Hiatus

Dear Readers,

I am taking a hiatus from Mad Medicine.

I have instituted an employment ban on myself.

For the past decade of my short life, I have focused solely on the attainment of my medical degree, completing two years of internship and the year of community service in 2009 that inspired this blog in the first place. The first half of this year found me floundering around in unchartered waters: namely, formulating a life-plan for myself, one that was not predestined by the rules of the Department of Health.

For the first time in forever, I can choose whether or not to work. And I can enjoy the luxury of waking up late on a Saturday morning, in fact every single Saturday morning, consecutively, in a row, knowing that next weekend I will not be on call, and can enjoy breakfast at 11am again while reminiscing the craziness of the previous night's party.

So for the next few weeks I have chosen unemployment.

Which means, no patients. (Besides the friends and family who call regularly for advice and prescriptions.)

I'm going into hibernation for a little while, and Mad Medicine will lie dormant while I focus on another little literary adventure....

Feel free to read older posts, and reminisce on the journey you took with me during the escapade of 2009/2010...

Thanks for all the encouragment, criticism, and hilarity.

Thus, I leave you with the everlasting and ominous words of the Universe...I mean, Mr Universe:

"I'll be back."

(Arnold Scwarzenneger - for those of you too young to know about Terminator)

I think the Potato might just be a better option...

Sometimes one gets lucky.


Sometimes one works with an actual nurse, other times one works with a potato.


For the last few weeks I've been performing locums as a medical officer in Internal Medicine


Which means I'm at the back of the hospital,in the wards, far away from my beloved emergency unit.


The nurses here are few and far between.


But there are very, many, potatoes.


Everywhere I look:


One Potato,


Two Potato,


Three Potato,


Four.


Tomorrow I am going to bring a bag of potatoes to work, stand at the entrance of the ward, throw the potatoes between the beds, and then try to distinguish between the actual staff, and the mindless starch...

(Which will require an amount of mental agility that I simply do not possess.)

The Secret Organ

There is an organ, possessed by one half of the population, and coveted by the other half.

An organ, shrouded in mystery and secrecy.

One which is so awe-inspiring, it can render one reverent, and engender fervent maddening worship at the shrine of its wondrousness.

Intoxicating, and inspiring, like a fragrant exotic flower that only blooms once a year under the full moon, in the middle of an abandoned oasis that one happens upon after a solitary soul-destroying walk in the cruel, sun-scarred desert.

*I get carried away sometimes, forgive me*

Ah yes, it is an organ that nourishes, and revives!

One which sings the secret notes of the symphony of seduction, and one which delivers a monstrous roar when its almighty power is displayed at the debut of a life.

All hail the Vagina!

Say it with me: VAGINA.

Composed of thrilling folds of furled flesh, it is moist and inviting, dangerous and exciting!

Like a precious jewel guarded at the top of a tall tower, the vagina is hidden away at the pinnacle of two silky inner thighs...


"Oh my!" I  hear you sigh...

I'm sighing too....but for a different reason...

You see, this organ, this mighty, mystical, gorgeous organ that is everything I have described,
is also grossly misunderstood by both its owners, and those invited to relish in the pleasures of its inner sanctum.

A very young, conservative couple came to visit me in the GP office one day.

After a year of marriage, and one year of religious oral contraceptive use, they had decided that it was time to try and make a child.

I admired her for being brave enough to let the sperm germs infect her uterus, and was keen to help this young couple conceive.

They seemed well equipped to raise a child together, but had come to me for the sole purpose that they believed that she was infertile.

And they believed that she was infertile for two reasons:

1. After one month of trying she was still not pregnant.
2. After one month of trying her vagina was still not sucking up every single last drop of semen after ejaculation, in fact it was still allowing all the semen to leak back out and dribble down her inner thigh instead of hoovering it all up into the uterus. Silly vagina!

Yes, you may read that second reason again if you have to. 

Because I am a kind doctor, I pinched myself really hard on my own inner thigh to stop from laughing, and drew anatomically correct diagrams of the machinations of the vagina in order to explain to them that its roof was not like the vacuum attachment they had on the hoover at home!

Which got me thinking, if vacuum cleaners are complex enough to need an instruction manual,then perhaps the vagina needs one too ???

