Monday, June 29, 2009


I never ever thought this day would come...

But if one examines the history of state health service in this country, the current strike was a long time coming.

I have two days left at the Community Health Centre I work at - but I did not go to work there today.

A decision was taken at a meeting on Friday to strike for a better future in state health care, for patients and doctors. The meeting occurred at our tertiary referral centre, and we decided that all day hospitals would close down, and that the state doctors from those centre's would go and help out at their secondary and tertiary referral centres. We decided to keep only the essential services running at these hospitals.

Thus, the Western Cape Province is only running emergency services, like casualties and trauma units, labour wards and ICU, for life-threatening emergencies. All non-essential clinics and elective surgeries have ben cancelled.

Of course, defining what actually constitutes a life-threatening emergency is difficult. Do we stop giving chronic disease patients their antihypertensives? They are not technically an emergency case, but not having their meds might result in an emergency. Do we continue running the anti-retroviral clinics for the HIV patients? It's really hard having to deny patients care in this way. But we are completely fed up, and have no other recourse. The government has exploited our humanity for too long. They know that we will always put ourselves above our patients. But who puts us first?

Why are we actually striking?

We are fed up with the current pathetic state that our Health Care System is in. We are shocked by the government's lack of urgent action to remedy the situation. All of their children and relatives must be using private hospitals. Nobody in a position to change things could just stand by if they knew exactly what was going on at the state hospitals.

We are saddened that we cannot provide the quality of health care we know we are capable of due to the fact that our resources are so limited. Some hospitals do not have sterile gowns in the operating theatre. I have often had to man the trauma unit without an ECG machine or an oxygen saturation monitor. I have colleagues, at my level, working up-country who have to do three jobs at once. And by that I mean: Putting the spinal anaesthetic into the pregnant patient themselves and making sure she is stable - then scrubbing up and performing the caesarian section themselves - then resuscitating the child after delivery - then rescrubbing to close up the wound from the caesar-then monitoring the patient in the recovery room. They're supposed to be working as COSMO's ( community service medical officers) like me - instead they are the anesthetist, paediatrician and obstetrician all at the same time! IT'S RIDICULOUS! And dangerous. And unfair to the patients.

Furthemore - we are insulted by our current salaries. Compared to other government employees - Dr's are undepaid by up to 50 percent. This is not a comparison between South Africa and other countries - this is a comparison with our OWN government employees. A judge at the highest level gets paid 50 percent more than a chief medical specialist. Despite that medical specialist having worked longer hours, and trained for longer. A bus driver's basic salary is the same as an medical intern's basic salary without overtime. How does this make any sense?

We are striking for an increase in our wages to ensure that our doctor's stay in this country we love, and not be forced to move overseas due to better working conditions there and greater financial reward.

The government was supposed to implement the wage increase last year in June 2008. But since then, nothing has been done about it. The strike, started in Kwazulu-Natal Province, forced the Government to begin talking about our wages again, and begin implementing them. Recently the government thought they were clever, and presented us with an offer - claiming that they had increased our salary by 30 percent. But it was nonsense.All that they did was collapse our rural allowances, scarce skills pay and overtime into our basic salary. The actual increase worked out, for some of us - in the region of an extra R300 a month.

I was one of only two doctor's from our community health centre who decided to strike today. The rest don't seem to be interested. And my clinic ran as usual today with no change. Perhaps they feel that things are running smoothly. Perhaps they have been suffering too long to stand up for change. I'm not sure. Perhaps they just can't leave the patients. All I know is what I've experienced and what I've experienced has been shocking.
I might get into a lot of trouble for staying away, I might not. I don't know. But someone has to do something.

So today about 300 of us from hospitals around the city, toyi-toyi'd and marched and sang. All the media were there. It was hectic.

I am seriously frightened for the future of health care in this country - it's stressing me out.

I start as a medical officer in the trauma/casualty department of a secondary hospital on the flats on Wednesday. As this falls under emergency services I will definitely be going to work then....

We'll see what the future brings...the bargaining chamber is still hot with discussions as to what the Department of Health should offer us... so far what they've offered has been akin to a slap in the face.

Sunday, June 28, 2009

Michael Jackson

Michael Jackson died on Thursday night.

I am distraught.

