chest.

A young 19 year old boy presented with a pneumothorax one busy Saturday evening in the front room. It was pretty obvious that he needed a chest drain. However, I had a feeling that this boy ( who was also high on tik at the time) was not going to be very co-operative. As we were operating with inadequate amounts of staff ( including porters, nurses, cleaners, security guards etc)I politely asked one of the ten family members if they would like to assist in positioning the patient properly during the procedure.

Of course, the taller than 6 foot, big burly older brother stepped forward, and in that "I'm in charge of this gig" manner announced that he would do it.

"Are you sure?" I enquired "It's a pretty gruesome procedure. Blood, guts, gore and all that - are you sure you can handle it?"

Not about to be shown up in front of his family, he informed me, in that quintessential South African way of expressing that everything would be cool, that things were...

"Hundreds, Doc, hundreds!"

Except, things were more like one hundred and twenties.... as in 120 seconds into the procedure, while my fingers were stuck inside his brother's chest, I found myself screaming for somebody to come and pick the dude up off the floor.

Have you ever seen anyone actually faint?

IT'S HILARIOUS!!!!!

I mean, it is also SO very dangerous as the patient could seriously injure their noggins, or c-spines, etc..

BUT! It's also nonsensically funny.

This is how the sequence of events went before macho man's head introduced itself to the floor:

1:A gentle degeneration of his conversation with me into a mere open mouthed and fixed stare

2:Soggy beads of sweat formed above his brow

3:Ominous swaying occurred reminiscent of a tree in the last stages of its felling...

4:Eyes rolled back into his head...

One last helpless gasp uttered and then...

TIMBER!!!

The man's head, along with his macho pride and ego, deposited themselves on the bloodstained floor of the unit with a comical thud.

He remained out for the count of about five seconds before hastily standing up and attempting to regain his composure.

While breathing heavily, and swallowing incessantly he attempted to explain, mostly to salvage his shattered ego, what had happened.

"Oh? Wow! SHU! Erm...you know, erm, doctor, I didn't eat anything today yet,erm.. and erm, I'm feeling like my sugar levels are low, you know...and erm, I think I should go and get something to eat because I'm not really feeling well hey, Ja it's because I didn't eat today you know, erm...ja...you know?"

Ja I DID know. You just fainted at the sight of blood my friend.

Viciously sinking my canines into my bottom lip was the only method I could think of to stop myself from enjoying a belly-aching cackle and embarrassing this poor man even further.

And so, sensing his acute mortification that he had totally inflated the strength of his consitution in front of a lady that looks more like an 18 year old girl than a doctor, I simply nodded and let him slink off to the tuckshop without "ROFL"-ing like I really wanted to.



I haven't conducted any formal studies, but the anecdotal evidence I've collected has shown me that the sex most frightened of medical proedures, and the ones needing the most reassurance are those patients in posession of testicles.

The real alpha male macho types who have perfected that "Big Dick" swagger, inevitably are the ones fainting and screaming like little girls when faced with a little needle or a dribble of blood!




Fainting in the face of an unpleasant experience ( ie watching a chest drain insertion):

Medical term: Syncope - brief and sudden loss of counsciousness

When faced with the sight of blood, syncope is the result of a non-cardiovascular cause, in particular due to autonomic nervous system problems.
The autonomic system is responsible for regulating heart rate, blood presure and response to fear, anxiety or emotional stress.

Vasovagal syncope typically occurs when a person is standing upright and experiences an unpleasant emotional or physical stimulus ( eg fear and anxiety at the sight of blood, or pain).

The autonomic system causes the heart to beat faster and stronger, and sends an incorrect message that the heart's ventricular chambers are full of blood.

Receptors in the heart then send a message to the nervous system saying that blood pressure is too high, when it is actually too low as the heart's chambers are NOT full.

The brain then recieves this faulty message and slows the heart rate and dilates the blood vessels, dropping the blood pressure even lower and thus pumping less blood to the brain...thereby increasing the risk of fainting!

Monday, November 9, 2009

Retarded Referrals (1)

The front room in this secondary level hospital sees patients referred from the surrounding local day hospitals, and private GP practices.

Nobody, unless presenting in an emergency is supposed to be seen in our unit without a referral letter from a doctor.

However, sometimes we get referrals from retards pretending to be doctors.

(Yes, I said it,you read it, RETARDS)

(The referral letter being a self-written testament to their idiocy.)

I'm not the sharpest tool in the shed.
I'm not even marginally clever.

But compared to these blunt brained buffoons, I'm like a freaking diamond cutting laser.

This is thus the start of what is sure to be a series of posts about retarded referrals:

If you please....


Dear Colleague,

Patient seems frought with worry! I can't seem to elucidate what's on his mind?
He complains much of genital issues/? crying?/He didn't want medicine and is asking for a chest X-ray. Please see if you can manage.

Thank you,
Dr Retarded.




First lesson in retarded doctor school:

Do not even ATTEMPT a diagnosis.

Worry?
Genitals?
X-ray?
WTF is going on?!?!?!

For god's sake man! How about taking a proper history instead of raping the man of 200 bucks and then palming him off to someone else to do a proper job. You cannot refer a patient just because they want an X-ray! Did you even examine the man's penis? Or listen to his chest? Or look him in the eye? CARE a little bit why don't you!

Lick your right elbow while trying to bite your left ear and repeat after me:

"I am a retard!"

Saving lives???

16 years old.

Intubated and ventilated by the doctors on the previous shift.

No beds available in the High Care Unit at the back of the hospital, so he was under our care in the front room for the night.

Not that there was much more we could do for him.

TB meningitis. Severe. Untreated. Currently brain dead.

Awaiting...?

Two huddled figures were standing next to him at the end of the bed.
Crying.
Mother. Father.

I had to, uncouthly, squeeze past them to run the blood sample in the blood gas machine situated in the corner.

I tried not to make eye contact as I apologised for my rudeness.


But the father looked straight at me and then...he called me, softly, by my first name.

Shocked, I looked up at him.

The horror of recognition flooded through my veins.

I knew this man.

He was one of the barmen at a restaurant I worked at during my student days.

We used to chat and joke with each other to pass the time. He was one of the people who christened me with my Xhosa name, Ncumisa.

It means "she who causes a smile".

This was not the time for smiling.

His son was busy dying in front of us.

I was suddenly frightened, fearful, embarrassed that there was nothing more I could offer.

I found myself shaking, and my voice quivering, when I explained gently to him that his son would probably die.

He responded by nodding silently and accepting unquestionably everything I said.

'Goddamit!" I thought. "Fight with me! Tell me that I don't know what I'm talking about! Kick me out and request someone else to tell you that your son is gone forever. I'm the fucking GRIM REAPER, bearer of the worst news possible, but you're treating me with the respect reserved for someone who gets to make life or death decisions."

Sometimes this job just sucks.

Saturday, November 7, 2009

Pregnant? The patient's guide to parenting.

How did it come to be that every time I mention I'm not feeling well, the knee-jerk reaction from friends and colleagues is that I MUST be "with child"?

Is it not a perfectly normal reaction to throw up a little bit in my mouth after I've witnessed runny mustard poo leaking down my patient's leg?

Is it not a perfectly normal physiological response to want to up-chuck the contents of my intestines after examining a most foul-smelling macerated cess-pool of pus that used to be a scrotum before Fournier's Gangrene got hold of it? (Scrot-rot - in layman's terms)

Apparently, according to the four ovary-less-hairy-testicled type of doctors I worked with yesterday morning, it is a clear indication of impending mommy-hood.