Education is an Extreme Sport

This one's for Dr "Kitty" M.


Two weeks ago I threw myself out of a plane.



Willingly.


Granted, I had a professional skydiver strapped to my back.

Furthemore, the professional skydiver had a parachute strapped to his back.


The combination of these two facts resulted in a thrilling, exhiliratingly extreme experience, at 9000 feet above my beautiful city.

Yes, I know. I willingly chose to put my life in danger.

I didn't want to be left out, you see. Life-threatening extreme sports are what everyone is into nowadays. And by everyone I mean schoolchildren.



Like the 17 year old patient of ours today who was stabbed in the heart by his fellow pupil at school.

Serves him right for being foolhardy enough to want an education, I guess.

He died, after being rushed into our emergency unit,
after having his chest cracked open in the front room,
after being sped off to theatre by our valiant surgeons.


He died by bleeding to death on the operating table.


Fuck bungee jumping off Bloukrans.


Fuck skydiving.


Next on my adrenaline rush list... school on the Cape Flats.

EC Syndrome

I'm not sure if you're aware that there is a plague invading the Western Cape.

It is not the recent measles outbreak that has caused so much anxiety.

No.

Far more severe than that.

Far more frightening.

This disease is a conglomeration of the most purulent, macerated, chronic and cancerous iniquities of pathology.

To diagnose it is easy.

To cure it, an impossibility.

It is what we in the Western Cape call: Eastern Cape Syndrome.

Something is not happening in the Eastern Cape.

Something is not happening a lot in the Eastern Cape.

And that something is health care.

Patients, on death's door, are making the arduous journey all the way down to Cape Town in droves, in the hope of better treatment.

Like the bastard child you forgot to tell your wife about, these poor patients from the Eastern Cape rock up, unwanted, at the holy doorstep of the nationally renowned Western Cape Health Department.

I have had three such patients in the last two locum shifts in casualty, who literally arrived in Cape Town on the morning train from somewhere East of the Hinterland, and were on a stretcher in casualty before the noon gun had a chance to blast them back to where they came from.

At medical school they talked to us about the "heart sink" patient - ie the patients that literally make your heart sink...

These are they...

I don't even write notes on them anymore. I just document: "Arrived from Eastern Cape today..."

and then hand them over to the medical registrar....Who will then write down what we all know to be wrong, a combination of, or variation of one of the following

• HIV stage four, and all of the complications that come with it
• disseminated extremely drug-resistant TB
• some fungating cancerous metastasised mass with superadded infection and no hope of cure
• septic and gangrenous legs, unsalvageable and ripe for amputation
• spinal pathology that if treated early could have prevented the total lower limb paralysis of some poor teenager...
• etc
• etc
• blah
• blah
• blah

You will forgive me for being so dismissive...

It's just that I cannot expend any more energy cursing the Eastern Cape Health Department for not getting their act together...and after months of being faced with the embarrassment of having nothing to offer these dying guests from another province...I've kind of just given up on ever being the brilliant host they hoped for...if only they had presented earlier...or if something had been done for them in their home towns...

Welcome to the Eastern Cape, enjoy South Africa's finest beaches where dolphins play in warm waters, game reserves full of wildlife, where people greet with smiles and enjoy the holiday adventure of a lifetime. Explore the Eastern Cape and experience the best South Africa has to offer, absolute tranquillity and relaxation...

This is a description of the Eastern Cape as promoted by the Eastern Cape's tourism website

However, in terms of health care, the Eastern Cape can only be described as a big black hole of disease.

p.s. Any Dr's out there working in the EC who want to disagree with me please go right ahead and prove to me that I'm just spouting my mouth off when I know nothing of the true state of affairs... My opinion on this matter is of course entirely biased and based only on first hand experience with the patients, not a gold standard randomised control trial.

But I think I know what you're going to tell me...that the fault lies not with the staff, or the facilities, but at the feet of the administrators and managers who are supposed to use their provinicial health budgets to enhance their health service, not drive their patients to seek help in other provinces...

Booty Plundering

There is a small community of Somalian refugees living near the GP private practice where I'm currently performing my locums.

One of them is a 16 year old boy.

