Sunday, May 31, 2009

Prison games

It is really not fun in the trauma unit.

From the broken filthy chairs we sit on, to the never-ending supply of emergencies to deal's not what one would call a healthy working environment, or a good night out.

So, we find ways of surviving the onslaught, just to make sure we don't get too depressed and blow our own brains out.

One of these ways is inventing games to play while at work.

This particular game can only be played when the police bring in a prisoner with non life-threatening injuries.

Nobody knows I'm playing the game - that would be unethical of course - I play it with myself and it's all undercover. Under the cover of my skull and inside my own brain.

The opponents are myself, and my cynicism.

What I do is, I don't say anything to the police, except asking them to seat the handcuffed patient in front of me.

Then I play the role of the doctor and ask the patient where it hurts, where it's bleeding, how I can ease suffering etc.

Standard and correct doctor behaviour.

Once I've built up a rapport with the patient, I like to ask how they got their injuries.

Note - I don't ask why they're in handcuffs - just how the injuries happened - for documentation purposes.

What follows is usually a very long story about how the patient was just minding his own business on a street corner when he was attacked, and that the police got confused and arrested the wrong guy.

The prisoner is , without fail, always incredibly polite, well-behaved and upstanding.

I listen, and take all this in. I force myself to believe everything they tell me - hoping and praying with all my heart that this is the complete and utter truth.

Then, comes the crunch point. I interview the police to hear their side of the story.

And I can tell you, they NEVER have the same story. Never.

Mostly , the prisoner was doing exactly the opposite of minding his own business and was either beaten up by the community who caught him, or physically reprimanded by the police while being arrested.

The hard part of the game is not judging the patients when they tell me their story. I like to see how long I can hold off my skepticism. It's especially hard when I examine a prisoner and find the frightening gang tattoos covering his body.

I've seen some insane things tattoed on people's bodies, but these two particularly stand out.

1: If you fuck with me I will kill your wife.

This was tattoed on this guy's FOREHEAD! It had the hangman drawing next to it for further emphasis that he meant what he said. Scary.

2: I rape for fun and kill for joy.

This was tattoed on this man's torso. I could only imagine what he'd done to his victims. Turns out he had been a criminal for many years, until somebody gave him a taste of his own medicine and stabbed him with a sharpened bicycle spoke in his spine. He is now a paraplegic and thus rendered completely unthreatening.

Karma? You've got to believe it.

Unfortunately in this bit of trauma unit fun - Cynicism wins all the time.

I have never won this game.

Which is, I think, exactly why I keep playing it, to force myself to have faith in humanity, despite the gross misbehaviour of its citizens toward one another.

I pulled that last bit out of my subconscious. I don't usually like to go there. There are things in there I've worked long and hard to keep well buried. That was just a little taste. Don't expect a full meal. If you're reading a post and there's a lot of psycho-babble - you know I've gone there and am probably hugging my laptop and blubbering in a corner.

Ghost Stories

I do not believe in ghosts.

Fundamentally - no, I do not think they "exist".

Did you see what I just did there? I made the words do tricks. exist vs dead vs the living dead. I'm an awesome word manipulator.

I have friends who tell me their great aunts or friend's sister's uncle's mother in-law could communicate with the dead.
While I secretly wonder as to the possibility of this, mostly I just find these stories hilarious.

During Thursday night's tea break - the sister's and receptionist staff were entertaining me with ghost stories from the hospital. These included stories of:

*An old hospital clerk haunting the filing room,moving chairs around and switching lights on and off etc.

*Seeing old patients sitting in corners of the trauma unit observing the goings on.

*Hearing the screams of aborted foetuses while sleeping in the on-call-room ( which is actually the termination of pregnancy counselling room during the day)

and so on and so forth.


I'm not scared of the dead. I'm scared of the living.

Some of my patients actually are the living dead.

Those COPD patients with secondary heart failure who are still smoking...walking dead.

Those sugar-saturated diabetics with an insatiable appetite for cream cake and a practiced ignorance of their limb-threatening periphral vascular dead . ( they can't be the walking dead because they've usually had their legs amputated.)

Those sallow yellow alcoholics with liver disease and portal hypertension and oesophageal varices who won't stop drinking despite bleeding from their intestines...once dead.

By the way, do you think that when an alcoholic dies they become a methylated spirit?

Ha Ha! I just made that up. Seriously.I crack myself up.

I had a patient yesterday who was not mentally unsound.

He was just really really drunk. He was so drunk he did not even know why he was at the unit.

He was so drunk every cell in his body was drunk with him. Even his blood corpuscles were drunk-driving through the clearly demarcated road map of his veins and arteries -and took a wrong turn - ending up pouring through the large laceration in the left side of his head.

He apparently was assaulted with a bottle which is why he had a big gash in his scalp.

For some reason I really liked this guy. He was not one of those angry drunks, or sad drunks. He was just a happy-go-lucky peace-loving homeless drunkard.
We were having a quiet evening, so instead of asking the sisters to do it, I stitched him up myself.

Normally we are so busy that we have to ask the nursing staff to suture, and as it has been a while, I'd forgotten how much I enjoyed it.