When I was little I was completely obsessed with him.
I used to dress up like him, wore plasters on my fingers like him and curled my hair like him. Sometimes I believed I was him.
I used to sneak his tapes into class and listen to them surreptitiously on my walkman. Once, I was caught being naughty, and was told to stand up and explain myself in front of everyone. To prove a point, my eleven year old self climbed on top of the desk and danced like Michael Jackson instead.

What does this have to do with medicine? Not much. I just wanted to remember him on my blog. He was a huge part of my childhood. And I'm going to miss him. Despite the scandals he was the most phenomenal artist. Ever. We will NEVER see the likes of him again.

Heal the world.

Here is a little story I'd like to share with you, which does actually relate my Michael Jackson mourning to the community health centres...

My colleague and dear friend, Dr MJ ( yes, her initials are also those of Michael Jackson's) was my clinical partner and great friend throughout medical school. Thus, I have been privy to the bizarre behaviour she displays when having to go long periods without sleep.

Most of us get tired and grumpy, Dr MJ gets silly. Really goofy and silly.

She was on call, at a day hospital similar to the one I work at, not too far from ours, on the night that Michael Jackson died.

At about 4am, manic from lack of sleep, she decided that it was her duty to walk into the waiting room and make an announcement.

This is how it went:

Dr MJ: "Verskoon my, maar is julle bewus dat Michael Jackson gister aand gesterf het?"

Excuse me , but are you aware that Michael Jackson died last night?"

The patients,some on IV lines, some with possible heart attacks or twisted bowels, were more shocked that the doctor was in the waiting room than by the actual news. They seemed to forget their woes and just nodded there heads sadly, "ja dokter, ja dokter" (Yes doctor, yes doctor.)

Not satisfied with their bland response she then went on...

Dr MJ: "Kan ons aseblief nou 'n minuut stilte hou vir Michael Jackson"

Can we please now have a minute's silence for Michael Jackson.

AND THEY ACTUALLY OBEYED HER! They all sat there quietly, bleeding and aching at 4am in the morning, for one full minute.

Dr MJ is officialy my new hero(ine).

How peculiar is that?

Such is the greatness of Michael Jackson!
Long live the King of Pop!

Tuesday, June 23, 2009

McGuyver Deliveries.

I'm in the tabloids!

Listen up people! In the world of the public health system - there are strict rules.

The first rule is this: There shall be a gross understaffing of all units, and a severe lack of working equipment.

The second rule is this: This means that to receive the free health care you want, you will have to wait.

The third rule: Being brought in the ambulance, or arriving before another patient, does not mean that you will be seen first. There is a triage system - stabbed chests, heart attacks and the likes get seen before chronic back pain and boils on your bum.

If you do not like this, please go and visit the GP down the street who will take your money and send you back here for an x-ray anyway.

No matter how many times I have to explain this, you still don't get it do you?

Maybe I should say it in Afrikaans.

Die dag hospitaal is 'n wag hospitaal!

What's that, oh you don't like this system? Why don't you put some effort into your complaint and write a letter to the government? Oh wait ,the clever previous Government, they didn't prioritise education for those living on the flats, so you can't write!

What did you say? My mother's what?

Oh and now you're threatening to sue me and put me in the tabloids? Which one, may I ask?

The "Daily Voice", is that right?

Come on man, don't be cheap, I'm worth more than that, put me in the Cape Times!

My poor patients, frustrated up to their eyeballs by the long waits they have to endure, have this one recourse - to threaten those of us actually working in the system with a call to the tabloid to "expose" us. The "Daily Voice" is a very popular community tabloid. Some buy it for the "information" it contains, some for the page three girl. Either way, it costs somewhere in the region of R2. Which means that it is cheaper than toilet paper.

Poor Paramedic

Bleee Blaaaa! Bleeee Blaaa!

That is simultaneously the sound of the ambulance van approaching and the sound that my brain makes after a heavy night of......the trauma unit.

The ambulance uses it to signal some heavy incoming trauma traffic.

Brain uses it to signal to the rest of my body that there will be NO MORE outgoing neuronal traffic, because being awake for 30 hours is incapacitating. All efforts from the quivering grey jelly in my skull are then reduced to maintaining vital organ functions, and movement towards a horizontal position.Preferably on a soft mattress. Without fleas.