Yesterday, the day of constant nausea, I also had my blood drawn for HIV testing as I've now finished my course of ARV's. Happy to report, the test was negative.

YAY!

No more condoms necessary during sex with my long-suffering husband!

Yet, my aforementioned male colleagues were more interested in my obvious pregnancy.
Mastermind MB, of course, used my HIV testing as an opportunity to phone the lab and request a quantitative beta-HCG (formal pregnancy test) on my blood...just to make sure...soooooo funny.

But it got me thinking...

What if I WAS pregnant? I don't know anything about being a parent!

But then I rememembered...

Just take lessons from your patients Dr S!

Over the last two shifts these are the parenting lessons I've picked up:

1: When your twelve year old son gets thrown over a fence by some bigger boys, and tears open his scrotum on the barbed wire, bring him in to the hospital at night, and then leave him there all alone.
Let him open up a folder by himself.
Let him suffer the pain of having his ballsack sewn closed by himself.
Do not leave your cellphone number for the doctors to call you when he is repaired. Tell him to walk home, in the dark, through the most notorious ganglands in Cape Town, by himself.
He is a whole twelve years old after all.

(We ultimately called the police to take him home)



2:When your seventeen year old son's eighteenth birthday rolls around,just before matric final exams, do not remember it.
When he reminds you that it is his birthday, tell him you don't care.
When he asks you if he is not important to you, agree that he isn't.
When he tells you that he might as well then kill himself, encourage him to do it.
When he overdoses on 50mg of benzodiazepines in a desperate attempt for your love and is rushed in to the casualty unit by the paramedics, show him he is indeed not worthy of your love by not visiting him.

(He survived,thank heavens)


3:
Drive like an asshole and hit a twelve year old child. Don't bother stopping, even though the kid has flown halfway across the street and is lying on the road motionless. Oh no, what one does in this situation is put your foot on the accelerator and drive away as fast as possible, leaving the helpless child for dead.

(The paramedics who brought him in to be intubated on his way to the children's hospital told us that in a fantastic intervention by karma - the car's licence plate had been left on scene!)

I'm writing all of these lessons in my little book of things to do when I get pregnant.

(Which I'm not. Test turned out to be negative.)

Wednesday, November 4, 2009

PIGS AND PATIENTS

We arrived on shift at 4pm last night with twenty patients already waiting to be seen, and a constant stream of ambulances pulling up outside the trauma unit.

Yay!


Dr MB and I had still not recovered from this recent weekend of nights:
Friday, Saturday, and, Oh-my-God-shoot-me-in-the-head Sunday.

The reason Sunday night deserves adjectives is because our new Registrar, Dr KL, ALSO had a needlestick injury and unlike me was developing nasty side-effects to the ARV's. Knowing what it's like to be sick and at work, we sent the poor man home for some TLC from his wife.

HOwever, this meant that just MB and I were left to man the unit on a Sunday night, on Halloween weekend, on the end-of-the-month-I've-just-got-paid-and-will-thus-get-smashed-and-stab/shoot/beat-someone-close-to-me weekend.

40 severely injured patients later,and by the time the Monday morning ward round rolled around, we had both, understandibly lost our minds.

MB attempted to stay awake during the round by performing strange, sporadic,forward leg lunges .(Don't ask). I was so tired I did not know whether to cry or vomit, and so to prevent both, I focused on ridiculing MB enough to spur him into some sort of retaliation. This usually involves hair tugging, pinching or "reminders" about his superiority and general world dominance. Sometimes I respond with a witty comment. Sometimes my response is to stab his testicle with my pen. This is how we help each other stay awake. We literally fight to survive the long shifts.

Anyhow. That recent weekend of horror was the reason we were still exhausted when we returned to work for the Tuesday 4-midnight shift. As expected, it was insanely busy. Why wouldn't it be? And in the middle of the shift three policeman walked into the unit and informed me that they had brought a very violent and aggressive psych patient for admission. When I asked them where he was they said that they had left him in the van outside and that I should see him in the back of the van.

This already pissed me off. I weigh 52kg. I am not particularly strong or tall. These three policemen had biceps bigger than my waist. What in God's name did they expect ME to do with a very violent psych patient in the back of a police van? I demanded that they bring the patient into the unit where we could, with their help, immobilise him on a bed and thus facilitate proper sedation. They strode off sulkily, obviously not happy with being told what to do by a little lady doctor.

They returned with the violent young man in handcuffs who was complaining bitterly about being manhandled by the police, and shouting obscenities at everyone.

I took a deep breath and approached the patient. I noticed that he was bleeding from his leg.

"Oh you poor man!" I began in my sweet, soothing, comforting voice,while stroking his hand," You have been so badly hurt, how terrible. I'm sure you must be in a lot of pain, will you let me take a look at that and give you a nice injection to make it better?".

This is my sneak attack tactic when it comes to psych patients. They do not expect someone to be nice to them and are then usually caught completely off guard, and thus more amenable to cooperation. Destroy them with kindness. Being severely lacking in the brawn department, the only weapons I have at my disposal are my smooth tongue and powers of persuasion.

"Let's ask these nice policeman to uncuff you so you can lie on the stretcher comfortably, hey? What do you say?" He nodded his head obediantly. But the policeman refused.IDIOTS!!! Could they not see that I was busy working my magic here? Play the game with me you brain donors! I eventually managed to communicate non-verbally to the policemen that the cuffs need to come off so I could sedate him. Which I eventually did, with 20mg Valium and 10mg Haloperidol. The poor patient started swaying after 30 seconds at which time I informed the policemen that they needed to help me get him onto the bed properly in the next minute before he collapsed on the floor.

They jumped into action immediately by... staring at me with blank expressions. I caught the damn patient myself when he fell, and was assisted by the elderly aunty of a radiographer who happened to be walking by at that moment. The two of us struggled to pick the patient up off the floor and put him on the bed while the policemen played with each other's assholes.

Yes, I'm all for the empowerement of women, but why should that empowerment and chivalry be in competition?
Sometimes a girl just needs men to act like men.
Then again,how silly am I expecting those pigs to behave like men?

Like Bonnie Tyler said, in one of my favourite epic 80's rock songs:

"Where have all the good men gone
And where are all the gods?
Where’s the street-wise Hercules
To fight the rising odds?

Isn’t there a white knight upon a fiery steed?
Late at night I toss and I turn and I dream of what I need

I need a hero
I'm holding out for a hero 'till the end of the night
He's gotta be strong
And he's gotta be fast
And he's gotta be fresh from the fight

I need a hero
I’m holding out for a hero 'till the morning light
He’s gotta be sure
And it’s gotta be soon
And he’s gotta be larger than life
Larger than life!

Wednesday, October 28, 2009

THE C-WORD

The fingertips of my right hand have been trained, over the past few years to pick up subtle irregularities in the examination of a patient.

The sensory information gained from these soft pads of palpatory precision, communicate via amazing electro-chemical pathways along my nerves, to send a message of alarm or calm to that central processing unit in my skull.

As doctors, we usually begin our examinations by using these sensitive fingertips of ours to feel pulses.

It's probably the first thing one learns to examine. I remember practicing on my fellow students after our first clinical skills tutorial, and bragging about who had the lowest heart rate and could thus claim supreme athletic fitness.

Such a simple thing, feeling a pulse.

And yet, at it's most basic of functions, it is an ultimate determinate of life, or death.

Lub-dub, lub-dub.

A rhythmical, cyclical affirmation of life, beating a constant reminder into my fingertips that, "Yes doctor, I am alive, don't give up on me yet."

Except that this time, the pulse lied...