Aahh...the sterile instruments, the meticulous piecing together of flesh with correctly spaced sutures, the utter practicality of it, the fact that no-one can bother you because you're performing mini-surgery. I love it.
I also enjoy having the patients to myself to chat to while I work. This is usually when I hear the most interesting stories. For instance...

This guy started off our conversation by telling me that he was dead.

"Oh don't worry sir," I explained,"Wounds on the head always bleed a lot, even when they're very superficial. You'll be alright. This is not a life-threatening injury."

" I know doctor, " he said, "but I am actually dead. I'm a ghost."

OK..umm...what? I've only been trained in the field of medicine for living non-apparitions. I do not know the correct suture for a wounded spectre's head.

What I have been taught to do is keep the living, living.
Do I do the reverse in this case?
If so then what method should I use to keep the dead, dead?

Me: "Explain, sir. Explain immediately what you mean...because ghosts don't bleed dude. Ghost's cant get hit in the head with a broken bottle. I've watched TV. The bottle goes through the ghost's head because he has magic ghost powers. Next you are going to tell me Demi Moore is your girlfriend."

That last joke went over his head.

Ghost: "Well I definitely died the last time I was here. My friend stabbed me in the neck and then I died. When I woke up I was back on the streets, I don't remember the hospital or anything. That's how I know I am dead. So sometimes I come and say hello to everyone here."

I didn't say much further after that. Didn't think either. Was he a loony tune or a member of the after-life? Who knows...not for me to ponder. I just got on with the job, sewed him up and sent him back to his favourite haunt.

He winked at me on his way out.

That's when I knew he was fucking with me.

Or not.

And then I wondered...Did I just communicate with the dead, like John Edwards. I hate John Edwards, and now I had become him. Oh Shit! I should have asked him more questions about the after-life! Another opportunity missed.

In the words of Alice in Wonderland, this job just gets curiouser and curiouser.

Humans are fascinating aren't they?

I'm just interested...if you die and become a ghost - do you have to haunt the place that you died in? If that's's fucking terrible. Imagine being stuck haunting the godforsaken trauma unit for the rest of eternity!

Remind me to go to Mauritius to die. Or the Seychelles. Or behind the scenes at an all-male modelling show, or in the audience at a west-end theatre so that I can be entertained by musical theatre for the rest of eternity!

Monday, May 25, 2009

Sloth and Competence and knowing when to use them.

It's half past two in the afternoon.

I've just managed to teach my brain to communicate with my body again.

My brain was awake for an hour trying to convince my skeletal muscles that listening to what it has to say is a good idea.

Brain was saying that Skeletal Muscle should help Body get out of bed, hunt for food and evacuate the bladder.

Skeletal muscle was telling Brain to go fuck itself.

Brain won in the end, after a lengthy hour long debate.

Skeletal Muscle got it's own revenge though, and operated like a sulky teenager after being told to clean up it's room...apathetically, slowly, and with no respect.

Which is why I looked something like the illegitimate retarded offspring of Shrek and a three-toed sloth...slouching round the house half-blind, in last night's scrubs top, underwear and socks...mumbling incoherently while in search for the kitchen.

My keen sense of smell led me to the fridge - On which I pinned all my hopes and dreams for a nutritious lunch.

I opened the silver doors and the holy light from within flooded my sleep encrusted face ...

Aahhh *insert choir of angels here*

# Leftover pizza that someone ordered last night ( Score! It's mine now!)
# Crackers with gourmet prawn dip with real prawns from Woolworths.
# Zoo biscuits.
# And a jar of Nutella's spreadable chocolate.

This surely is heaven, and just reward for the shitstorm of last night. Thank you, Fridge Gods!

My call was insane. Which is why I was so tired that when I got home, I couldn't even perform my usual post call ritual of jumping in the shower and scrubbing off the evening's filth, until the top layer of my skin has washed down the drain.
I just shoved an energy bar down my gullet - took off my pants and collapsed on the bed.

The bullshit started out when the locum doctor, who was supposed to be on call with me, arrived two hours late.

While awaiting his arrival, I called the emergency contact number for the locum agency he was from to find out:

The fuck.
He was.

The middle-aged lady that picked up on the other end could possibly have been a product of incest.

Product of incest:"Oh, um, ja, who are you?"

Me: "It's Dr S from ________trauma unit. Where is the locum you are getting paid to send us tonight?"

Product of incest: "Oh yes, he called three hours ago to say he would be late. But, where is the other doctor for tonight?"

Me: "I AM THE OTHER DOCTOR. If you knew that he was going to be late - WHY HAVE YOU NOT INFORMED US of this fact timeously."

To which the product of incest replied...and wait for it...this really was her excuse..." I was in church!"

Me: "Being in church is no excuse for incompetence. You should stop using your religion to justify not doing your job properly. We'd all LOVE to be in church, or in mosque, or at home on the couch watching the Sunday night movie. But we aren't. We are here doing our jobs. "

I was too pissed off to listen to her ranting and raving that "being in church " was a valid excuse for letting us flounder in primary health care hell on a Sunday night without assistance. So I very politely put down the phone. That woman should take a good look at herself and pictures of her uncle/mothers cousin. There will possibly be very striking similarities.