A few days ago - one of the ambulance drivers arrived at the trauma unit.
My heart usually sinks when I see them as I know that they usually only bring me one of two things:

#Cold, green cases ( infected toenails, chronic constipation, flu, and even flea bites. Yes, somebody called the ambulance at midnight for flea bites.)

#Heavy red/orange cases requiring resuscitation or referral to another clinic.

This is not their fault, they are required by law to bring everything that is called in, to the trauma unit. The patients know this and abuse their rights, using the ambulances as taxi's instead of the highly equipped emergency vehicles staffed with highly trained professionals that they are. In this way the ambulance services are backed up with transporting bullshit when the real emergencies are left waiting...dying...

This time, however, the ambulance driver WAS the patient.

She was on her way through the townships to start her nightshift, dressed appropriately in her ambulance jumpsuit. Suddenly a large mob abducted her and took her to an area where a man was lying prostrate on the floor. He was dead. But the mob refused to listen to what she was saying, and threatened her with stoning and stabbing should she not do what they say, and bring him back to life.

So she performed CPR on the dead man.
For two hours.
Under threat of death.
Eventually the ambulance van showed up and fooled the crowd into thinking that they were taking the dead man to hospital.

She was distraught and hyperventilating from the episode.

I suppose in a twisted way they were offering her the highest compliment, by believing that she could bring people back from the dead with her holy paramedic skills.

That poor lady. I wonder if she'll be one of the many moving overseas to work in safer, more respected working conditions?

She is not forced to help you, she does it because she wants to help and because it is her job. Her working conditions are bad enough as it is. She has no real support from the department of health in trying to change things, but she sticks it out anyway to make sure you're ok.

So was it really necessary for you, you bastard, to threaten her with her life? Could it be that she may have willingly helped you, if you had simply just asked her?

Friday, June 19, 2009

Little Pink Shoes

I have tried for four weeks to write this post.

It's been difficult.

I feel as if I have an obligation to tell it, but every time I try I don't know how to write it so that it has the most impact. Whichever way, it's a story that needs to be told, because it is the story of many in South Africa.

This is the best I can do...

Despite the 5am darkness and freezing rain, she was grateful for the job that forced her to get up at this hour.
It provided an income, without which she wouldn't be able to clothe and feed her, beautiful 2 year old daughter Zandi*.

Her little sulky Zandi, she's always grumpy at this hour,and protests bitterly at being forced from the warm mattress they share.

She hugs her and speaks softly in Xhosa, 'get up my child, I have to go to work and you must go to the Aunty's house while I'm gone'.

While getting ready in the tin-walled, leaking shack they live in, she worries about her HIV positive status. Yesterday the clinic doctor told her that her cd4 count was low. She didn't really understand because the doctor spoke only English, but she could tell by the way the doctor spoke that this was not a good thing.

Suddenly scared, she offers a silent request to the ancestors that she will stay healthy long enough to support her child into adulthood. After all, there was no-one else to do it.
Her parents were dead and the father of the child just a distant, regrettable memory.

When she moved to Cape Town from the Eastern Cape, it was difficult as a single mother. But luckily she found a job as a domestic worker in Claremont. An old lady in the township offered to look after her child during the day for a fee of 30 rand a week. That lady was a very clever business lady. She looked after many children during the day for 30 rand a week each. No wonder she had a radio AND a TV in her place.

Dropping Zandi at The Aunty's house was always a difficult part of her day, what with Zandi always crying and pleading with her not to go. Today though, Zandi just looked sad and watched her leave with watery eyes. Perhaps she was beginning to accept her daily fate at the Aunty's House. Her daughter looked thin and small standing in the doorway.

But, there was no time to feel guilty, the queues for the taxi's had already started forming and The Madam is always very upset if she arrives late.

The Madam's house was enormous. And her children had so many toys! She spent most of the day cleaning up after them. Scrubbing floors, making beds, washing windows. It was tiring, but she thought of her daughter and persevered.
If she just managed to keep her job and earn enough to send her daughter to school, their luck would turn around. It was her wish that Zandi do better then her, and be the first in her family to get her matric certificate!

Maybe if Zandi got a good matric, she could get a bursary to university! But that would only happen if she had enough money to send her to school and to pay for all the books and school clothes.