She was logged in the book as "???oesophogeal cancer???"

That question mark prefix:

Mostly an indication that the diagnosis is still being worked up.
Often a symbol of hope that our suspicions are unfounded.

I drew the curtains, armed with my cheery and hopeful, yet concerned bedside manner.
The one I've developed over the years to try and lessen the terrors of being in a state hospital and the threat of a disastrous diagnosis.

But I was no match for the enemy that confronted me.

I was physically shocked. My years of service have brought me face to face with the destructive forces of disease and trauma, yet I have never been this physically moved.

There it was.

Present.

I did not need to touch her to know what I instinctively felt.

Cancer.

I could hear it cackling at me, callously thrilled to have so viciously ravaged her body.

So confident in its permanence that it willingly revealed itself, showed its hand, tortured me with its unquestionable impending victory over her life.

She lay there, motionless, except for the slow sad movements of eyes sunk deep into the despairing depths of her skull.

In a defeated and very small voice I introduced myself to her.

She responded after a few seconds with only a painful exhalation.

Touching her made me shiver with horror.

Her skin, like old leather that has been trodden on and left outside to be battered by the rain and sun, was stretched unwillingly over her skeleton. I looked at it listlessly collecting in the hollow that used to be her abdomen, and watched it tiredly continuing on its journey over her chest - her nipples the only hint of the breasts that fed the three children huddled around her bedside.

Her arms and hands were like the branches of a dead tree...thin, dry, reaching hopelessly into space.

I knew then that I had no weapons against such an advanced and evil adversary.

I could feel her spine when palpating her abdomen.

I was sickened.

And before feeling it, I saw her abdominal aorta pulsating, valiantly carrying on the physiological fight, regardless of the inevitable surrender.

Why did this lady only present to us at such a late stage?

Because she is poor? Because she doesn't speak English?

Why did the initial slow deterioration of her life not warrant ear-splitting sirens summoning sympathy and support and treatment?!

But it was too late for all of that. The cancer had metastasised.

Any further medical intervention would have been cruel and inhumane, and would only prolonged her torturous demise into death.

I gently informed the family of the very poor prognosis, and let them know that she would most definitely stay in hospital for the night while we tried to find a placement home for terminal care.

When her husband left, he bent over the skeleton that used to be his wife and kissed her forehead. He then turned to me and placed an old washrag and a bar of soap in my hands.
"This is her washrag." he said. "I'm the one who washes her every day with this washrag. Can I leave it here? Will someone wash her while I am away?"

Choking back the tears all I could manage was a nod of the head.

I handed over the washrag to the nursing staff, and finished my shift, dejected.
By the time I arrived the next day, she was gone.

But what remained with me is cancer's destructive power and our frightening inability to conquer this terrifying disease.

Sunday, October 11, 2009

HIV, Will you get me? Not with the help of ARV's.

So I'm taking ARV's.

A.R.V's.

Sounds like the latest gas-guzzling 4X4 from Pajero.
Or some super-cool new street drug that with one hit can send you on a round trip through the milky way, with a stopover in Heaven and possible delays in Hell.

But, nope.

ARV's are way cooler than that.

They are anti-retroviral drugs!



They can prevent the contraction of HIV, when a doctor exposes herself to it while she is taking blood, very diligently and gently and with gloves on, from her HIV positive patient who moved during the procedure resulting in the bloody needle piercing her thumb.

No biggy.

This is only like the fourth freaking time this has happened to me.

The first time was when I was a fourth year medical student doing my paediatrics rotation. The poor paediatrics registrar was struggling to gain intravenous access on a very sick neonate with veins smaller than the cannula diameter. I was helping her hold the neonate still while she attempted the procedure for the 20th time. After failing, for the 20th time, and understandably frustrated, she threw the needle into the sharps bin. Except that it didn't make it into the yellow sharps container. Instead I watched, in slow motion, as it did a spectacular somersault through the air and embedded itself, rather painfully, in my thigh.

I was distraught, and upset and got loads of sympathy from family and friends.
I started the ARV's immediately and sweated through the ensuing 28 days, petrified of sero-converting to HIV, and ultimately testing HIV negative. Phew!

That was five years and three similar events ago.

This time I didn't even tell my colleagues until someone saw me squeezing out the blood from my wound. It was near the end of the afternoon shift and I was completely disinterested in myself and my patients. (horror)
But my concerned colleagues forced me to go and open up a hospital folder, have my blood taken and start the ARV's.

So now I'm taking them. twice a day.

These drugs are brilliant, but can result in nasty side effects such as:

Diarrhoea
Vomiting
Skin Rashes
Anaemia
Bone marrow Suppression
Pancreatitis
Depression
Hepatitis
Lactic Acidosis

YAY!

Luckily I have only suffered mild nausea and muscle pains thus far.

Oh, and I've also suffered at the hands of Dr MB's torturous pranks.

After behaving very sweetly, and drawing my blood very gently, and phoning the laboratory for my initial test results before starting the ARV's...he then stole one of my personal patient stickers from my file, and stuck it into the front room's patient log book along with this made up diagnosis for all to see:

Patient: Dr S

Working diagnosis: Retained foreign body, +/- ?sex toy??


Hilarious.

I eventually got my own back though with this entry into the logbook:

Patient: Dr MB

Working diagnosis: ?Haemaphrodite. Vaginal Bleeding, Grade IV prolapsed rectum and dysmorphic buried penis.

Overkill? Maybe.
But that's my style.
I'm ruthless with my retaliations.

I guess that's one way of making fun of a ridiculous situation.

With almost every second patient that we see being HIV positive, it's inevitable that one of us will be accidentally exposed to the virus while trying to treat patients.

It's so common that I don't think I've met one doctor who hasn't been on post-HIV-exposure prophylactic ARV's.

Which is why I keep reminding my husband that he could have married a prostitute, as both doctors and ladies of the night run the risk of contracting HIV from their professions.

Tuesday, October 6, 2009

Comedy Crusaders

Friday morning handover round.
08h00.
Our team ( The A-team) is handing over the numerous patients we've spent the last night seeing, to the new team coming on for the day.

Dr MB begins one of his patient presentations. The patient is curled up under one of the government issue blue hospital blankets in the fetal position.

Dr MB: "This patient is a 28 year old lady admitted at 06h00 this morning for strange behaviour. She was brought in by her colleagues for bizarre delusions. She believes that she is a doctor and that she is at the hospital to help people get better. She is not a known psychiatric patient but currently displays signs of mania, psychomotor agitation and formal thought disorder..."

The consultant leading the round, Dr G, then decided to wake the patient, and moved over to the head of the bed. She lifted the blue blanket to reveal....

MY very own pretty little face giggling hysterically from beneath the covers.

I was so dog-tired after our long shift that while the rest of my team were busy presenting and discussing another patient, and with no further patients of my own to present, I decided to climb into one of the empty patient beds and rest my weary head. It seemed like the appropriate thing to do at the time.

Which is when Dr MB and I came up with the idea of presenting me as a patient on the ward round.

Luckily Dr G was a young, newly qualified emergency medicine consultant with a sense of humour. She laughed heartily , and then shook her finger at me for being crazy enough to risk catching patient germs in aid of a little comedy...

She doesn't understand the lengths we are prepared to go to for a laugh in this place.

Doesn't she know that every shift is a war between patients and our sanity?

Nonsensical frivolity is sometimes the only defence against impending work induced depression and despair.

Our next practical joke will involve elaborate co-operation from the nursing staff and fellow colleagues. We are planning on bandaging up my head just before the new team arrive at 08h00 for the next handover, and then shocking them with the story that I had been stabbed in the head by a psych patient and had to have my lacerated scalp sutured up and then bandaged.