When the guy eventually arrived - the tragic thing was, I realised that I was probably better off working alone as he was NO HELP whatsoever.

In total, we saw 100 patients from 17h00 to 07h00.
I saw 70. He saw 30.
He would do things like, send a patient off for a urine sample and then WAIT until the patient came back. One can see up to four patients by the time it takes a paralysed stroke victim to go to the bathroom and pee.

When a man walked into the unit and immediately collapsed while having a generalised tonic-clonic seizure, he just stood there and watched me ( 5o kg, petite female me) try to move the man onto a bed to begin treatment.
What a dick. I ended up asking the porters and security guards for help.
They were brilliant and knew exactly what to do - handing me the correct fluids and instruments for IV access.
Fuckwit doctor strode around the bed with hands in his pockets issuing instructions which I, of course, ignored. I don't take advice from brain-donor men who believe that they are automatically in charge - just because they own a penis.

The sisters and I spent the rest of the night ignoring him and swearing at him in Afrikaans. The guy was from Durban so had no idea what we were saying. They don't speak Afrikaans in Durban. Mean - but necessary.

The cherry on the top was when at o3h30 he announced that he had a plane to catch and would be leaving to get his things in order. He then asked the sister in charge to sign his on call sheet from 17h00 to 07h00 so he could get a full night's pay.

He clearly did not know about Sister CrL. She didn't sign his sheet at all. Good girl!

Can I just say - that as I am a community service officer - my rates are standard, very low and fixed regardless of how hard I work. These locums get paid more than double what I make as they are from the private agencies -so in effect I got paid half the amount and was working more than twice as hard.

Did I mention that it's five weeks and counting?

Jeez - just got a whif of myself while reaching over the table. I smell like the hospital!!! AAAAAAAAAAHHH!

I thinks it's time for that shower now...

Friday, May 22, 2009

This is not an entertaining post.

This is a post full of complaints. It's not funny or entertaining in any way. It's just the truth.

Doctor's are currently picketing and toyi-toying in their lunch hours in South Africa.

We are sick of the pathetic working conditions we suffer.

We are tired of the ridiculous hours we are forced to work.

We are insulted that compared to other government workers in similarly highly educated fields in this country ( the judiciary for example) - we are getting paid 50 percent less .

We are emotionally drained by the sheer volume of patients we are under pressure to "see" every day.

This disheartens us as we are unable to provide the quality of service we know we are capable of, simply as a cause of poor management.

We are tired of being told that we chose to be doctors, and that we should just deal with it as this is the way it has always been.

We are disgusted by the service we "provide" to our patients. It's unfair that this will be their health "care" experience.

Why are other fields not forced to do community service like us Good Samaritan medics?

Teachers could do community service in the township schools.

Engineers, lawyers, IT consultants, business graduates should all be forced to serve their communities in the way medics are.

The members of those disciplines would be up in arms about it.

Not like us - we just blindly accept our fate, and continue pushing ourselves to our limits.

Why are doctors such pushovers when it comes to our own quality of life?

I'm certain it's a mixture of guilt, compassion for others and indoctrination by the heirarchy.

I'm very worried about the future of government health care in this country. There is no incentive for us to continue working for the government sector. Why would anyone continue here? The department of health only have themselves to blame for the "brain drain" of doctors emigrating for a better life overseas.

I get to work, and am scared because people get shot in the area that the hospital is situated in.

When I walk in the door - I'm immediately confronted with 200 or more patients crammed into the small waiting area - who have been sitting there since 4am to ensure that they are the first to get a number. The magic number that means you will be one of the patients lucky enough to be seen by a health professional that day. If you don't get a number - you are turned away and told to come back tomorrow - where it's not certain you will even be seen then.

The patients know I'm the doctor - despite trying to be inconspicuous - and immediately start harassing me with demands.

"When are you going to see me doctor?"
"I've been waiting for ever!"
"Please just rewrite my medication so I can get it from the chemist."
"Can you have a look at my foot please it's turning black"
"My baby, doctor, just listen to my baby's chest please!"

This occurs while just walking down the passage to the consulting room. Although one can't exactly walk down that passage - it's more like an obstacle course, having to step over people lying on the floor and children running around everywhere.

I have no safe place to leave my things - we are not issued with lockers or keys to the rooms. Even the tea room is unsafe - so wherever I go I have to take my bags and coat with me. Even into the toilet. Or across the hall to use the one phone in the whole hospital.

The nurses tell me that everything gets stolen - even your food out the fridge, even the plug socket coverings on the wall, even the metal plaques on the doors. everything!

By the time I start seeing patients they are already so pissed off from the long wait that they are not interested in a damn thing I have to say. They just want their meds and want to get the hell out of there.

If I even leave my consulting room for five minutes just to pee, the patients start grumbling...Where is she going? Is she going on lunch? How long will I have to wait NOW!? These doctor's don't care about us at all!. I don't make eye contact with them.