He spoke to me in a mash-up of English and Afrikaans.

(What I like to call Englikaans.)

As he entered the room, I couldn't help but be aware of the evidence of recent injury: antalgic gait, periorbital ecchymoses on the left, healing laceration right cheek. (i.e. limping, with a black eye and a scarface, you non-medic!).

My sharply honed diagnostic doctoring skills (and a year spent on the Cape Flats) immediately concluded that some-one had succeeded in beating the shit out of this guy.

"Salaam Dokter, haal af these things in my kop" he demanded.

(Salaam Dr, take out these things in my head)

"Hang on there a second Somalian, what happened to your 'kop'?" I asked him, knowing instinctively what his answer would be.

"Ya-Allah, these other guys hulle beat vir my kop. But I beat them back! The Dr put stitches in, long time, six weeks now, ya-Allah! You take it out.You take it out now!"

There was something lovable about this skinny beaten up boy sitting opposite me.
Something to do with him displaying all the bravado of a young man going through puberty.
I found it adorable.

Normally, I get annoyed by young men giving me orders, but this guy, with his staccato tempo'd instructions only succeeded in me wanting to take him home and feed him.

And that was not intended as a joke about hungry Somalians.

So I did what I usually do with people I have an affinity for, I play with them by engaging in a little teasing.

"You must have been very brave to fight off all those men! Tell me, what was so very important to you, my son, that you ended up getting klapped for it?"

I prepared myself for the standard response I've heard hundreds of times: "Vokol doc, I was beaten for nah-ting!"

However his answer suprised, and touched me.

"For Love, sister, it was for Love." He said. And with this, he hung his 16 year old head wearily, as if the cumulative weight of the world's tragic love stories was resident on his skinny little shoulders.

"You mean you took a beating because you were in Love? She must have been an incredibly beautiful girl, no?"

"Yes," he said, and his black and bruised eye began to twinkle.
"She was bootiful. She is too bootiful!"

"How beautiful?" I asked him.

"Ah, not like you,sister, not like you. Sy was lekker vet. Lekker vet with a beeg bum om my warm te hou in the night... Ya'Allah that is a mooi kind!"

I'm going to ignore the multitude of comments I could make about a boy from a country ravaged with famine, who finds himself in love with a well-fed fat-bottomed woman big enough to be like a blanket that keeps him warm at night.

"So what happened?" I encouraged him

"I took her from her house, and she come with me! For two nights we sleep together, but then her brothers come to fetch her and they beat me."

Which is when I realised that I was sitting opposite our very own Somalian Love Pirate of Passion! One who had invaded another's territory in the name of Amour, and then succeeded in plundering the big booty of his beloved.

Utterly intrigued, I asked him "Was she really that worth it? Was she worth getting your face smashed in for?"

Suddenly his demeanour changed, and his swollen, cut lips cracked into an enraptured grin.

"Ooooh yes, sister, oooh yes, It was the best two nights of my life, I will never forget it!"

I fell in love with that Somalian child right then and there.

And as I lovingly eeked each suture free from the purulent foul-smelling laceration in his scalp, I pondered on Love and the Laws of Attraction.

So many of my female friends were obsessed with the imagined gargantuan size of their gluteii.

Listen up, ladies!

Here was a man who liked big butts and he could not lie.

In fact, he liked big butts so much that he was willing to take a beating for them!

These are the type of men you should be dating!

In his mind, this woman was beautiful because she was booty-full!

*drum roll*

Why I did not become a dentist

Why does this type of 6 year old patient come to the Dr?

I don't know anything about teeth.

I refuse to know anything about teeth.

I hate teeth.

Something to do with the fact that I was born with very malaligned ones and had to endure 5 years of braces, and the nickname, Bugs Bunny.

Normally I stay well away from teeth. But when mommy and daddy insist on feeding their son sweeties, and don't brush his teeth, and Junior starts to look like an extra from a horror movie...well, then I feel the need to step in and make a plan.


My treatment plan included:

1 X smack through the head for mommy, PRN.
2 X punch to the groin for daddy, PRN.

Referral to those people like my dad and my sister who really really adore teeth, namely the Dentists.

Survival of the drunkest.