I think we'll be able to pull this one off.

I am 100 percent certain that the new team will actually fall for it.

After all, similar incidents have actually happened in the past.

Voltaire said that the purpose of the doctor is to entertain the patient as the disease takes its course.

Hopefully, as a defence mechanism against depression and like some kind of comedy crusade, we'll always be able to entertain each other while our shifts run their course.

:)

Friday, October 2, 2009

Friday night Folly

The following is an account of our end of the month friday night shift a few weeks ago. It's long. It has no structure. It might all seem a little pointless...

Which is pretty much a description of the evening itself:


My arrival at work is unfortunately not signalled by the large marching band, fireworks and a rip-roaring guitar solo played by a topless Greek God that I think I deserve.

Oh no...instead I am greeted with that age-old traditional greeting, peculiar to the lesser-incisor'ed native of the Cape Flats:
"Jou ma se poes!" (your mother's cunt!).

Seems that one of the psych patients has escaped from the front room, and is currently freaking out in the parking lot outside the unit, screaming obscenities at everyone. He is wearing a hospital blanket and shoes. As I walk past him into the unit, the security guards rush past me to try and capture him...but this one is a wily little bastard who immediately dropped the blanket, exposing his naked buttocks to the world and took off running like a man escaped from prison into the darkness...They might catch him, they might not.
Judging by the pendulous belly on the security guard, my money is on the patient.


I walk into the unit giggling...but this false sense of fun is soon arrested when I realise that there are no other doctors to be seen. Alarm bells start ringing when no-one is in the front room, it's a sign that they are somewhere else. And that somewhere else is usually in the resuscitation room, where there is probably some major shit going down.

I sheepishly shrink off to the tea-room to deposit my things, before braving the carnage I'm certain is waiting for me.

I'm not disappointed.

Dr MB and Dr Mommy are busy doing CPR on a morbidly obese lady in one corner.This happens in the resus room all the time. HOwever, what is peculiar about this is that they are performing this potentially lifesaving manoeuvre on the floor! Hospital is at capacity so no more stretchers available. Silly me to expect stretchers, in a fucking hospital.

What's that Department of Health? Oh, you don't give a shit? Tell me something I don't know.

Oposite them, Dr K and the surgeon are frantically trying to gain intravenous access on a patient. This man has been shot through his chest, possibly through his heart/aorta/lungs/trachea/oesophagus....blood pressure is dropping very quickly and things are looking pretty grave over there...

I notice the medical intern at the back of the room struggling to intubate one of his patients in severe respiratory distress...Looks like that's where I'm needed most, so I make my way over to help.

However, my efforts are thwarted by the head nurse who thrusts a fat folder into my hands and tells me that there is an old man having a heart attack in the waiting room. ARGH!

Sorry little intern...you're on your own.

As expected, the old man is of the Kentucky Fried Chicken-loving kind, and I can see the nicotine-stains on his teeth. According to his clinical symptoms and ECG he most definitely is having a heart attack.

By this time the resuscitation on the lady on the floor has been called off.
We couldn't save her and she couldn't save herself. Call the family. Break the bad news and move her out of there. My heart attack guy needs a bed in resus so that we can initiate treatment and try to save what's left of his myocardium, so that he can get to work on destroying that too .

As I wheel the old man into resus the gunshot wound patient is being wheeled out of resus to the trauma theatre...
He doesn't make the few metres to the operating table, and goes into cardiorespiratory arrest in transit.
All efforts to resuscitate him fail.
I wonder why he got shot? Was he the bad guy or the good guy? I suppose it doesn't really matter..

I stabilise Heart Attack Guy ( we speak about our patients in terms of their diseases, rarely bothering to learn their names) and hand him over to the medical team.

What a start to the shift! As I walk out of resus and back into the front room I am confronted with a warzone.

The front room looks like it has been the site of a recent explosion, people shouting, people wandering around aimlessly, people crying, people everywhere.

In five years time I am gong to have post-traumatic stress disorder and then I'm going to have Vietnam-war-like flashbacks to this moment.

I am immediately cornered by the staff from the ambulance vehicles who have brought us five patients involved in an MVA. Where in God's name are we going to put these people? As I wearily start accepting the patients I hear the door creak open to reveal the paramedics wheeling some more people in on stretchers.

Doesn't it ever end?

Despite the ambulances dropping off new patients, there are still about twenty unseen patients names in the book from the previous shift. Some of them have been here for more than six hours waiting to be seen. They are scattered all over the front room. standing, sitting, lying on the floor. There are no more stretchers available and the super-intendant is taking forever to close the hospital despite being at full capacity. I secretly want to curse the previous team for leaving us with so many to see, but I know that they were just as busy as we are and that I can't really blame them.

A little while later I hear a commotion in the corner, and look up as the police escort two violent psychiatric patients into our unit for assessment. While trying to wrestle them to the ground, the policemen are sending impatient looks our way as they wait for one of the three of us on for the night to sedate the patients so they can carry on with their jobs. I ignore them.

Almost immediately some traffic officers join the party and escort in three drunken drivers for blood alcohol testing. I most definitely ignore them.

Christ almighty I'm seriously hungry. Not sure when I'll get a chance to eat.
While contemplating how many patients could have been seen in the time it takes for me to eat supper, I notice an old demented granny using the dustbin to poo in.
After I shouting at her not to do so she stops, mid-poo and trundles back to her bed...dripping the rest of the interrupted evacuation in neat little puddles on the floor behind her.

I have suddenly lost my appetite.

Straight ahead lies an epileptic patient who is confused after having a seizure. He promptly whips out his penis to pee on the floor next to the bed. Some of it splashes on the escort of the patient lying next to him and a fight ensues between the escort and the confused epileptic.

Inhale. Exhale. Inhale. Exhale.

I try to comfort myself with the fact that I'm gaining invaluable experience tonight that I probably wouldn't have learned anywhere else.

What I'm actually learning from these patients is how to make the most of one's Friday night:

Get drunk, drive a car, crash and fracture your pelvis. Get drunk, walk through the ganglands alone at night, get stabbed multiple times. Get drunk, get high on tik, walk in the middle of the road and get hit by a car, fracturing you tibia in three places. The fact that you are too high and drunk to realise that your leg is moving in the most sickening paradoxical motion unintended by nature's design is a testament to the analegesic effects of beer. I can feel the pieces of your shattered tibia grinding against each other while applying the plaster of paris. I think I'm going to vomit.


And what about you lady? What lesson will I learn from you? I see that you are lying face down on the stretcher and you have decorated yourself with long curly braids, earrings, and a large knife handle protruding from your back. I assume that the blade is stuck somewhere in your chest cavity. Tell me, what style of knife handle is in fashion now? MUST get myself one of those for the summer.

Luckily for you, the knife gods divined that the blade should only penetrate superficially under your skin so I can proceed to cut the thing out of your back.

Cool! At last something fun to do!


And...oh...here we go right on time at 04h00 hours. It's the nightly on-call entertainment, performed by the resident nutjobs.

Settle in y'all ! Grab the popcorn! Tonight it's a gut-wrenching caterwauling ballad from psych patient number 6 of the evening. The verse is an ecclectic mix of beautiful arabic verse sporadically punctuated by "Julle vokken holnaaiers". (you fucking bumfuckers). The chorus consists of her screaming obscenities as we wrestled her to the ground to sedate her.