While working in the kitchen, her cellphone rang. The Madam had given it to her. It was an old one that her son did not want anymore.

It was The Aunty."Your daughter is not well", she said.

"What is wrong with her?", she asked.

"She is breathing fast, You must take her to the hospital.". And then the line went dead.

The Madam was very upset when she asked to leave early and did not seem to believe her story. But she had to go. She took the train and a taxi back to the township, and eventually after an hour and a half of anxious, worrying thoughts, arrived at The Aunty's house. There she found her little Zandi lying on the floor, eyes wide open and gasping for air...

I arrived at 5pm that day for the start of my night shift. Merely ten minutes into the shift, I noticed a mom walking calmly into the unit with a little bundle in her arms. As I was busy with another patient, I let the Sister do the triage.

The Sister opened the bundle and immediately called for a resuscitation.

I jumped up and ran over to the bed where the little bundle was now placed.

What I saw was an absolutely beautiful two year old girl, neatly dressed in a pretty top and pants, with a little pink jacket and matching little pink shoes.

She looked like a perfect factory-formed little doll.

And just like a doll, she was unresponsive. Only her little respiratory system showed signs of function, when it made one desperate effort and she gasped twice. She had no pulse. I also had to note that her pupils were fixed and dilated.

However she was still warm. Most of the people brought in from outside needing resuscitation have been adults, who were sickly looking and had cool peripheries. This little girl was well-looking and warm, and despite my doctor's senses screaming at me that this girl had a poor prognosis, the fact that she was warm was playing havoc with my mind.

We started the resuscitation. We called all the other doctors to come and help, even those busy in the clinics. I refused to stop. How could we stop when the mother was waiting just outside the door?

Eventually, when it became clear that we were losing the battle for her life, I knew that any more resuscitative efforts would be inhumane and in vain.

So we stopped.
And Zandi died.
Dressed like a doll in her matching pink shoes.

Her mother looked at me with hope and despair as I approached her.
I could do nothing but confirm her nightmare; her little girl had died, despite us trying to do everything. She cried and cried and cried. And I sat with her for half an hour listening to her cry. I refuse to cry when telling the family. It's not fair on them. I'm not the one who lost a child, so I really have no right to burden them with a blubbering doctor on top of everything.
So I just swallow really hard and take a deep breath.

She told me the story of how she had no-one here to support her and that she had no family left. She had moved to Cape Town for better treatment of her HIV, and for a better future for her Zandi. She told me how she ran to the taxi rank with Zandi in her arms, and begged them to let her jump the queue to get to the hospital quicker. She truly believed that Zandi would be ok. But now she had nothing left. I gave her all the money I had with me and let her use my cellphone to call a friend for help.

I finished my shift that night unaffected. After all, there were others waiting to be treated.

But, as soon as I got home the next morning, I remembered the little pink shoes and the waste of a little girl's life. I cried and cried the whole day.

I knew that Zandi was already gone by the time she got to us, and that there was nothing more I could do. The real tragedy lay in the situation of poverty her mother was in. The desperate lady had no recourse but to find a flipping taxi to get to the day hospital, while her child was busy dying in her arms all the way. This is what our patients face.

If Zandi had been born to a rich family, the signs of her illness would have been picked up earlier. The mother would have been able to stay at home and look after her. And if anything happened they would have called their private ambulance or got in their fast car to bring the child speedily to the emergency unit.
And the child would probably have lived.

Now every time I see little pink shoes I can't help but think of Zandi, and be reminded of the tragic situation our nation's poor patients are constantly battling against. It's too sad to contemplate. Mostly I just ignore it in order to function at work. And so far it's been the best way of going about things.

Zandi and her little pink shoes for forced me to open my eyes again and confront the horror.

*Name changed

Last night-call last night.

Last night was my last night on call at the Primary Health Care Trauma Unit.

After 30 crazy nights on call in this spirit-crushing, armour-building, crazy-wonderful place, I am amazed to admit that it was a bittersweet experience.

While being in a fantastically good mood all evening, ( even tolerating the swearing from our disustingly rude patients), the evening was nevertheless tinged with nostalgia for the night-calls past.

I was expecting the Fates to weave a kitten-clawed tangled mess for my last night at the trauma unit.