While on call in the trauma unit - all night, despite having worked a full day as well, we deal with violence on an unimaginable scale. The doctor's from first world countries are shocked by the violence. I met a doctor from the UK who had seen one gunshot wound in his life. His first night in the trauma unit and we had five gunshot wound cases - one guy had 16 holes in his body.

While on call, the security guards supposedly protecting us have been beaten up by gangsters, the trauma unit has been surrounded by gangsters with guns and I've narrowly escaped assault by patients.

And if that's not enough. It is perfectly acceptable, after working a full day and night - NOT to be allowed to go home when the on-call shift ends. Oh no - it's law that you have to stay and see a certain amount of patients post-call before you go home.

Their thinking is that if you just went home, it would mean that you didn't actually work on the day post your call. Which is BULLSHIT as you actually already worked 7 hours of that day - from 00h00 to 07h00. Assholes.

How is this going to change? I don't know the answers - but it has something to do with making us feel valued. Pay us properly. Improve our working conditions. Give us a reason to stay here. Pump more money into education - so that we have a bigger pool of candidates to train to become health professional - thus alleviating the short-staffing.

Perhaps the fault lies with doctors themselves, who have allowed themselves to be mistreated for so long. Our dog's life is simply accepted as par for the course. Our way of coping is to put our heads down, and just get on with it. This is our normality. We don't know any better.

I'm very tired today. Last night's call was exhausting. And then I still had to deal with rude patients in the consulting rooms this morning. I had to restrain myself from shouting at them.

There - I've gotten all my moaning out my system. Will try make the next post entertaining. There were a few things from last night that stood out.

Have I mentioned that this blog is my catharsis? I figured it would be safer than being an alcoholic or drug addict. And certainly cheaper than therapy.

Wednesday, May 20, 2009

SNVL (Episode 2)

One should always listen to one's inner voice. ALWAYS.

Today mine was screaming - "STAY IN BED! DO NOT GO TO WORK!"

I think the staying in bed part might have to do with the benzodiazepines (valium) I took last night.

No guys, I was not having a little private drug-addicted-doctor party in my bedroom. I was suffering from two days of intractable neck muscle spasm. And everything that I tried failed.

So last resort - benzo's - which I took, in the safety of my own room, after work, with my husband around to take advantage once I'd passed out. Naughty husband.

I was still sedated this morning. Which is why he had to smack me in the head to get out of bed this and effectively shut off that clever voice in my brain that said "Stay at home".

If you've read "SNVL (episode1)" You'll know what's coming next...

It's Winter now and it was pitch black outside by the time I arrived.
The car park was empty.
The red curtain over the trauma unit window glowed a sinister crimson from the outside.
It glowed the way one would imagine a window into Hell would glow... with the flames of Satan flickering through the window panes.

I've seen this Trauma unit many times before but this morning it looked scary. I should have known there would be a demon inside waiting for me.

The demon was patient three of my morning.

Patient three was brought in by her husband, Mr G. Mr G was talking to me but it was in a dialect native to the Cape Flats. Spoken through a gap in his front teeth, this dialect was made even more difficult for me to understand. Me, who over the last five months has been WELL educated in what I like to call, Cape Flats Gam.

He kept on screaming at me in this language and pointing to his wife, and then pointing fingers in my face and being rude. So I told him to get the hell out of the unit.

I then turned my attention to the patient - his wife, Mrs G. She was dressed in three dresses one on top of the other. Nicely colour co-ordinated in shades of red and orange. She also had a green t-shirt wrapped around her head. She wore a sandal on her left foot and a slipper on her right one.

This new style of dress is commonly known in medical circles as..."Fucked in the head fashion craze for crazies".

Oh but that wasn't the most exciting thing about her.
What she was screaming at the top of her lungs was terribly exciting, and possibly some of the foulest demon-possessed putrified verbal filth...

Don't say I didn't warn you....

Me: 'Hello Mrs G - how can I help you?"

Mrs G: "Jou ma se poes, jou fokken holnaaier! Moenie vir my vir 'n poes vatie! Ek isie mal ie? Jy's mal! Jy's almal fokken mal!"

Your mother's cunt, you fucking bumfucker. Do you take me for a cunt? I'm not mad, you're mad! You're all fucking mad!

Me: Ok Mrs G. You are right. I'm mad. Why do you think you're at the hospital today? What happened at home?

Mrs G: "Ek is hier om birth te gee vir my holy babas. Ken julle nie vir my nie? Ek gaan 'n honderd holy babas uitkram! Jou poes! Jou poes! Pasop vir my! Julle ken nie vir my nie - ek dra nie eers 'n panty langsaan my poes nie! pasop jong pasop"

I'm here to give birth to the holy babies. Don't you know me? I'm going to give brith to a hundred holy babies. Your cunt! Be careful of me - I'm not even wearing a panty next to my cunt!"

ME: I..

Mrs G: Fok jou! Julle willie vir my help me. ( starts sobbing hysterically and clutching onto the sister standing next to her.) Ek willie he my pa moet vir my slat nie! Hoekom skree hy soe vir my? Hy het nie vir my lief nie.

Fuck you. You guys don't want to help me. I don't want my father to beat me. why is he shouting at me like that? He doesn't love me!

and in the next breath:

Mrs G:
Ek het baie respek vir u doctor. Baie respek.