Furthemore her insane soliloquy is manifested by an interpretive movement piece performed by psych patient number 5.
He has been pacing around the big doctor's desk in the middle of the front room incessantly for the last half an hour.
Round and round and round on a mission to nowhere, wearing nothing but a hospital gown and a cool leather hat on his head.
It's impossible to stop him circling.
I dodge bumping into him for the nth time that evening, as I bend down to take blood from another patient (who is lying on the floor). As I do so,the flesh above the back of my jeans is unintentionally revealed. This sets the psych patient into a maniacal hypersalivatory state, resulting in him screaming at me to:

"sit jou hol weg. Maak toe jou hol! Dis MY hol, net ek kan jou holle sien!!!Die ander mans kan gaan kak!" (Put away your bum! Close up your bum! That's MY bum, only I can see your bum! The other men can go to hell!)

And that's when we rugby-tackled him, stapled a note that said "please abort" to his forehead and injected enough valium to send him straight back to his days as a fetus in the womb. Hopefully his mom would read the note and take our advice.

My sense of humour is nonexistent at this point and EVERYTHING is irritating me.

Even this poor 17 year girl who was depressed enough to try and take her own life by ingesting shampoo, hair gel, and toothpaste.

Even this 20 year old girl with multiple bruises after being beaten up by her boyfriend, and claiming that it was her fault she got hit.

Even the very frustrating fact that the nurses are only taking the temperatures of every second patient and not testing anybody's urine.

Speaking of urine - I should have gone to pee three hours ago.

But I'm NOT using the front room toilet. I don't care that I'll probably develop a urinary tract infection or an atonic bladder from keeping it in, but the last time I went in there, there was a delirious patient pissing all over the walls. And there was runny poo in the bowl.

The night is almost over anyway, I'll just keep it in until I get home and then burn a hole into the porcelain when I do eventually relieve myself.

Soon the new team arrives. I barely make it through the handover ward round, mumbling through my presentations of the numerous patients I don't remember that I've seen...I'm sure the consultant thinks I'm a retard.

Bleary-eyed and hypomanic from sleep deprivation, I stumble through my front door.
How did I get home? Did I drive? I can't remember.

While undressing I discover a huge blood stain on my sock. With no sign of injury to my foot I can only assume that the blood belonged to one of the trauma victims I saw last night.

What the FUUUUUUUCK!?!?!

What other bodily fluids have been deposited on my person that I don't know about?!?!

YUK!

I scrub myself raw with nuclear waste just to make sure I killed whatever was lurking on my skin.

I then collapse into bed like a boneless toneless fleshy lump. The most I can manage is to open my mouth while my husband feeds me breakfast...

I'm barely alive, but I survived the Friday night nastiness...

Only ten hours till I'm back for the Saturday night slaughter...

Friday, September 18, 2009

Going once! A hug! Starting the bidding at....

At 2am, in the middle of my night shift, I am not the most sympathetic of doctors.

I have to keep my emotions lean.

There is no inexhaustable supply of feeling at this time of the morning and I must preserve the little bit that's left for those times that patients and their families need extra special care.

I have to keep my mind keen.

I cannot waste brain power on repeating three times and in three different languages that your pathetic mosquito bites will not be treated at the emergency centre tonight. Go away. Stop sapping my brain power like a dementor out of Harry Potter.

I have to be mean.

I need my mean face to make sure the drunken assholes don't get out of control, and my triage skills have to be objective and ruthless enough to turf the patients whose issues can wait until the next morning.


However, all my patients will get one solid chance to prove to me that they deserve emergency treatment at this time of the evening.

Those that fail this test, do so because they are wasting my precious goddamn time.
You are WASTING my time and you are WASTING time that could be better spent on someone with real issues.

And those that make it past this initial test, well they get my everything.

EVERYTHING.

Some of them even get my neatly packed food and drink if they're hungry.
I can't tell you the number of times my patients have asked me for food because they haven't eaten in two days.
For fucking FOOD.
How can I blame you for defaulting on your TB meds and arriving at casualty with respiratory distress because you didn't have food to take your tablets with?

I don't feel particularly good when I go out of my way for patients in this manner.
One would expect to feel like a saint, or a good samaritan.
But I don't.
In fact I just feel livid.
It makes me want to stand in the middle of the front room and scream at whoever is responsible for this sick situation of poverty.

Yet sometimes, offering a non-medical type of comfort to a needy patient is actually the best kind of treatment I can offer at that moment.

For example, my 45 year old delirious patient from two nights ago.
I fell in love with him.
He was very well behaved, very trusting of the staff, but simultaneously slightly confused with alternating periods of lucidity.
This is a very rare occurrence in our casualty, confused patients who are well-behaved.
After being told to fuck off in numerous languages, how can one not love that?

Part of my work-up for his delirium included sending him for a chest x-ray.

I wheeled him to the X-ray department while listening to him talk gibberish and then deposited his confused self in front of the radiographer's desk.
As I turned to leave, he suddenly grabbed my hand, pulled me towards him and hugged my torso fiercely.

"Don't leave me alone here, Doctor!" He pleaded, "There's nobody else here. I must have people around me at all times or bad things happen!"

I thought of all the other patients waiting to be seen.

Then I looked at his eyes, wide open in terror like a child frightened of the bogeyman under the bed, and promptly forgot about the rest.

I sat quietly, with him hugging me for fifteen minutes as we waited for the radiographer. All the while casualty filled up behind me.
After a some time, suddenly unsure as to my commitment to his request, he pulled me closer to him and whispered frantically in my ear, "If you stay with me I will give you eight thousand rand. You are a good doctor. You can have my eight thousand rand if you stay with me."

Clearly this guy was not delirious, he was a freaking genius!

Eight thousand bucks for one of my hugs?

Now that's what I'm talking about!

The department of health barely gives me eight thousand bucks for my back-breaking overtime for the whole month!

This confused man, who probably had to scrape together the ten bucks to make it to hospital, highlighted his appreciation for the one thing we all crave so desperately, and which the poor get denied constantly; affirmation that one is worthy of love.

That said, I do give AMAZINGLY SUPER-AWESOME hugs.

It's no suprise that he was willing to pay thousands for some more of them.

My hugs are so awesome they will rock your world!

My hugs are so awesome they are like chicken soup.

My hugs are so awesome they motivate world peace, eradicate suffering and cure cancer...

Oh how I wish...

Wednesday, September 2, 2009

There are two kinds of people in this life...

Monday morning. 08h00 am.

Mondays come after weekends.

Weekends in the front room mean that we've had three days worth of collecting nutjob psycho's, sorry, I mean, "mental health care patients".

There are no mental health care physicians over the weekend so we can only refer them to the nutjob psycho's, sorry, I mean "psychiatrists", on Monday mornings.

This job usually falls into the hands of the most junior doctor.

Which would be me.

I like this job so much that I would rather remove my own pancreas with a combine harvester.

The handover Monday morning ward round progressed into the psychiatric holding area.

A young Indian lady patient proceeds to greet me in this manner:

"WHO ARE YOU?!!!"

I don't respond. I don't show any teeth. I make no sudden movements.

She goes on:

"ARE YOU A FUCKER? OR ARE YOU A LOCKER?"

I couldn't help but let my confusion show. Which one should I be?

Thankfully she made the decision for me.

"I KNOW! YOU'RE A FUCKER!"

I was not aware that those were the two types of people I could choose to personify.

I thanked her for making me a "fucker" and not, a "locker".




After all, as I could only interpret it, she was speaking metaphorically!

Thus, "Lockers" must ultimately get used by "Fuckers",
because "fuckers" get to put things INTO "lockers" !?!?!?!