There are certain things patients do when they enter the GP's office which indicate that the consultation is going to be interesting.

For example:

My last patient of the day, Mr V, introduced himself by politely lurching over the desk, slapping me on the shoulder and saying:

"Jammer Dokter, nuh!? Jammer nuh! Ek vra verskoning, ek wil nou nie ombeskof wees nie, en ek moet eerlik wees,maar ek het 'n paar biere gesuip voor ek nou hier gekom het."

"Forgive me Doctor,hey,forgive me for being rude,hey! But I must be honest and tell you I've had a few beers before visiting you today."
English doesn't do it justice.

Having been taught never to judge the patient I ignored his chronic pancreatitis history and did not immediately assume that he was an alcoholic.

In fact, it's probably most likely that he was just someone who has had such shitty experiences with the health service in the past that he knew he needed alcohol to survive a visit to the doctor.

I could understand this completely.

I mean, sometimes I feel like I need a few drinks just to survive some of the patients!

And that scene would go:

Goodmorning patient, I'm slightly sozzled right now, so do forgive me for having accidentally palpated your thyroid through your rectum instead of your prostate...yes?

GP VICTORIES!

Gastro for a week?

NO! Ruptured appendix in septic shock - surgical emergency - rushed off via ambulance to hospital.

Neck pain post rugby match. Cervical myalgia?

NO! C-spine disruption! Immobilised and sent off to trauma unit STAT.

Normal period 4 weeks post last menses?

NO! Missed abortion - off you go to the gynaecologist.

Circular lesions on anterior shin? It's just eczema isn't it doctor?

NO! It's actually a classic ecthyma!

Today, I was, the GP QUEEN!!!!!!!!!!!!!!

Woop Woop!

:)

A Private Problem

I remember puberty.

(Unfortunately)

Specifically I remember developing breasts and how unbearably ashamed I was of this fact.

Puberty is a painful, agonising, angst-ridden, awkward time where one is basically a confused child struggling to deal with the sudden onslaught of adulthood.

It is also the time one becomes both secretly thrilled, and horrifically aware of the sexual organs...both one's own and those belonging to others! Eek!

But then, one grows up, studies medicine, becomes a doctor, is exposed to naked flesh of all shapes and sizes on a daily professional basis...and suddenly there is no difference between a nose and a penis, or an ear and a vagina.

They're all just organs to us.

(Even the diseases of these organs are the same: a penis gets syphyllis, and a nose gets sniffle-less!!! Hee Hee!)

This has put us totally out of tune with our patients' embarrasment at revealing themselves physically in our consulting rooms.

My elderely, conservative Muslim uncle of a patient with testicular pain, couldn't understand my insistence at physically examining his genitals.
And I couldn't understand his resistance.
I had to pull out all my medical knowledge, and subtle scare-tactics about cancer before he would let me anywhere near his genitals. I even mentioned Lance Armstrong. Livestrong, Uncle, Livestrong!

He eventually reluctanctly relented.

After the physical assualt on his privates he remarked quietly that he felt sorry for a "young girl" like myself having to deal with such terrible things on a daily basis.

Stupid, desensitised, Doctor that is me, didn't even realise what I was saying when I responded that I like it and try to have as much fun as possible with the patient.

It was only after he gave me a sly grin, and winked on his way out the door, that I fully understood the ridiculousness and possible inappropriateness of my statement...

In the words of Homer Simpson, DOH!

Baby Fat

A few days ago two young parents brought their baby in for a consultation.

They were so terribly worried that their pigtailed 2-year old child had a runny nose.

When I looked at the child I nearly fainted.

"How many children do you have?" I asked them nervously.

"Just this cute little one." The dad beamed proudly.

"You're lying!" I almost screamed at him! "You actually had THREE kids and this child ATE the other two!"

This kid was the size of three kids.

What in the hell were they feeding this child?

Fried fat wrapped in pastry covered in cream, basted with lard and a side-order of baby?

And she had that hungry look in her eyes.

I examined her very quickly with my left hand.

The left one I was prepared to lose in case she desired a quick snack.

The right was too precious to risk.

Nothing wrong with your child, folks, except that she's morbidly obese.

I explained to the parents the horrors of this delicious death trap they were setting for their little one, and how I would be referrring them to a dietitian for expert advice.