I have lots of respect for you doctor, a lot of respect.

and in the NEXT breath:

Mrs G: Jy's a jintu! Jy wil my man naai. Ek ken vir jou - jy wys jou poes vir almal en jy soek net piel.

You're a whore, you want to fuck my man. I know you - you show your cunt to everyone and you are just looking for cock.

At which point she shot up out of the chair, lurched towards me with a fiercely clenched fist on it's way to connecting with my cheek.

But I'm quick like a ninja and dodged just in time, just as the sister grabbed her hand and surely averted a trip to the trauma unit myself.

Have I mentioned how the sisters are my bodyguards in this place?

Good God. We needed six people to hold her down while I injected lorazepam, valium and haloperidol into that one. Maybe a little bit of overkill, but - she was dangerous - and like every good ninja knows - hit them hard and hit them fast.

Back to the loch with you, Nessie!

I mean, straight to the loony house with you, lady! I did feel a little bad though - seems like all of this, like with most of the crazies, stemmed from a terrible childhood.

But anyhow...Phew! Nearly came home with a black eye today!

And that set the theme for today's trauma unit adventure - I saw seven crazies today. SEVEN that were so psychotic they needed admission.

Must be a full mooon or something. Or just Satan playing tricks on me again.

Monday, May 18, 2009

I laugh in the face of chinese torture

Oh my God.

The clinic is a very very special kind of torture. Very very special.

45 to 60 patients a day.

Today 3 doctors were absent from work. But dutiful, competent little me was unfortunately not one of them. I can be really annoyingly dutiful - this is very much to my own detriment I think.

THUS... guess what awaited me today at work...???
Everything was waiting for me.

Oh it's no problem though! I simply waved my magic stethoscope and miraculously all my patients looked like male models.
So that was cool - examining 45-60 well-oiled well-defined torsos, not a bad way to spend the day. I went home satisfied that I had a great career and thanked my magic stethoscope for a job well done.

I wish.

Every single patient today, despite their normal uncontrolled hypertension and diabetes - brought a freaking SHOPPING LIST of problems to their consultations. The clinic has specific days for certain issues. Today was diabetic day. They knew this, having been diabetics and attending the clinc longer than I've been alive.

Yet they saved up the last 25 years worth of niggling medical problems, shoved them in their green pick 'n pay shopping bags and then poured them all out onto the desk in the consultation room. With 45- 60 patients, and a few hours in the day - this is NOT FAIR!

Not fair on me! Not fair on the patients waiting to be seen. NOT FAIR MOMMY NOT FAIR!

PEOPLE! I'm here to assess your Diabetes and it's side effects.

I'm not here to:

*Apply for a disability grant. You have no grounds for a grant. Unless obesity and non-compliance count, you do not qualify!

*Write letters to the freaking traffic department so you can park in the disability bay right next to the mall entrance. LAZINESS is not a medical condition. Stupidity maybe - maybe I should write you a letter for that.

*Diagnose the skin tag that has been present on your ass for the last 12 years.

*Listen to you moan that you don't have taxi money and that I should give you some so you can get to the referral centre I'm sending you to...when ACTUALLY you are spending up to 40 bucks a day on cigarettes. NO. NO. A thousand times NOOOOOOOOOOOOO!!!

And so on. And so forth...


stay away from the sharp scissors.

Today was horrible. I think it's getting to me now. I have 6 weeks left in this place. Must stay sane until then...

By the way - did anyone see the new Star Trek movie? I have never even watched ONE episode of Star Trek but I totally loved it. I especially loved the doctor and the cool things he got to treat in space. I want to be a doctor on a spaceship in space! Someone invent time travel already so I can go there! I'm sure there's no diabetes in the spaceship in the future.

Tuesday, May 12, 2009

Thank you for the presents!

We love to complain that Medicine is a thankless job.

Often, we do awesome heroic things that look really cool like cardiopulmonary resuscitation, or inserting chest-drains, or putting intra-osseous lines in neonates.
I've been thanked maybe a few times for doing those things. Not that I really expect it - it's my job after all. (also - after forcing a tube through one's rib cage I doubt anyone's going to be that motivated in gratitude!)

HOWEVER....I have noticed that in the quiet of the clinic room - 9 out of ten times I get a sweet, "Thank you, Doctor" as the patient walks out the door. I get thanked for the little things more often. Mostly I get thanked just for listening, even when I've really done very little in the way of physical exam or medical treatment.

This is very touching. Anyone can listen - one doesn't need to be a doctor to do that.

Sometimes the patients go as far as giving me presents. I try to refuse as much as possible but never win. My patients are very poor so the presents are not very big, and so often it's more harmful to refuse the gift of a few sweets or a plum than to accept and make the patient feel good for giving, when they already have so little to give.

Sometimes the gifts are slightly peculiar.

Here is a list of the gifts I've received as a med student and as a doctor in the community.