Yet, they must have taken pity on me, and as a reward for surviving six months of primary health care hell, deemed my last night to be a peaceful one.

The only interesting bit was the hour between 10pm and 11pm - whereby not less than three stabbed chests with possible pneumohaemothoraces* rolled through the door.
Which resulted in me performing mini-surgery and inserting three chest drains* consecutively.

By three am it was unusually dead quiet and we spent the rest of the night reminiscing about the past six months, laughing at the ridiculousness of the situations we've faced, and sympathising over the particularly emotionally tough cases we've had to treat.

I was on call with a fantastic team of Sisters, some of my favourites:

Sister B - a nursing sister with a constantly jolly spirit, absolute commitment to her cause of helping those in need, and one who operates as everyone's mother. She baked banana loaf, date loaf and fried samoosas for a midnight feast in celebration of my last night. What a darling!

Sister S - most famous for her "finger of doom" and short-temper. A brilliantly skilled lady, she can also reduce grown men to tears when she is irritated by their behaviour or health ignorance. You know you're in for an ass-whipping when Sister S pulls out her "finger of doom" and starts pointing it in your face. There is more threat in that first finger on her right hand than the entire nuclear threat in North Korea. My most prized compliment from the day hospital, was when she herself told me she became a little bit frightened of me after I unrelentingly berated a patient for their rudeness towards the trauma staff. I told her that she was my inspiration.

And then there's Sister M - the sweetest Sister of them all. Quiet, competent, unassuming and never, ever threatening in any way.

As they are all working night shift, last night was the last time I'll ever see them - unless I come back to do locum calls later on in my career.

I'm so ever grateful to them for making my stay at the day hospital tolerable. Despite the pathetic working conditions they face, and paltry salaries - they are committed to helping their communities, never fail in their happy working spirit, and are ever-ready to support and guide the frightened new doctors. All of which makes them the best nursing staff I've ever worked with.

In my mind they are giants and heroes, and I will miss them greatly when I finally leave here at the end of the month.

So in the messed-up way that a victim falls in love with her captor, so have I become very attached to this crazy place.

Isn't that called Stockholm Syndrome?
Well, I have it.

But don't worry my readers, this being my last night here does not mean the stories will end.
On the contrary.
I'm off to work at the most notorious secondary hospital in the whole of the Western Cape, and maybe South Africa at the end of June.

And I'm 100 percent sure that the stories from there will not disappoint you!

*haemopneumothoraces: the plural for haemopneumothorax - blood and air in the space around the lungs, causing compression of said lung and compromising breathing. Usually caused by external penetrating injuries of the chest wall.

*Chest drain - having to cut through the skin, subcutaneous tissue, dissect through the rib space and puncture the membranes surrounding the lung on the affected side, and then inserting a tube attached to a drainage bag to decompress the lung by draining off blood/air.

Monday, June 15, 2009

I'll just die if I don't get my hands on that jacket!

I'm a fashionista.

I'm obsessed with clothes.

I'm a woman so this is not really that suprising, but sometimes I even amaze myself at the outfits I come up with. Can I just brag a little bit and say that I've won two best-dressed awards in the last three years: the first being at the end of medschool,( Best dressed student) and the second at the end of internship (best dressed intern).

That being said - not even I would go to the lengths this guy, my patient, did for fashion:

My patient last night was absolutely distraught. He was crying when he told me that while he was walking home he was held up by five men who demanded that he give them his money.

This he did willingly.

They then did the unthinkable horrific thing of asking him to hand over his wool-lined leather bomber jacket.

*insert blood-curdling-fashionista-scream here*

This man absolutely refused.

So the assailants pulled out their gun,and held it threateningly to his head.

Despite impending death, the man still refused.

Was this jacket a family heirloom? No.
Was it the last thing his father wore before dying a hero in the war? No.
It was just a really good-looking well cut real leather jacket.

The enraged gunmen, then used the back of the gun to butt him on the head, and forcibly removed his jacket.

My patient, instead of thanking his lucky stars that they did not shoot him, ran after them screaming and demanding that they give his jacket back, which is when they decided to stab him.

Did I mention that my patient was gay? Not that it's of any significance, other than the fact that only a very fashionable gay man could have more passion for clothes than a woman.

If only I had my awards with me last night I would have instantly, unthinkingly and ceremoniously presented them to this man.