WTF-"er"?!?!

The write way to kill your friend

Monday morning 10am: (No lies!)


I'm busy dissecting through the right side of my patient's chest wall with blunt dissecting scissors.

I have made sure that I'm working in the space between the fourth and fifth ribs on that side, and my fingers are hurting from the effort it takes to make it through the muscles into the space surrounding the lungs known as the pleural cavity.



I'm patiently waiting to hear that ultimately satisfying "POP!" as I breach the pleural space.

But this is taking longer than usual, and I'm getting irritated because the patient won't stop screaming and writhing around, despite the more than adequate local anaesthetic and analgesia I've given him.

I think he's behaving this way because he's dressed in a school uniform, and is fifteen years old.

I glance over at his blood-stained school rucksack on the floor next to him. For some reason I find this overused hand-me-down school bag very touching. It reminds me of my own schooling, and of just how much of a nerd I was. I really loved school.

Then again, unlike this dude, I was never scared of being stabbed by my classmate during class for using their eraser.

He was stabbed with a ballpoint pen on the right side of his chest, in a vicious enough way to puncture his pleural membranes and cause a pneumothorax collapsing his right lung.



Sorry kid.

You missed acquiring knowledge in first and second period.
But you've at least been educated, if somewhat ironically, in the lesson that the pen can sometimes be, as mighty as, the sword...

Sunday, August 23, 2009

Horror at the Hospital!

My application form to University read as follows:

Application to read for the degree of:
1st Choice: MBChB (Academia. Medicine. Doctors. Patients. Studious. Saving lives)
2nd Choice: BA Film and Media.(Actress. Glamour. Oscars. Broadway. High heels. Fabulous)

No jokes.
Those were my two career choices.
Of course, I was more than fully qualified for both, being both studious and superglamorous.

However to my drama teacher's dismay, and to my hard-working parent's delight, I swapped Broadway for a different kind of theatre, the operating theatre.

And where my actress colleagues were cabaret-ing down the path to stardom, I was dragging my weary feet up and down hospital corridors for hours on end.

"Don't worry darling," my mother cooed, "You can always sing and dance for your patients! After all, they're the ones who need the entertainment the most."

*Which I've tried to do! For more info see my post entitled TLC*

A truism indeed,dear Mum, but not one which will bring me closer to my dream of making out with some hot Hollywood male lead!



Sometimes, when I get particularly nostalgic about being on stage, I go on a little journey into my mind to that happy place where I was adored by applause at the end of each show.

And sometimes, when I'm alone in the eerily quiet front room, it truly does seem that I'm involved in some kind of hospital horror flick...

*Insert MGM theme tune here*

Based on a true story...
The shocking blood-curdling tale of...


HORROR AT THE HOSPITAL!


Three am.
Graveyard shift.
Dr MB and Dr K are snoring in the tea room.
Things are unusually quiet.
Most of the patients are sleeping and the psychs are still heavily sedated.

A lonely little doctor keeps watch.
She sits forlornly at the large desk situated in the middle of the unit.
The temperature is bordering on freezing, so she has wrapped one of the blankets normally reserved for patients around her shoulders.

She can forget about closing the windows.
With the scourge of Tuberculosis ravaging the community she serves, it is better to risk hypothermia than catch TB by closing the windows and concentrating the dreaded germ in one space.

From her position she can spy on all parts of the front room, except for the small, dark chamber at the back of the unit where the psychiatric patients are kept.

Bad things have happened in there. Very bad things. Things the hospital has forgotten about yet which are still talked about in hushed tones, behind locked doors.

Suddenly she spies movement at the entrance to the psych patient chamber and an involuntary reflex forces her pretty head to look in that direction.

What she witnessed will forever be burned onto her retina.




A dark, vile creature had emerged from it's slumber and was crouched on the ground staring menacingly in her direction. Saliva dribbled incessantly from it's fangs and bubbled with each threatening growl.

It stood up, and stretched out it's arms. Gnarly filthy talons pointed in the small doctor's direction.

It spoke.

"Woman!" It hissed through its rotten mouth. "Woooman! Wooman!"

The beast took one giant step forward in her direction and began thrusting its festering groin in what could only be interpreted as a beastial mating movement.

"I want woman!" it screamed as it lunged in mad lust for the helpless beautiful health worker!

But luckily she was possessed of some mad ninja-type skills which greatly assisted in her evading rape by a psychiatric patient.

She managed to awaken her sleeping colleagues who took great delight in tackling, and maybe unintentionally eye-gouging, the beast to the ground, whereafter she got her own revenge by sedating it with 30 mg of Valium and 10mg of Haloperdol intravenously.


Suck on that, you psych beast bastard!!

Nobody get's near my goodies without my permission!

That was a true story, and not the only one involving narrow escape from physical bodily harm by psych patients.

The "beast" was a bona fide, hypersalivating, utterly psychotic psychiatric patient,namely Mr MX

The "two sleeping colleagues" were played by Dr MB and Dr K, who enjoy nothing more than a bit of psychiatric tackling sports.

And of course, the protagonist, the "stunning lonely doctor" played be me,Dr S.

*And...bow. Smile. And...bow again.*

All the world's a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages.


(W.Shakespeare, As you Like it)

Screw being an actress!
My reality is way more entertaining right now.
Who needs the flashing paparazzi lights when you've got the flashing ambulance siren signalling an incoming life-threatening emergency?

Theatrical emotionally draining diva's? I've got soul-sucking whiny still-smoking-asthmatics to deal with.

Drama, Comedy, Horror, Romance? Why, I can get all of that and then some in one patient alone.

Perfect Hollywood endings? Well, we don't always get those. Most of the time our endings are tear-jerkers.

But sometimes, we watch patients who were rushed in on stretchers on the brink of death, walk out of the hospital smiling.

And that's all the applause I need to ensure that I keep coming back to work, shift after shift, after show, after show...

Saturday, August 22, 2009

Brothers, Sisters, and the Godfather.

I spend more time with my work colleagues than with my own family.

This happens when one is a mean, lean, life-saving machine working night shifts when everyone is sleeping, and is sleeping when everyone else is working.

I'm spending so much time at work that it's like my work colleagues are starting to become my family.

It's inevitable.
The team effort it takes to piece together a polytrauma victim, take down a violent psychiatric patient, or resuscitate a patient back from imminent death is certainly a bonding experience.

Witnessing one's colleague being vomited/urinated/shat/bled/spat on are all priceless moments of hilarity that provides the fodder for friendly family-type banter.

Spending four nights on call in a row with the same people provides insight into their characters which would otherwise not have been learned during polite dinner conversation.
Sleep deprivation is like being drunk, it loosens the tongue and disinhibits the mind.

What I'm saying is, we're getting way too comfortable.
It's only a matter of time before we start farting around each other, and then rating those rectal whistles like real siblings.

Here's the family breakdown:

Dr D: A specialist neuorologist. She does locums in our trauma unit sometimes to supplement her income. She's like everyone's mum. She doesn't hesitate to dole out the "mama treatment" when you've screwed up or are pissing her off, but is also quick to praise, offer advice and soothe.

Dr MB: You've read about him and his drunken exploits already. He gets to play the role of the mischievous older brother.

Dr S: That's me - taking centre stage as the misunderstood, brilliant, beautiful and slightly insane little sister.

Which leaves us with Dr K to play the role of father.

Except that Dr MB and I are convinced that he should actually be playing the role of Godfather.
And by Godfather I mean the scary Sicilian-mafia-gangster-type godfather, not the sweet loving I'll-take-care-of-you-when-your-parents-die-and-raise-you-in-the-name-of-Jesus type godfather.