1: peanuts, sweets, chips and fruit. (usually given by the old ladies. I love gifts of food because it means I have something to snack on during the long day as I often don't get a break for lunch. I'm always suspicious of the peanuts though, especially if they're unsalted. My dad once told me a story about an old age home where it was discovered that the inhabitants would lick the salt off the peanuts and then put them back in the packet, as they couldn't eat them due to their false teeth! Now every time I see unsalted peanuts I think of old people's saliva.)

2: religious verses ( I've been given copies of bible psalms, prayer strings, quranic verses - the works. They all always say they'll pray for me. Thus I am so well-connected now in all spiritual realms nobody can fuck with me!)

3: phone numbers from male patients ( the young ones always try their luck. seriously inappropriate!)

4: phone numbers from grandmothers who want me for their grandsons ( Despite me telling them over and over again that I am taken, and happy with the man I have! I even had one granny bring her grandson with her one day, pushed him into my office and left the two of us there to .....?? Not sure what she wanted us to do. The poor dude was so mortified. Sorry dude - you weren't bad-looking, just not that into 17 year olds!)

5:narcotics. ( that's right, narcotics. When I was a 4th year medstudent doing my obs and gynae rotation, we were delivering babies in the labour ward one evening. This particular couple had lost two children and were really counting on this delivery to go smoothly. Which it did - we did very little as the baby basically delivered itself. The dad, a Rastafarian, was so thankful that he took us behind the hospital and gave us a bag of dagga. I can't really remember if we kept it or not....)

That was probably the most insane gift.

Here is a list of gifts I would like to get ( but would probably have to refuse ethically)

1: 300 million British pounds,
2: 400 million British pounds,
3: 500 million Britishpounds,

you're getting the picture right....

Here is a list of gifts I really really want the patients to give themselves.

1: Compliance in taking their medication EVERY DAY!
2: Healthy sugar free diets, especially if you are DIABETIC.
3: CONDOMS! they're FREE you promiscuous bunny!
4: Exercise for the obese patiens.
6: Not taking tik when you are psychotic.
7: Not drinking, and then stabbing your friend or family member.
8: Leaving that asshole wife-beating husband of yours.

Oh yes, and before I forget did I say thank you to the nurses? It's NURSES DAY today! Thank you you hardcore beautiful lovely ass-kicking wonderful caring nurses!!!! You guys are the best most useful gift I could ever ask for at work!

Sunday, May 10, 2009

What to do next year?

There comes a time in every South African doctor's life which is very very scary. It induces hyperventilation, irritable bowel syndrome, anxiety and depression.

It's called the "What the hell do I do after Community Service???" conundrum.

You see - us medics are notorious for being a really responsible bunch. We go to school for twelve years. Study hard and get into medschool. Then we are handed the next six years of our lives in the form of obtaining our MBChB's. While we are doing this we watch the business graduates and BA students partying up a storm. We think really long and hard about changing to Bcom or business science - but then decide against it cos we're too far down that "becoming a doctor" road and what the hell are we going to do with three or four years of a six year course? Nobody is really going to give you credit for that, and there's no bridging degree!
After that we are instructed as to the next three years of our lives in the form of two years of internship and a year of community service. We accept all of this without question, and do as we are told.

So effectively - after school, the last almost decade of our lives have been set out for us, cast in stone, inscribed on our foreheads, tattoed on our eyeballs.

"You will do this, then you will do that and then you will do this!'

We haven't been in charge of our own lives at all! Our daily schedules, amount of free time, where we work - whether or not we can attend that birthday breakfast on a Saturday morning or not -- have all been determined by health authorities and on-call rosters.

But that's all coming to an end in under 7 months.

So now what?

What the hell are you people asking me to do? Actually make a decision for myself? That's LUDICROUS! You didn't teach us how to do that!

Now I have to make a decision on my own, and go and apply for jobs, and go for interviews, or not go for interviews and go overseas. Or not go overseas and stay in SA where the government is constantly finding novel ways to make our working conditions worse and having a rate-limiting fixed amount of overtime payment - despite working far more than the required overtime hours.

Also - what jobs should I actually apply for?

Should I specialise?

If I specialise then I'm committing to five years of hard grafting. Furthemore - what specialty should I choose? There are like three hundred thousand options. Actually 299 998 because I will never do paediatrics or obstetrics.

Should I not specialise and open up a gp practice?

Also - I have OVARIES. These ovaries are busy shutting down as we speak. If I specialise then it would be prudent to put off having a child until I've finished. But then I'll be 59 years old or something and my baby-making capabilities will have passed. Why don't men have to deal with this problem. Oh yeah - cos they can still inseminate when they're 79.

AND - do I actually want a child? (But that's another blog post waiting to happen.)

Deep deep sigh. All of these questions are now constantly lurking under the surface of my usually crystal clear pool of a mind. It's unsettling.

The hubby suggested we take two months off to travel through India. At the moment this seems like the most perfect option!

Any ideas, anyone?


Tuesday, May 5, 2009

Jive bunny, Jive granny.

I once had an old lady in my clinic room.

This is not unusual. most of my patients are old.

This lady was unusual though. She was brought in by her daughter. Her daughter was already old , about 60, and the patient , her mom, was somewhere over 90.