Some women will kill for clothes. Some gay men , apparently, are prepared to die for them.

p.s. This post is dedicated to my mom, from whom I inherited the style gene.

Thursday, June 11, 2009

Money Hungry ( Human ATM)

Hello. I just got back from gym. Random. But just thought I'd let you in on the fact that I gym.

So I'm guessing none of you know what the yellow drip is yet. Too bad. I'm not telling.

I will tell you this though; that a frantic mom rushed into the unit the other day, dragging her breathless ten year old behind her.

The ten year old was choking.

I kind of had my hands full with an epileptic fitter.

But Sister B wasn't worried.

Her well-practiced and experienced hand suddenly popped out of nowhere and violently smacked the centre of his back.

The unsuspecting child instantly coughed up a five rand coin.

The mom, completely confused with relief, then smacked her child again presumably to teach him a lesson.

"That was our taxi money!" She screamed at him. She then fished the five rand coin out of it's phlegmy pond on the floor, turned on her heel and marched him out of the unit refusing to waste any more time.

Everyone just shrugged their shoulders and carried on with their duties. Nothing unusual about that, just another normal occurrence in the trauma unit.

I must say that I secretly wished I could give birth to a child that would produce money every time I smacked it. Like a human ATM.

That kid would be black and blue by the time it was five.

p.s. my sister wants me to say that she was the one who "coined" the "money hungry" title for this post. Thanks sis.

Ode to the yellow drip

Oh Yellow Drip!

How magical you are!
News of your powers have certainly spread far!

When the curse of "no power" strikes.
You, Oh Yellow Drip, help us to fight!

Vomiting, diarhhoea, TB and AIDS,
When they see the yellow drip,
Their severity fades!

Nothing is better than your strength and power.
Not even president Zuma's Aids shower!

That was for the medics in the audience.

I know you guys know what I'm talking about.

I know you're probably ROFL right now.
And I know that you're laughing for all the wrong reasons.
I also know what those reasons are, which is why I'm laughing.

If there are any non-medics out there who know what I'm talking about - say so and you WIN a lifetime's supply of yellow drips to keep you healthy.


At least three nutcases a day.

My god, is everything on this blog going to be about my psych patients?
They do provide most of the entertainment though.
Not one single day passes without us having to admit at least three psychiatric patients for acute psychosis.

No lies.
At least three.
Every day.

Makes you wonder about that kooky guy at the corner shop that everyone says is "eccentric" hey!?

The psych patients that are part of our primary mental health care clinics somehow feel safe at the hospital, and regularly use it as a place to visit on their days off from harassing their families. These are not scheduled visits mind you, but operate more like pleasant outings for them.

They visit regularly, thus we get to know them, and they get to know us. Most of them are just well enough NOT to be admitted, but ARE unwell enough to cause disruptions of varying severity.

The two most famous are as follows:

Mr P who suffers from schizophrenia punctuated by religious delusion:

He believes that he is the holiest pastor that has ever lived. His commitment to religion is spectacular and frightening. He can rapidly, incoherently, and without taking a single breath deliver entire sermons in ten seconds, spewing spit and dental caries as he goes.

Every single morning at 6am without fail - he is at the hospital. He is fervent in his daily mission to preach to the hundreds of sick patients in the waiting room. He says bizarrely prophetic things that may or may not make sense, depending on your analytical talents.

For example:

"Gister het julle mense gaan slaap, maar julle het nie vanoggend opgestaan nie! Praise jesus!"
(Last night you people went to sleep, but you did not wake up this morning! praise jesus!")


Inappropriately pointing out the scarf-wearing muslim patients and saying," Jy moet jesus vra om jou leef te het! Luister na die venster van vredeheid!"

You should ask Jesus to love you! Listen to the window of freedom!

Often he starts singing praise songs at the top of his voice, and dancing to the tunes in his head, completely oblivious to the fact that the tired, hungry, sick patients are not at all interested.

Often one of the patients, whose stabbed-scalp-and hangover induced headache is made worse by the mans caterwauling, shouts out some profanity like, "hou jou bek." or "gaan kak."

shut up or go and take a shit

I find this paradoxical mixture of extreme religiosity and swearing quite hilarious.

