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.

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

Yes,guys, that is me!

This is for all of you who have noticed the change of profile picture, and are confounded by it!

Yes, that hair is mine.
Yes, that white coat is mine.
Yes, that burgundy stethoscope WAS mine before it got stolen.
Yes, the nose, lips, chin, hand- they're all mine.

And no, Ketan, I was not in the process of beating up a patient!


It's me people, just a little taste, and the only pic I have of my lost stethoscope!

Goodbye, my love.

Goodbye, My Love.
I can't believe our relationship of ten years is over.

The moment I laid my innocent, uneducated eyes on your stylish slender frame,it was apparent that within your beautiful form lay the secrets of superior knowledge and skill.

Oh how I fervently wished for a chance to prove to you my worthiness.
On that first day of our chance meeting, I silently made a pact that should I be granted this one wish, and that I should spend my life dedicated to the mastery of you.

Ten years have gone by, and now abruptly, suddenly, we are together no longer.

I feel as though I've undergone a sudden and violent amputation of a limb.
There is no cure for this wound.
I am haemorrhaging loss and despair from my every pore...

I will miss the comfort of your tender embrace around my neck...

I will miss the gentle way you whispered the secrets of the heart into my ears...

Time and hard work took its toll on you...yet despite your mis-matched ears and wonky spine, I loved you all the more...

Something new hangs around my neck now,my love. But know that you will, and never can be, replaced...

My darling, burgundy, Littman Classic II 3M Stethoscope!!!!!

Why have you forsaken me!!!!



My stethoscope, a doctor's stethoscope, becomes like an extra appendage. A third arm, or an extra hand. Just two weeks after starting my new job, it was stolen...Oh dear, my eyes are starting to well up...

I have had to buy a new one...but it's not the same...we don't share the same familiar old intimacies that I did with my first love...

That one was a gift from my father when I started medical school. Now she's gone. God knows where she is now...probably in the grubby paws of some sick perverted thief with a fetish for "doctor-doctor" games...

If I find you, sicko, you will be on the receiving end of the largest rigid urinary catheter I can find...and it will be inserted, unkindly, and without KY jelly...

Initiation

When starting a new job, it's important to make a good impression.

There are RULES as to the way one does this.
These rules, they are COMPLEX.
They involve EVERYTHING, from the way one dresses on the first day, to learning the names of your colleagues speedily, to not allowing all one's thoughts to pass from their inception in one's insane brain to manifestation at one's luscious lips. One's new boss may have a moustache reminiscent of a 70's porn-star, but best not to mention this fact on the first day.

DO NOT forget that the most important people to befriend in a new job, are not necessarily those at the top.
The one's at the top should not be your friends - it will just be awkward on the day that you take over their jobs and assume the position of world domination.

Far better to befriend those in low places - the clerk at the front desk, the porters, the cleaning lady. These guys have been around for ages. And believe me, they know EVERYTHING, and can "organise" anything in a hurry due to their years of training in beating the system.

BE SUPER NICE TO THE NURSES. This is in fact the number one golden shiny rule of medicine. I'm not going to elaborate. It's pretty self-explanatory. If you're one of those dickhead doctors who enjoy ordering the sisters around, and getting off on your own sense of superiority because there's nothing else that's cool in your life... prepare yourself for a life of hell. Nothing is worse than the retribution from a nursing sister.

DO NOT think that you can throw your weight around immediately. Be calm, be cool, be like a detective and assess the situation.
Understand, that as the new bitch, it is unfortunately up to you to be slightly subserviant, and pleasant, and willing. These are the rules...But don't worry, it won't last long - soon there will be another new bitch, upon which to inflict your initiation torture...


My initiation experience occured last week...


After the handover ward round from the off-going doctors of the day shift, to the oncoming doctor's of the night shift (me being one of them), one of the instructions was to discharge one of the patients lying in the medical holdings area.

The patient, Mrs T.Y. was suffering from a mild lung condition that did not require admission into hospital, and could thus be sent home with oral medication.
The way to find a patient in medical holdings is to look at the name on the folder lying underneath the stretcher's mattress. The body on the bed then belongs to that folder. It is pointless asking the patients what their names are, as most of them are either deaf, psychotic, delirious, confused or don't speak English...

I located Mrs T.Y.'s folder, and proceeded to examine her.