Pretty cool I thought. To be 90. Also she had pink stockings on. I thought this was particularly cool.

I made a mental note to wear pink stockings when I was 90.

Anyhow - that's was not what made her unusual. She was unusual in that she was smiling! She was smiling and laughing and joking around with me. I loved it. I asked her daughter if she had any symptoms bothering her, and they both emphatically shouted, "NO!".
And she didn't.
All her bloodwork was normal, her blood pressure was fine and her glucose levels were acceptable. This lady, at 90, was the picture of health.

I must have had some kind of incredulous look on my face, because the old lady suddenly jumped out of her chair and said through her toothless mouth," Hey Doc, you don't believe me hey? Watch this!"

She suddenly started twisting away, like we did last summer, in my consultation room. All the while letting out whoops of delight and going , "Hay-yo! Hay- yo! Look at my hips, look at my hips! They've still got the mooooves. Look at my mooooves!" (she said moves, like that, with four O's.)

That was awesome. Oh man - I didn't want her to leave. This funny old pink-stockinged 90 year old grooving to the tunes in her head in my office.

I considered testing her for dementia. Then I thought, Nah, stop being a cynical doctor for a while, Dr S, and just believe that this lady still has a great zest for life.

I figured that if her daughter didn't mention anything then there wasn't a problem. I'm certain that once she starts grooving naked in the middle of the living room while guests are over I'll see her back in my clinic. Until then, I'd just add some supplements to her meds and spare her the barrage of testing...

You go Jive granny!

Verbal spankings

Mostly - I love my patients. I really love them. People are so interesting and have such varied characters. I am also privileged to be able to learn intimate things about patients in a space where I try to make it easy to express themselves.

But sometimes , when in the clinic, one is forced to consult with that one hardcore poisoned apple of a patient. That patient manages to infect one's entire day with irritation and frustration, despite the fact that when you woke up that morning you promised yourself you would spread love and joy and compassion to everyone you met.

Of course, one tries hard not to let it show, but that patient - oh that cunning patient knows just how to get under your skin. There are a number of ways they do this - they can be rude, they can be sexist, they can be racist, they can be stubborn. Whatever it is they just know how to push one's buttons in a way that makes you want to start busting out some martial arts moves.
Of course, we can't inflict karate wounds on them. Even if we do know how to patch them up afterwards.

No see, WE have to be professional. WE have to suspend our human qualities and emotions. WE have to be the solid rock that despite being abused in all sorts of ways by our trade, is never ever allowed to be flustered. Doctors=saints=superheros.

Let me tell you about my button-pushing patient. Let's call him, Mr FU. Mr FU was patient three of the day. So there was no reason for me to be irritated. I was fresh from a good night's sleep. I woke up in time for a healthy breakfast. I even managed to watch a bit of morning news before heading off to work.

That day I endeavoured to be a healer. I would be a holistic wonderful western/eastern healer and heal physical and spiritual problems. I would do this by really listening to the patient and by being non-judgemental. I would be awesome.

However, in walked number 3, Mr FU. MR FU was about 66 years old. Average height, previously owned a farm in the Boland, was stinking of cigarette smoke and started sighing before I'd even greeted him.

"Oh shame", I thought, "this man seems troubled- perhaps I can get him to open up with my soothing voice and gentle nature."

Wrong babe. Wrong . Fail. try again.

I open up his file - a known hypertensive and diabetic. A smoker. ( that was obvious). Has already had two heart attacks and a triple bypass operation which probably cost thousands, but which he paid nothing for as he is now an unemployed pensioner. After being discharged post-surgery he had a team of specialists come up with a comprehensivve treatement plan. He has defaulted on this treatment for the past three years.

Oh-oh..I started to hear the clang of distant warning bells...

I began in my standard way.

Me:"Goodmorning, how can I help you?"

MR FU:"Agh Jesus man, just do what you is supposed to and write out my tablets? None of you doctors is even helping me. So don't blerrie ask me any questions. I'm sick of questions."

Right. Ok. This one was going to be a toughie. Not only because I wanted to correct his English but also because he was proving to be difficult from the get-go. But, No problem, I thought, I can handle this.

Me: Sir, I sense you've been very frustrated by our health service thus far, is there anything I can do differently to help you? Perhaps explain something to you that you didn't understand or maybe try to treat a symptom that is bothering you?

Mr FU: I has burning feet. You probably has no idea how to fix it so I don't know why I is even telling you this.

Me: Actually, I know exactly why your feet are burning and I AM going to try to fix it.

Mr FU stared at me for a few seconds, suddenly a little interested in what I had to say.

Do you want to know why?

Mr FU: Ja fine. explain to me why my feet is burning.

: You have Diabetes. The sugar level in your blood is very high. It's affecting the nerves at the end of your body.I see you haven't taken your medication, and this is not helping you to keep the sugar level from affecting your nerves, you see....

Mr FU suddenly interrupts me:
Um... doctor?

Me: Yes, am I going too fast for you?

Mr FU:
Kry net klaar, my klimeid, en gee my my medikasie.

That was in Afrikaans. It's pretty damn rude in Afrikaans. In English it's the equivalent of saying, "Just hurry the hell up, and give me my medication, you little girl."