Then there's Mr G who pays the trauma unit a visit every week,to tell us that he is leaving for London very soon.
He has been doing this for the last three years.
He always dresses up very smartly and insists on shaking hands with every staff member before moving on to the rest of the hospital.
Sometimes he pulls out an official "letter" to prove that he is going to London. It's so official that he wrote it himself on a piece of fullscap in blue ballpoint pen.
We play along and wish him a safe flight.

Those are two of many. The staff treat them as part of the family and tolerate their visits with a friendly smile. They tolerate their antics as they know that these random visits help to make these normally ostracised patients feel as if they are a part of a community that cares about them.

This morning though, a psych patient started kicking up a huge fuss because he wanted antibiotics for a sore throat.

He was not frankly psychotic, being one of the few who were compliant on their meds- he was just being rude.

So we decided to ask security to escort him off the premises as he was being disruptive. He went quite gladly, and without resistance, all the way to the police station, and then returned to the unit with a form. The man had convinced the police station that the security guard at the hospital had assaulted him and they gave him a medical certificate for me to fill out so as to open up a case. I was legally bound to interview him and complete the damn thing...but cleverly and legitimately moved his non-urgent folder to the back of the queue.

He eventually got tired of waiting, forgot why he was there and left...singing merrily on his way out...

Sometimes the best medicine is no medicine.

Argh! There are so many more psych stories I want to tell you from today!

But I'll give you guys a break for now...maybe in two or three posts I'll bring you back here..

Friday, June 5, 2009

Sneaky psychs.

This was truly bizarre.

The security guard wheeled a young man into the unit at about 19h00 last night. This man was totally unresponsive and slumped lifelessly in the wheelchair.

He did not look chronically ill. He was not bleeding. He had no bruises. He had no broken bones. Also, he had no escort with him.

Thus - we had absolutely no history other than that the security guard found him lying on the floor at the entrance to the hospital.

The man was warm, and alive. Blood pressure, pulse, respiration, temperature, oxygen saturation, haemoglobin, urine and glucose were all perfectly normal. But patient was totally unresponsive.

We tried all the cruel ways they taught us of trying to elicit a response:

Deep pressure on the fingernail beds,
knuckles pressed hard into the sternum,
pinching the skin under the tricep,
and my worst - twisting the nipple.

Alas, he gave us nothing to work with.

We have no other tests available to us after hours, so we referred him to a secondary hospital for further investigation. While waiting for the ambulance to arrive we kept him on the stretcher in the unit.

Whilst processing the constant supply of patients, we kept monitoring him. But he stayed horizontal and unresponsive, mouth agape and eyes open.
I became worried about his corneas so I taped soft pads over his eyeballs to protect them from drying out.

The health factory continued to process patients well into the night.

At about 23h00, we were suddenly shaken by a huge commotion.

Our unresponsive friend had, in a spectacular and violent manner, suddenly jumped off the stretcher, pulled his drip out and was swearing that we should stop "putting shit in his veins". He was a very tall, well built man who was by then frothing at the mouth and glaring at all of us with mean intent. He climbed onto the desk and proclaimed ominously while gesturing around the unit: "All of this is mine. I want it. It's all mine."

The security guard in trauma tried to coax him down, but he bolted, and ran through the hospital in his underwear and hospital gown screaming, until he got outside where he began trying to open the doors of the cars in the parking lot.

It took four security guards and an electric tazer to take the man down.

They then "escorted" him to the police station next door and I didn't see him again.


What a sneaky psych patient!

Such strange things happen in this part of the world. This man must have been psychotic. He did not display any classical signs of delirium, or dementia. This was psychiatric...I'm beginning to develop a sixth sense about these things.
They seek me out these psych patients.
My colleagues are calling me the psych whisperer.

I'm still not sure what exactly happened use dwelling on it though. No doubt I'll get a similar case in a few weeks time. History repeats itself often in this trauma unit.

Fact: An abortion is not the same as a pregnancy

The last twenty minutes of the trauma shift are nerve-wracking for me.

I've usually managed to sort out most of the emergencies by then , and am just waiting for the next doctor to arrive. I'm on edge in those last twenty minutes because without fail, always, always, always, some crazy emergency comes rolling through the door. This ensures that I will be tied up dealing with it way past gong-home time.

Like this morning. At 06h40...