There have just been too many incidents pointing to the fact that Dr K could currently be, or previously have been, a gang-leader on the Cape Flats.



1: He has an expressionless face with cool green eyes.

2:He broods. A lot. And skulks around the unit like a moody killing cat.

3:Whenever the hardened criminals come in to the unit and start trying to cause chaos he manages to silence them by just looking in their direction.

4:He revealed that he goes to visit some of his "friends" who currently reside in prison!! He claims that these friends are actually really good people and that when they get out they will be staying with him.

5:He only wears tops with long sleeves and high necks. We're convinced that this is because his torso is riddled with gang tattoos which he can't reveal in public.

6:During an episode of "immobilise the violent psych. patient", I watched as he controlled the guy with a one-handed vice-like choke hold. When we mentioned that perhaps this was not the healthiest method of immobilisation, he simply informed us that this was indeed the best way because once they become hypoxic they stop struggling!!!!!!

7: Whenever a gunshot wound comes into the unit he can correctly identify the type of gun that was used and the calibre of the bullet retrieved.

8: It's possible that he's packing heat.

Do you get the picture?

I mean it's pretty cool to have the damn Godfather on our team right? Lord knows we need some extra protection in this gangland trauma unit.
So now my pseudo-family is more like a pseudo-familia

And I'm loving it.

Except, that I'm also slightly nervous that I might do something to seriously piss him off and then wake up dead the next morning....

Only 5 weeks to go until the registrars rotate and he moves off to another unit elsewhere in Cape Town.

So until then it's yes Dr K, no Dr K, please don't kill me Dr K!

Wednesday, August 5, 2009

Boozy Sunday Brunch


Sunday morning 8am:

Arrive at work for the third time this weekend.
Dr K arrives shortly after that.
Dr MB is currently AWOL.

Sunday morning 9am.

In the short space of time that I've been at work, I've already drawn blood from three drunken drivers for forensic purposes. The police bring them in is as "DUI's" (driving under the influence). These patients are highly inventive and almost always create bullshit stories which are supposed to prevent me from taking their blood as evidence.

For Example: "I refuse to let you take my blood doctor, I'm a liver patient and the Professor of Livers at Groote Schuur said that you must be careful when taking my blood." Oh yes you most definitely ARE a liver patient my friend, being an alcoholic is compatible with destroyed livers. But I guess the liver is evil, and must be punished.

Or:"I have very thin blood doctor. And I have very thin veins. Don't take my blood or I will bleed to death. I don't want to bleed to death!" Oh yeah dude, I get what you're saying! You mean, you don't want to bleed to death like the people you could have hit while drunk driving would bleed to death? Good call, I wouldn't want to die that way either, you imbecile.

One of the three DUI's happened to be a police officer, caught drunk, on duty, while driving the police vehicle at 8am that morning.
This genius, after I shook my head at him, tried to convince me that he had just been working a very long shift and that he was so tired that he merely appeared drunk!
By the time I was done listening to how simply tired he was, I was getting simply drunk off the concentrated alcohol fumes emanating from his rancid mouth!

Sunday morning 10am:

Dr MB currently NOT at work.
Have received text message from him saying that his flatmate has parked his car in front of his and has lost his keys, thus resulting in his lateness.

I attend to a patient with multiple stab wounds. This guy is still trashed from last night. Too trashed to feel the pain of the, fortunately superficial, gashes on his scalp, back and torso.
He proceeds to blame the stab wounds on his wife. Apparently he was out drinking last night with his friends, when she came looking for him to drag him home. On their way home they were stabbed and robbed by gangsters. Stupid wife is clearly to blame,of course, and should have rather let him drink himself into a coma.

Sunday morning 10:30am:

While still busy suturing the lacerations, the cleaner stumbles into the room and stands next to my suturing trolley. He sways slightly while informing me in slurred speech that I need to throw the unused instruments in the special bin placed outside the room.
"Why thank you cleaner dude, I know this, but thanks for reminding me anyway!" I say. Cleaner dude now needs to leave me alone to finish suturing. Yet, he continues to stand there swaying to the rhythm dictated by the alcohol pumping through his veins, and stares intensely at the instruments on my trolley.
As a little bit of drool starts seeping down the side of his mouth onto my sterile field he begins again, "You know doctor, you must throw these instruments into the bin outside when you are finished, because that is where the dirty instruments must go."

Yes I know you drunken fool! Now take your alcoholic self off to the nearest dark corner and help us all by sleeping off last night's party before attempting any further brain function!

Sunday morning 11:00am

Still no sign of Dr MB. I'm starting to get worried. This is South Africa after all, and these foreigners from the UK don't understand words like, security, and hijacking and trellidoors and safety!

At this point I notice Dr MB's flatmate walking through casualty happily jangling his car keys...Dr MB is not in tow.

Thus my hijacking fears are allayed. Me thinks that Dr MB, like everyone else in casualty today, is also suffering the after-effects of drinking the devil's drool!

Sunday 11:30pm

The paramedics wheel in a morbidly obese lady with no past medical history other than being a known alcoholic. I get the feeling that in the last few months she has been sober less times than she has been able to view her own genitals beyond her massive stomach. She is currently comatose. It could be that she has drunken herself into a stupor or that she has suffered some other major pathology. First rule of intoxicated patients: Do not assume that all their symptoms are attributable to the intoxication. So after some major resuscitation, we send her off to Groote Schuur for a CT scan of her brain. My friend texts me later from Groote Schuur to inform me that she has suffered a massive sub-arachnoid haemorrhage*, whose initial symptoms were probably not picked up due to her having imbibed satan's sap all weekend. Brings new meaning to the term, "smashed out of your skull".


Sunday, midday:

Dr MB arrives, body intact, in the casualty unit. Hoorah!

He looks more like a patient than a doctor:
I begin my examination....
No evidence of hijacking noted, thankfully.
On observation though, possible evidence of a rough Saturday night: hair unusually unstyled, face slightly puffy and red, eyes glazed.
Clothes noted to be dishevelled: having fallen asleep in them last night is highly likely.
Non-purposeful wandering around trauma unit: a clear indication of hangover. That and the fact that he is periodically pressing his palms to his temples and moaning softly.
Patient delusional: Believes that he got two flat tyres on the way to work and thus had to spend the best part of the day sorting it out. Patient even promises to show me the receipts.

Patient forgets that I am female, have two brothers, am a wife, and a doctor. I can smell bullshit from kilometres away.

Never mind, Dr MB. I'll forgive you seeing that after your IV caffeine treatment you perked up and saw most of the patients for the rest of the day, while the rest of us slacked off a little.

I was just annoyed that EVERYONE was enjoying a boozy-Sunday-brunch style afternoon in casualty EXCEPT ME!!!!

It was then that I decided that I needed to get my own back.
Come Monday morning, I would stumble into work stoned, drunk, high on tik, still wearing last night's clothes and screaming like a lunatic that somebody needed to get me another drink...

But I didn't. I remained the diligent little girl that I am, had a good Sunday night's rest and arrived in good spirits, unfortunately not methylated spirits, for work the next morning...

Good little Dr S, always doing the right thing. I have terrible luck though. Knowing me, if I did ever try any nonsense I most certainly would be the ONE person in the unit to get caught, reported and probably disbarred.
Wait...hold up! Being disbarred means I never have to work as a doctor again right? Pass me that crack pipe!!!!

Thursday, July 30, 2009

Brain Transplantation


Never in the history of medicine, has a secret this revolutionary been revealed.