All the while I kept one eye nervously on Junior, and one hand gripping my patella hammer in case she decided to attack me.

With each stomp around my consulting room desk her pendulous belly rippled and a tsunami of fat travelled infero-superiorly up her abdomen, threatening to engulf her head, but then thankfully richocheted off the two Dolly-Parton-sized fat pads that should have been her chest.

It took all my strength not to jump through the window behind my desk and run for the hills screaming that The Blob was going to eat us all!

Baby fat is cute.

Obese fat baby monsters are not.

Show and Tell: Crabs

Doctors are like hookers, I've already explained that in earlier posts.

Doctors are also like priests, in that we are in the very privileged position of being told secrets.

(This humbles me without fail. Every time I am privy to such sacred and volatile information, I am humbled immensely.)

Totally top secret.

Makes me feel like a supercool secret government agent handling top secret state-of-the-nation information.

Like James Bond.

Oh yes!

Did you see how I did that? Are you smart enough to follow my logic?

I just proved that doctors are cool like James Bond.



Uh...Oopsy...sorry!

Don't mind me, just got a little carried away there.

I should have warned you that my mind is usually served twisted, not stirred.


What I mean to say is this:

We are human vestibules for people's secret fears and whispered confessions...

For example, "Hi Doctor, I have crabs."

Which was how my last patient of the day introduced himself.

I was thereafter also politely introduced to the actual crabs, enshrined in a little plastic bag and thrust in my face for me to inspect.

"Hi crabs." I said.

They were dead though, suffocated I think, so they didn't return the greeting.

The recognition of crabs (pubic lice or pediculosis pubis to those in the know) is immediately followed by the feeling that one has them crawling all over one's body.

Suddenly scratching myself vigorously, I thanked him for being clever enough to bring the offending evidence in for me to scrutinize.

I do love it so when my patients play "show and tell" with me.

Reminds me of being at pre-school.

(Hey Teacher! Look what mommy got as a present from the poolboy!)

Why I will NEVER be a paediatrician.

I just remembered the reason I will never ever ever ever ever ever EVER be a paediatrician.

Not because I hate children.

Nope.

I love children, and I feel too much pain when they're ill.

But that's not the main reason.

The main reason is that children come with MAJOR baggage.

Two big lumbering overladen travelling trunks of baggage,

Namely...

THE PARENTS!

I just really can't deal with the parents.

Sorry.

The Sore Sound

This one's for you, Dr MJ.

There is a sound, made by patients, that I am incapable of reproducing.

This sound is akin to nails screeching down a chalkboard in its ability to cause me physical pain.

Needles, like poison-tipped needles puncturing my tympanic membranes.

It is not the agonising groan of the patient with the ruptured appendix.

Nor is it the gasp of the patient being given the horrifically painful bicillin injection to cure their syphilis.

Oh no, it is the sound made by the “otherwise well” patient.

The patient that you spot happily chatting away to the receptionist in the waiting room.

The patient, that jumps up when the receptionists calls their name.

The patient that, as soon as they walk into your office, and see your face, immediately makes “THE SORE SOUND”.

No, “ Hello Doc”.

No, “This is my problem”.

Just. This. Damn. Sound.

I can’t even describe it – let me try,

“SSSsssthhhhhhmm”.

NO wait, that’s not right, it’s more like,

“Phffffffffffffffhhhhhshhhtttmmmm”.

Jees, I’m not doing this properly...

It’s like the sharp indrawing of a breath while at the same time exhaling and whistling through one’s teeth and moaning.

It is also invariably accompanied by sorrowful head shaking, the avoidance of eye contact and the slow rubbing of a fat thigh.

They make the sound for about sixty seconds. Unmercilessly.

By this time I am hiding under the desk...whimpering, clutching my knees, and rocking slowly back and forth while a little drool dribbles out the side of my cheek.

My regression into a basket case is due to the knowledge of what the Sore Sound actually means. It is signal that announces that the next seven hundred hours of your life are going to be spent listening to this patient complain about a painful something - usually a knee, or foot.

A knee or foot, that is under immense physical pressure from the unjust weight of the gargantuan monstrous thigh and buttock that is certainly the cause of the pain in the first place.

