Friday, September 18, 2009

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

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

I have to keep my emotions lean.

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

I have to keep my mind keen.

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

I have to be mean.

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

Eight thousand bucks for one of my hugs?

Now that's what I'm talking about!

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

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

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

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

My hugs are so awesome they will rock your world!

My hugs are so awesome they are like chicken soup.

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

Oh how I wish...

Wednesday, September 2, 2009

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

Monday morning. 08h00 am.

Mondays come after weekends.

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

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

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

Which would be me.

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

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

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


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

She goes on:


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

Thankfully she made the decision for me.


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

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

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

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


The write way to kill your friend

Monday morning 10am: (No lies!)

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

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

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

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

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

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

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

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

Sorry kid.

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


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