Oh yes, dear reader, simply by following this blog you will become privy to the most highly protected top secret information regarding a world-changing medical miracle.

Are you ready?
Are you sitting down?
Do you have a paper bag to hyperventilate into?

You do?

Well get ready...this is the big reveal.....

BRAIN TRANSPLANTATION!!!!!!

Yes, that's right. You read that correctly! The harvesting of one person's brain to the inside of another person's skull is indeed possible!

You sound skeptical.

But my dear reader, look around you.

The proof is everywhere.

Think of your past. Think of your present. Think of people you know who are constantly behaving in stupid ways. People who are happily flaunting their idiocy in ways that leave you speechless. Think of the dumb, retarded, mind-boggling actions you have had to endure from a moron who happened to enter your life.

And so? Does it now become clear? Has the penny dropped?

These people MUST have donated their brains to science.
This is the only explanation for their brain-donor behaviours, and therefore conclusive proof that indeed, brain transplantation is taking place.

Of course, their are strict guidelines for those selected to donate their brains.

The main one being that you never used it in the first place.

There are also other reasons brains get removed from skulls. However those removals are not for tranplantation purposes, but for urgent HUMANITARIAN purposes. What I mean is that the brain is removed to prevent future generations from suffering the same afflictions.
Some of these serious afflictions are as follows:
Faecocranium - medical speak for "shit for brains".
Pneumocranium - medical speak for "air-head".


Last week I personally encountered a living brain donor.
Now I hate berating the nurses for anything. They are grossly understaffed and have terrible working conditions. But my God, this one was definitely operating with an empty cranium.


I asked this nursing sister, very nicely, to take a temperature reading on my patient who clinically felt like he was stoking a raging 40 degree fire inside his torso.

This is not unreasonable.

She told me that a request like that was impossible to follow as she did not have a thermometer. When I asked her to borrow one from her colleague, or go and get one from another ward, she simply said that it was not in the nursing guidelines and that each nurse was to use their own thermometer.

WTF lady - then where the hell is yours? When I asked her if that meant that none of the patients coming through the door would have their temperatures screened, she stared blankly at me and said, "Unfortunately that is how it will be tonight".

It became apparent then that I was conversing with a non-cerebrating individual.
The wheel was turning, but the hamster was dead.

An argument would have been in vain. Better results would have been gained by arguing with the wall.



After staring at that lazy cow of a sister's fat ass waddling slowly from patient to patient all night, I endeavoured to practice its rectal thermometer capabilities on her...

I never did get to try it out on her though.
My focus was suddenly shifted to the psych patient whose sedation was wearing off, and was at that moment then harassing another patient's mother IN FRONT OF THE SECURITY GUARD.
The security guard, although positioned in the perfect viewing spot for the pending assault, continued chewing on a string and playing with his navel.
Clearly another brain donor ripe for rectal thermometer testing.

Do you see?! What did I tell you - there are brain donors! They're everywhere!

Brain transplantation, people, it's happening!

Believe it.

Just remember where you read it first.

Sunday, July 26, 2009

TLC

Trauma.

Oh God - my body has gone through Trauma...

Four consecutive nights of night shifts, in a row, consecutively for four nights, one after the other, all night, for four nights...in a row.

They ended last night.

Therefore, I am now allowed to initiate the recovery process from the face down position under my duvet...

Step One: Climb inside skull armed with ice pick and begin breaking through the 2cm too tight steel casing compressing the brain and causing massive post-call headache.

Step Two: Once the brain pressure has been relieved, initiate neurotransmissions to rest of body. Expect MASSIVE resistance from skeletal muscles, known for their surly contempt of brain's authority.

Step Three: Scream violently upon realisation that your perfect skin is the angrily inflamed crime scene of a bloodsucking flea-bite feast festival.


Step Four: Remind yourself that being a doctor is both the most awesome and flipping worst profession in the whole world, and that this moment is just located near the bottom of the awesome/terrible scale.


Step Five: Obtain TLC - in whatever form: Food, or music, or a phonecall to a friend, or raindrops on roses and whiskers on kittens, or bright copper kettles and warm woolen mittens, or brown paper packages tied up with strings,
you know... just a few of your favorite things... ( Musicals are some of my favourite things...ESPECIALLY the Sound of Music musical...)



Jeez, I really really heart musicals!

I love musicals so much. My Mom and I used to watch My Fair Lady and the Sound of Music over and over when I was little. Singing and dancing and acting at the same time!?!?! It's the most glorious manifestation of happiness, am I not right?

The hospital front room is a very dreary place. I've made bringing a little musical magic into it one of my objectives.

Here's an example:

Last night, our front room team had two very sick patients in the resuscitation area whom we knew would not make it through the night...

Sherbert, I haven't told you about my team yet have I? It consists of:

Dr S- that's me. (newbie and very green community service officer),

Dr MB - (an English Medical Officer who travelled all the way from the UK to experience 3rd world medicine and take advantage of our superlative weather )

Dr K (The registrar in charge of our team, i.e. specialising in Emergency Medicine, who was once described my a patient as looking more like a tow-truck driver than a doctor)


Got it? That's our team right there, in a nutshell.

Back to the dying patients in the resus area - we can't get distracted now - they are dying after all.

One of the patients was mine, and the other Dr K's. We were both pretty saddened by the fact that despite extensively counseling their respective families that their relatives would surely not make it through the night, the families still decided to leave the hospital and go home.

If that was my relative I'd be in the bed with them, holding on tightly and whispering words of love all night until they left this world...

We had done all we could in terms of medical treatment. All that was left to do was make their last moments on Earth pleasant.

This is difficult in the Emergency Department...

But that didn't deter us. As we had exhausted all the medical ways of helping these patients, Dr MB and I, possibly delirious from our four consecutive night shifts, began singing harmonious lullabies at the top of our voices, in order to peacefully lull them to sleep, forever.



Dr MB might have gone a little bit too far though when, after I mentioned that the patients were for TLC management only, began singing:

"Don't go chasing waterfalls, just stick to the rivers and the lakes that you're used to. I know that you've got to have it your way or nothing at all, but I think you're moving too fast"

i.e. The group, TLC's, most famous song.



I won't lie, it's such a catchy tune that I couldn't help but sing with him.

Appropriate or not, it made us feel as though we were at least trying to bring something magical to the last part of these patient's lives. They died just before seven, all alone with no loving family members by their sides. I felt terrible for them, and was glad that in the end, we could provide a little TLC on their journey out of this world...

To those of you who know me...when I'm dying, please can you sing songs from My Fair Lady and The Sound of Music? I don't mind some TLC either. Some sexy rock ballads and a hard-hitting gangsta rap number might be nice as well. If you even think about breaking out the Britney Spears or Celine Dion - I will most certainly come back as a zombie to terrorise you for eternity!

Being a doctor means one comes into contact with death constantly. Mostly we don't like to think about it in order to function. If we had to process every death we'd seen our brains would explode.

That said, I once found this poem which I like to refer to when those death barriers I've erected around my emotions start to falter.
Please read it out aloud.

It is my favourite poem about death of all time:

If I die, survive me with such sheer force
that you wake the furies of the pallid and cold
from south to south, lift your indelible eyes,
from sun to sun dream through your singing mouth
I don't want your laughter or your steps to waver.
I don't want my heritage of joy to die.
Don't call up my person, I am absent.
Live in my absence as if in a house.
Absence is a house so fast
that inside, you will pass through its walls
and hang pictures on the air.
Abscence is a house so transparent
that I, lifeless, will see you, living,
And if you suffer, my love, I will die again.


Pablo Neruda

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