Oh no you don't, don't you dare call me a fattist!

Only when you have a morbidly obese patient sitting across from you making the sore sound, who:

1:Refuses to listen to your multiple counselling sessions to lose weight.

2:Refuses to keep the many appointments you have made for the dietitian because they coincide with the annual church cake sale.

3:Never went to the orthopaedic surgeon you referred her to because the state health service is so overwhelmed that an appointment could only be made for 7 months down the line and therefore was forgotten about.

4:Prefers to sit in your office and make the sore sound, and complain about the pain, so that she can just be prescribed the damn voltaren tablets that, "the other doctors know to give me, Doctor."


Then, only then, after suffering all of this, are you allowed to tell me I'm being rude...

Of course,by then it will be too late...

I won't be able to listen to you seeing as the patient has just successfully worked on my last nerve, namely the cochlear!

A little pee to help you see?

Please note:

Urinating onto a dirty washrag and then squeezing drops of urine into your eye is NOT the correct treatment for conjunctivitis.

Regardless of what 'Aunty Marie down the road with the daughter who is a cleaner by the chemist' told you.

Private Practice

A young lady Dr, beaming, opens the door of her very own, clean, air-conditioned GP consulting room. Feeling particularly professional in her black satin pencil skirt, silk blouse and expertly applied make-up, she represents the polar opposite of the cranky, pee-stained, sleep deprived trauma doctor she was a few weeks ago.

A mornings only stint in a lovely private practice for the month of February.

This should be a breeze.

Would she like it? A gentle GP breeze as opposed to the tornado of trauma she's used to.

Snotty noses versus gunshot face?

Sore throats versus panga to the cranium?

Will she even have to engage in any taxing cerebral activity?

Flashing a radiant smile at the long queue in the waiting room she welcomes her first patient.

The patients all look at each other nervously.

Nobody makes eye contact with her.

Nobody stands up.

This is not going as planned.

She tries again, this time clutching the stethoscope around her neck. This serves both to remind the patients that she is a doctor, and to remind her of what that stethoscope has helped her to achieve in terms of patient care.

Number 5 in the queue, a middle-aged gentleman, eventually stands up and makes his way into her office.

“Are you new here?” He asks her.

She responds, “Yes, I’m filling in for one of the doctors who are on leave. How can I help you sir?”

“Are you really a doctor? You look too young. And you don’t look like a doctor. They are saying outside that you’re too young to know anything and that they would rather wait to see the older Doctor that’s been here for years. But he’s not here yet and I’m in a rush so I thought I’d try you out. I hope you can help me.”

She takes a deep sigh, this is not the first time she has been sorely accused of youthfulness.

She wonders if a few greying streaks and some crow’s feet would help instill confidence in her patients.

As the morning progresses and she is confronted with skin rashes that didn’t read the textbook definition of their supposed morphology, vague symptoms that do not tie neatly into one specific diagnosis, complaints of being stressed, and other such symptoms that she was not taught how to treat at medical school...it dawns on her that there is more to being a GP than meets the eye.

Thankfully, The Universe has decided not to punish her completely for being so blasé about GP’s in the past, and has given her the gift of Dr BD in the consulting room next to hers. Dr BD, is a bubbly, enthusiastic doctor with what can only be described as an inspirational passion for GP medicine. (Who knew these Dr's actually existed!)

Dr BD is in possession of all the little secret GP tricks that one can only gain with experience and she makes excessive use of his knowledge throughout the day.

Luckily for her he is keen to teach her the art of this general practitioner stuff!

That first brave patient who took a chance on her poured out his soul in 20 minutes, and discussed very intimate details of his troubled relationship with her.
She is supremely humbled by this, and unsure of what concrete medical treatment to give him, she lets him talk, probing gently here and there for signs of depression or suicidality. There are none that she can detect. He leaves her office with a referral to a psychologist and social worker.

“I hope that I helped you in the end, sir.” She says before he leaves, wondering if the patient would be satisfied with the lack of anti-depressants/anxiolytics she had not prescribed.

“You’re young, but at least you listened to me.So yes, you did help me.” He says.

Hmm...Listening.

A new weapon to add to her medical arsenal?