Uncle of patient comes into trauma unit, says that Niece had an abortion in January, and now is complaining of tummy pains. "Did the patient have the abortion in our clinic?" we ask. Uncle says yes, and that she just has some tummy cramps that have been going on for a month.

Clearly not an acute emergency.

Niece gets sent to the line to wait for the doctors in the consulting rooms.

Uncle comes back to unit 5 minutes later, saying that the patient is now having a baby.

Confusion reigns.

We insist that Uncle brings Niece into the unit for examination.

Niece is clinically 8 months pregnant, in fully fledged labour with a fetal head crowning between her legs.

Niece is adamant that the tablets she was given for the abortion in January have only started working now in June.

*this is what's known as - "a lie"*

Doctor S and nurses rush the patient on a stretcher through the hospital to the Midwives Obstetric Unit next door, as we do not have the correct instruments for delivering babies in the trauma unit.

Niece "aborts" a full term healthy baby girl. Congratulations Niece!

The whole truth is that Niece wanted a second trimester abortion in January and was referred to a secondary hospital for the procedure. Our hospital only does first trimester abortions.
Niece never went, but still believed that the abortion would happen, somehow.
Niece was in denial for 9 months. Niece thought she could "believe" the baby away.

Niece did not know the difference between an abortion and a pregnancy.

This was not Niece's first pregnancy.

Niece had already been through two pregancies.

The power of denial is mind-blowing.

Doctor S only left her trauma shift at 07h40.

Saving lives, one gross act at a time....

Some of my friends have recently confided that they love gross medical stories. The more gross the better, and they are always probing for revolting tales of yuckiness.

Unfortunately/ Fortunately - having been constantly exposed to patients and their bodily fluids for a few years now, my gross-o-meter has been rendered completely useless. I am not sure what is actually revolting or yucky anymore!

I rely on other people's reactions to my stories and then realise afterwards that, "oh yes, that festering pus-filled abscess probably was pretty gross!"

One thing these fascinated non-medics cannot fathom, is the concept of the digital rectal exam. The mere mention of it sends their facial muscles into disgusted spasms.
(Which manifests in their mouths pursing up to look something just like the aforementioned revolting sphincter. So cute!)

May I just clarify - the anus ( that's right, ANUS, say it out loud) is an amazing organ.

It. Is. Amazing.

It is a very complicated piece of machinery that involves an external and internal sphincter, and nerve endings which are sensitive to pain, touch, temperature and stretch. It has lubricating glands which help to lubricate the stool on its way out of the body. It has a voluntary and involuntary part, thus allowing one to maintain dignity when desiring defecation.

It is the last border post between digestion and the porcelain throne. It can allow air to pass through it in the form of a beautiful sometimes thunderous rectal whistle, while simultaneously holding back solids.
Like I said, amazing.

Furthemore, the digital rectal exam is a LIFESAVING PROCEDURE!.


One can tell loads from the rectal exam. One can diagnose haemmorhoids, one can assess neurological function by the tone of the anal muscles, one can determine intestinal bleeding by the contents of the rectum - and in fact determine the site of the bleeding depending on the consistency and colour of the blood on the glove. One can assess the state of the prostate and screen for cancer. One can assess posterior wall of the vagina.

Sometimes one can even determine the state of the thyroid. (Just kidding)

Consolidate it: the rectal exam is lifesaving and the anus is amazing.

Get over it.

What I must mention though is that very rarely - I do encounter things that stimulate my barf reflex.

Yesterday, a rectal exam was indicated on an eighty year old man with urinary obstruction. At the point of actually wanting to perform the digital rectal exam, I noticed that my finger was obstructed in its purpose by a large wad of toilet paper covered in old faeces still stuck,fiercely, between the man's gluteii.

The man was completely oblivious of this fact.

I threw up a little in my mouth and spared him some embarrassment by not saying anything,and removing it myself before proceeding with the examination.

Satisfied now my buddies - was that gross enough for you guys?!?!

Not much induces my vomit centre anymore - but day old loo paper, post -use, most certainly does the trick!

Please my dear patients, us doctors don't mind probing in supposedly disgusting places. Really, we'll do what it takes to keep you healthy. But you must also play your part. Endeavour to make things a bit easier for us.
Like wiping properly.
It's the right thing to do.


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