Wednesday, November 25, 2009

Retarded referrals (2): Surfer Doc

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

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

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

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

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

Quote, unquote:

Telephone: "tring tring!"

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

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

Dr S: "Um...What?"

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

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

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

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

Saturday, November 21, 2009

Macho man versus the Needle.



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

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

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

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

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

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

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

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

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

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

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

"Hundreds, Doc, hundreds!"

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

Have you ever seen anyone actually faint?


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

BUT! It's also nonsensically funny.

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

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

2:Soggy beads of sweat formed above his brow

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

4:Eyes rolled back into his head...

One last helpless gasp uttered and then...


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

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

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

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

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

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

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

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

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

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

Medical term: Syncope - brief and sudden loss of counsciousness

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

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

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

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

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

Monday, November 9, 2009

Retarded Referrals (1)

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

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

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

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

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

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

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

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

If you please....

Dear Colleague,

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

Thank you,
Dr Retarded.

First lesson in retarded doctor school:

Do not even ATTEMPT a diagnosis.

WTF is going on?!?!?!

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

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

"I am a retard!"

Saving lives???

16 years old.

Intubated and ventilated by the doctors on the previous shift.

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

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

TB meningitis. Severe. Untreated. Currently brain dead.


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

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

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

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

Shocked, I looked up at him.

The horror of recognition flooded through my veins.

I knew this man.

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

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

It means "she who causes a smile".

This was not the time for smiling.

His son was busy dying in front of us.

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

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

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

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

Sometimes this job just sucks.

Saturday, November 7, 2009

Pregnant? The patient's guide to parenting.

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

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

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

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

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


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

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

But it got me thinking...

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

But then I rememembered...

Just take lessons from your patients Dr S!

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

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

(We ultimately called the police to take him home)

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

(He survived,thank heavens)

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

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

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

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

Wednesday, November 4, 2009


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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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