Sometimes no medicine is the best medicine, apparently.

And like a war veteran returned home after surviving the battle, nervous that she would be bored by anything other than the constant adrenaline rush that had so dominated her life, she ended her morning satisfied that wherever she goes, there are knew things to learn and secrets to discover, both about herself and the world around her.

It's just a matter of being receptive to the lessons...






p.s. Stupidosaur, Deluded, Ketan...this one's for you. I have recently moved residences and have been without an internet connection for days, with no wifi on the horizon for at least a few more weeks thanks to the non-efficiency of our telecommunications company in SA. I won't go into the details of the killing,maiming, pleading and selling of my soul I had to go through to be able to publish this post...I'm just saying...I hope you're satisfied?!?! :)

Confession Time

Forgive me reader, for I have sinned.

I have lied to you.

In the way that an omission is also a lie.

I am not still working in the front room of that amazing hospital that is a beacon of light in a sea of poverty and despair.

My compulsory government service came to and end on the last day of December 2009.

I'm currently unemployed. ( Oh the shame!)

And for the first time since I was 6 there is no plan for my future.

This is how my life plan until this moment went:

1:School BANG!
2:Medical School BAM!
3:Internship BOOM!
4:Community Service KEPOW!

And now........?

Well now I have the peculiar feeling that I've been cruelly severed from the umbilical cord of institutional protection.
Like I've been ripped away from my comfort zone of striving together through shit situations with a team towards a common goal.
Or like my family has disowned me or something similarly nonsensical.

I miss my colleagues.

I miss the patients.

And I feel kind of...lonely?!?!

Take charge of my own destiny, you say?

Not sure if I know how, think you can help me with that? ( ho hum)

Three weeks of holiday later and I'm uttery dumbfounded as to what to do with my day.

I find myself praying that someone will collapse in a shopping centre and need resuscitation. (this has actually happened to me before, but that's a story for another post)

Or that I'll come across an accident scene with a patient in need of some kind of trauma assistance.

But it's not all doom and gloom...I have some things in the pipeline...

Namely:

*A possible post in Infectious Diseases as a medical officer at the end of Feb.(pending results of an intense interview that felt more like my final medical oral exam)

*A GP locum job seeing private patients with minor illnesses starting on Thursday.(This might prove mind-numbing after the madness of 2009)

*Joining MSF and going to work in some war-torn part of the world.

*Becoming a stripper.


Oh, this doesn't mean the posts will disappear...on the contrary! Now that I have all this free time on my hands, I might delve into all sorts of introspection and subject you to unending mundane musings about the most banal trivialities of my life...

Or I might remember the hundreds of mad medicine stories I didn't post purely because there wasn't enough time.

We'll see...

It's all up in the air right now...

Retarded Referrals (4): Passed Away Disease

Honestly, I have no words for this referral, which I am not shitting you, is exactly how it was sent to us, punctuation and all.

Read it and weep.

I did.


Dear Doctor,

Thank you for seeing above mentioned patient with Parkinson's Issues "best friend passed away" disease, otherwise stable, social.

Please assist with further investigations and management.

Thank you,

Dr Retarded.

Incontinence: The emotional kind

We're a funny bunch, us doctor-types.

Funny "strange", not funny "ha ha".

(Although some of us have been known to be in possession of a rather hilarious wit.)

What I'm trying to say is that we are not what one would call... normal people.

Oh, we can fool you, and put on our professional serious bedside-manner hats.

And pretend that we've shut down our emotions in order to stay objective.

But you need to know that underneath that white coat lurks a complete lunatic, who after years of desensitisation, and total sleep deprivation, is usually cruising along at work, at a speed known as, "this close to cracking".

And...well...somewhere along the line there's that one poor sod who's going to push that doctor over the edge.

Sorry for you buddy, but you were just in the wrong place at the wrong time.

Like the guy who stumbled into the front room, trashed out of his mind and stabbed in the hand... and proceeded to vomit, and bleed, on my chair.

"NOOOOOOOOOOOOOOOOO!!!!!!!!!!!!" I screamed at him, that's MY CHAIR!!!!! My chair, my place to rest my bum! My place to sit down and pretend to be civilised and write my notes. MY CHAIR!!!!