But she certainly did not look like she had a mild respiratory condition. When I asked her how she was feeling, she just stared at me blankly, and then buried her head under the blankets while mumbling incoherently to herself.

"What the hell is this?" I thought. "Why have these other idiots decided to send this lady home? Clearly she's confused! She can't go home for God's sake! That's just negligence!She needs investigations! She needs X-rays! She needs medicine!"

While seething with the injustices of this world, I placed my stethoscope on her chest to inspect her "mild lung condition"...
...at which point, the patient suddenly, and violently shot out of bed and tried to strangle me.

I'll say that again. Tried to strangle me.

Yes.

Oh Yes...that's right.

Do you see what happened there?

This was NOT in fact Mrs T.Y.
Mrs TY was in the bed next to this patient.
This patient was a Mrs I'm-fucking-psychotic-and-abusing-copious-amounts-of-tik type patient.

Thanks a lot guys. Good one. Switch the folders around. Excellent joke to play on the new girl. Never mind that she might have suffered a FATAL INJURY at the hands of this mad, malevolent bitch. Hilarious. Really. Well done.

They claimed that it was a genuine mistake. But it was a little hard to believe them while they were all cackling and clutching their sides with laughter.

Unintentional initiation?
Maybe.
It's actually too brilliant a joke to have been planned...

I need to remember this one when we've got a fresh new fish to torture....

Hookers versus Doctors

As I sit at my kitchen table awaiting the start of my 11pm to 8am shift this
evening, I am struck by the fact that I, the Lady-Doctor-Working-Night-Shift, am not dissimilar to those other Ladies of the Night...

This is how:

*We both work night shifts

*We both can contract HIV, hepatitis C and other funky shit from our occupations.

*We both have a uniform. ( Although mine is slightly less, um, exciting...)

*We're both getting screwed ( Hookers by their clients, and me by the Department of Health)

*We both don't like to tell people what we do in case they ask us for "favours"!!!!

Loose ends and new beginnings.

Goodness gracious me...

What with all this strike action, and starting a new job I have had ZERO time to even log on to the internet...

No wonder I've been mildly depressed!

But I'm back now, so don't worry - more mad medicine to follow....

However, before we reminisce over last week's occurrences, let me first tie up some loose ends.

THE STRIKE:

On Friday last week we decided to call of the nationwide strike. Our fellow doctors who had been fired in Kwa-Zulu Natal were re-instated, and a final offer by the Government was tabled. In lieu of these two facts, and the fact that we had been striking for an entire week, it seemed pointless to continue striking. The government was not prepared to offer any more than a five percent increase in our salaries, and closed the bargaining chamber. We deserved 50 percent. Thus, we unanimously rejected the final offer. We are currently awaiting the arbitration process.

Calling off the strike does not mean we have given up the fight. The government has said nothing about improving working conditions or pumping more money into our failinng health system to improve facilities for our patients.

In fact this is just the beginning...

For the first time in South Africa, doctors across levels of seniority, across institutions and across provinces were united in one cause. We realised for the first time that as a medical fraternity we have the ability to stand up an effect change in our country. Strange that it has taken us doctors, in a country famed for it's constitution and democracy, this long to realise our power.

The other awesome consequence of this strike is that we showed the government what it means to implement a Minimum Service Level Agreement. A doctor's right to strike is enshrined in our constitution - provided we implement a minimum service, and keep emergency centres open. The government promised for two years to define what our minumum service level should be, and of course, never got round to it. So we had to take matters into our own hands. As a result we managed to protest without jeapordising patient care, and nobody died as a direct result of the strike.


OLD JOB:

I never actually had a proper ending to my stint at the day hospital. The last two days there were spent toyi-toying and striking at the great tertiary institution on the mountain, Groote Schuur Hospital. (Site of the very first heart transplant performed by our own Dr Christiaan Barnard.)

So I slipped away, without any fanfare...

Many of the Sisters there noticed me on the news and in the papers - and sent words of encouragement. I miss them already...


NEW JOB:

My new job is in the "front room" ( trauma and casualty unit)of a secondary hospital also on the Cape Flats. This hospital is notorious throughout South Africa for being impossibly overwhelmed with patients. I remember it from my student days...patients lying on the floor, staff overworked, no facilities, patients sitting in the corner of the unit - for hours, and eventually dying there, unseen.