Except that the word he used for little girl, "klimeid" was a word used by the Afrikaners when referring to their Coloured housemaids or farm workers. It's pretty derogatory.

That's when I decided I'd had enough. Peace, calm and spirituality went hiding under the table.

Me(enraged, and with blood spurting from my eyeballs):

MR FU! YOU were the one who just asked me to explain this to you and now you're telling me to shut up!? Furthermore, you will not EVER speak to ANYONE in this hospital that way or we will refuse to see you. Jy is ombeskof! ( you are rude) WHAT exactly are you doing here? You've already had a triple bypass operation, that saved your life, but it doesn't seem like that made an impact at all.I do not have to treat abusive patients. So I'm giving you two choices now. You either leave my office immediately and go home to have another heart attack in your own bed, or you take off your shoes and get on my examination bed immediately so I can try to help you.

I expected, and unfortunately actually wanted, him to get up and walk out.

Amazingly - he obeyed my instructions and got on the examination bed. He was dead quiet for the rest of the examination and history taking. He was all, "Yes, Doctor. no Doctor, thank you , Doctor".

As I suspected, he had peripheral neuropathy and I managed to talk to him about how it was caused by his lack of glucose control. I also asked him if he wanted me to prescribe something for the burning sensation - which he did.
I asked him to come aback for a check-up in a months time - to which he agreed.

The clincher was that at the end of the consultation - he apologised to me and thanked me for sorting his problem out so thoroughly. He claimed I was the only doctor who took the time to help him. I'm not sure if he was being sarcastic or not. I have pretty good sarcasm radar - and mine wasn't going off.

Was I wrong in telling this man off? I think that in this case, no. The answer is no because the outcome was good. He actually came back and at that consultation his glucose level was lower and the burning sensation in his feet was less troublesome.

So what am I saying? I'm not saying we need to lay into all the non-compliant patients. And before you accuse me of wanting to bring back corporal punishment in schools and the death sentence, all I'm saying is that maybe, just maybe - people need a little verbal spanking from time to time to help them realise the seriousness of their behaviour.

We really have to try every angle to get through to our patients...a little whipping with words unfortunately DOES sometimes do the trick...

Monday, May 4, 2009

Welcome to theTrauma unit - what is your non-emergency?

Sometimes, I really just don't know what is wrong with the patient, despite their best efforts, their really valiant efforts, at describing their symptoms.

For example, my patient who decided that she had a problem that needed urgent attention at 3am on a Monday morning.

This was our actual conversation. ( bear in mind that she actually sat and waited for 3 hours in the waiting room to see me with this problem. Also bear in mind that I was pretty freaking tired so if this makes sense to any of you, and you can come up with a diagnosis please let me know.)

ME: Goodmorning, what is your emergency? And please let it be a freaking life-or-death emergency because that's all I should have to deal with at this time of the morning. ( No, not really - but that's what I wanted to say. Instead I just said "Hello, what seems to be the problem?" like the good little doctor I am.)

Patient: Well, Doctor, you see I have this pain in my right back side of my head.

ME: how long have you had this pain?

Patient: 6 months

ME: What the hell lady! 6 freaking months and you are here at 3 in the morning forcing me to listen to your chronic issues! Do you know the meaning of emergency unit? Do you? ( Again, no not really...but you're getting the picture, right?)

Patient: Yes so it starts in the right back side of my head, and then it like shoots to my left part of my chest. But sometimes it doesn't go the the chest it actually is in my back. Not my whole back, no not my whole back - only here on my lower back.

Me: So there's no pain in your neck?

Patient: No man - I told you, only in my chest and my back.

Me: And there are no other symptoms you're experiencing - like headaches, nausea, vomiting, blurred vision or weight loss?

Patient: No,just listen doctor: I said it's on the right back side of my head. Oh yes, but that's only during the day. But it's not every day - it's only sometimes, like when I've been drinking a lot of milk. And then at night - it starts in my foot and goes up , all the way up to my back again. Is it because of all the milk , Doctor?

This lady had just managed to describe pain from the top of her head all the way to her feet.

I honestly had no clue what was wrong with her. And at three in the morning my brain was not functioning well enough to play medical detective games. I toyed with the idea of telling her that EVERYTHING was milk-related and that she should stay away from all dairy products for the rest of her life.
But that would have been unethical, and wrong. So I did what any COSMO ( community service medical officer) in my position would have done.I gave her some analgesia from the pain cupboard and told her to come back in the morning for tests and x-rays.

It was honestly all that could be done after hours, and I didn't even have time to feel bad about it due to the numerous emergencies starting to roll in.

She was not the first, and she won't be the last non-emergency a COSMO will have to deal with during their slave-years. Some of the one's I can remember visiting the trauma unit at God-forsaken hours are: constipation, fleshy tags, eczema, and normal monthly menstrual periods.
The best is always the lady who comes in with "something moving in her tummy". And then that something, after a simple bit of magic called peeing-on-a-stick, turns out to be a baby!

I must say, that's the one non-emergency I don't really mind "treating" at 3 in the morning...


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