This hospital, had a drainage area of 7/8 of our entire metro district. The other many hospitals in our metro SHARED the remaining 1/8 between them. And this hospital was slapped with the task of treating the rest. Slightly unfair right!? But because of the way the city expanded, with the poorest of the poor shoved out into the periphery- this hospital was the closest beacon of hope in a sea of poverty radiating out around it.


I was expecting to be gobsmacked on my first day - and I was. But for the entirely paradoxical reason that the place was NOTHING like I remembered it. After years of disaster, the hospital management put their feet down and demanded that the drainage areas be changed. As a result - the hospital, while still busy, has a much more manageable patient load. Nobody was lying on the floor, nobody was dying in a corner, and the doctors had smiles on their faces. Incredible!

Thank you work gods!!!!! I must have done something good in a past life to deserve such an unexpected blessing!

My new job also dictates a new kind of lifestyle for me - a SHIFT lifestyle. I have been assigned to a team of doctors. There are 6 teams. Only one team is on per shift. I'm in the first team. Each team consists of an emergency medicine registrar, a medical officer and a community service doctor like myself.

Which means....I'M NOT ALONE ANYMORE!!!!! Yippee! Wherever I turn there are doctors more senior than me to ask for help. This is excellent news.

Our shifts are as follows:

During the week: either 8am-4pm, or 4pm-11pm, or 11pm to 8am the next day.

Over the weekends: 8am to 8pm or 8pm to 8am.

If one is on on the weekend you do the WHOLE weekend - fri, sat and sunday night, or fri, sat, or sunday day.

Often one has days off during the week.

This is fantastic news!

With all these new blessings bestowed upon me, I can only forsee great things for the next six months...

It's only been a week and I 'm loving it!

The strike continues...

And so the strike continues...

We are on every tv news broadcast and I made it onto the front pages of two major Cape Town newspapers yesterday, along with some of my fellow strikers.

All the offers for remuneration increases made by our government have been rejected by us, across the board. Why? because it's pretty much exactly the same offer as before. It equates to about R300 extra a month. Our colleagues in Kwazulu-Natal were fired - 300 of them- for striking after they ignored an interdict to go back to work.

The ridiculous thing is that the Department of Health decided to single out individuals who were striking, and did not fire everyone. How did they determine which individuals deserved to be fired when the rest of us were doing exactly the same thing?
The stupidity of it is that they served some doctors with interdicts who weren't even striking! People who had been at work every day during the strike manning the emergency centres they were contracted to work in! Idiots!

All this does is send out a message that we are indispensable. They went on record to say that they will get foreign doctors to work in those posts. If they have the money to pay those doctors their locum rates - why do they not have the money to pay us what we are worth?

Why are they spending millions of rands on their lavish banquets, and birthday parties for the president's daughters - yet cannot afford to pump money into the failing health system? Where are their priorities?

People are berating us for striking. They keep saying people will die because of this strike. The strike has gone on for days and nobody has died yet. Why? Because we are still running emergency services. The doctors from the clinincs are now helping in these centres so there are more doctors focused on the worst cases.

Furthermore, people have DIED way before we were striking. Many died directly as a result of a lack of equipment and lack of adequate staffing. How does one expect one doctor on call for the night to handle three emergencies at once - with many potential emergencies lurking in the waiting room?

People keep saying that as doctors we knew what we were getting in to, and that we have a responsibility towards our patients, that it is illegal for us to strike.

I tell these people that we are not Gods. We are not superheroes. We are NOT saints. We are human beings, we are citizens like the rest of the citizens in this country and we have the SAME constitutional rights. Why is it that we are always the ones being depended on to do the right thing. Is it because we save lives?

Let me tell you something. Every single citizen has the ability to save lives. Feed that child begging at your door. Buy it some shoes and a warm coat in winter. Volunteer your time to go and teach in underprivileged schools. Ask where help is needed and go and provide it. Why is nobody berating YOU for not doing anything? You have NO idea what it means to be poverty stricken, and to be a patient in our state system. Some of these patients, the ones directly affected, SUPPORT us! We are faced, every single day , with the injustices done to our patients by the current health system. We are witnesses to the neglect.


At least we are doing something. And this strike is about so much more than the money. Pay our doctors properly so that they stay in the public sector. If you don't they will leave, and leave us in a worse position than before! We have been picking up the slack for years, stretching ourselves to breaking point to try to maintain a crumbling health system. We are tired of that responsibility - that needs to be shifted onto the shoulders of the Department of Health where it belongs...