Not, "Oh dear, sir, I see that you are bleeding and having some trouble with your retrograde intestinal motility, how can I help you?"

Just, "NO". (What's wrong with me!?!)

En.

Oh.

That's known ANGER and IRRATIONALITY.

The IRRATIONAL ANGER was recently preceeded by SYMPATHY and DESPAIR, having just held a sobbing mother in my arms after telling her that we'd failed to resuscitate her son. He was stabbed in the back and brought in by the ambulance in cardiac arrest. She told me that she knew who had stabbed her son, and that this criminal had also killed her firstborn child one year ago. (Believe it, because it's true.)

And before the SYMPATHY and DESPAIR, there was MANIACAL ELATION when I checked the lumbar puncture result of my ?meningitis? patient and there were NO red blood cells in my perfect CSF sample, prompting a spontaneous victory dance in front of my colleagues in casualty.

Quite rapid cycling through some extreme emotions in the space of about two hours, wouldn't you agree?

I think it's safe to say that I was suffering from emotional incontinence...

That sphincter on my amygdala needs some major re-tightening, it's slightly worn out at the moment ... just dribble dribble dribble, emotions seeping out with no filter of restraint...

Someone needs to put a diaper on this mental diarrhoea.

Any offers?

Anyone?

Retarded Referrals (3) V-Fib

Write! ( Yes, I'm doing that.)

I mean,

Right! ( In that authoratitive, I'm the doctor in charge, let's get this shit on the road voice)

This, my dear readers is another lesson in retardedness.

The moronic, blockheaded, boneheaded cretin-ness of this, the dimwitted,nincompoopy, pinheaded sheer stupidity of this referral, defies reason, defies logic, is as a matter of fact simply incredulous, spectacular in its stupidity, so utterly mind-blowing that my brain actually exploded all over the front room when I read it.

Please sit down before you read this:

Dear Doctor,

I have diagnosed ventricular fibrillation via Ultrasound in my consulting rooms.

Please do ECG and manage further.

Kindly,

Dr Retarded.


Ok just breathe.

Calm down, take a deep deep breath,

Here...have some of this sweet milky tea while I collect your grey matter off the floor and shove it back into your cranium through your nostrils using a spatula.

Yes,my darling, I know... VENTRICULAR FIBRILLATION! *insert blood curdling scream here*

V-fib ( which is what us cool kids call it) is a medical EMERGENCY.It is a sudden, lethal arrythmia characterised by twitching, fibrilliating, unco-ordinated heart muscle contractions that will kill you in seconds as there is no output of blood from the heart's ventricles to the rest of the body's vital organs.

Like the brain.

Which is why the patients I've seen with V-fib are unconscious.
Always unconscious.

This patient,totally raped of his hard-earned cash, had this v-fib medical lethal emergency "diagnosed" by Dr Retarded, and was then given a letter to bring to us, and as such, walked, fully conscious, into the front room with it.

(Makes the v-fib diganosis highly unlikely hey!)

Secondly a diagnosis of V-fib warrants immediate CPR and defibrillation (Electrical shocks delivered to the chest).

Which Dr Retarded, after making "this brilliant diagnosis" via ultrasound, did not think it necessary to do.

Wrong. Wrong. Wrong.

Fail.

Do not pass go.

Do not collect your R200.00

Go directly to jail.

Christmas Carnage

I worked every single day of the Christmas weekend.

It was tough. Doctors, paramedics, police throughout the country celebrated Christmas by working themselves to the bone.

Oh but there's one dude responsible for this:

I blame Santa Claus...you drunken red-suited buffoon!






Well done buddy.

Good Job.
Good Job.


Maybe you did you not read the freaking tourist manual to the Cape Flats that I sent you?!! Huh??!



Rule ONE: Do not drink the tik-laced milk and dagga cookies left out for you. IT’S A TRAP!

Oh it seemed tasty did it?
Oh you just couldn't help yourself, right?
What's that? It would have been rude not to partake of what was offered to you then hey?

Is that why you screwed up and rewarded the good little gangsters, and drug-induced psychotics, and alcohol sodden short-tempered aggressive folk with knives, and guns, and bullets, and other such cheerful weaponry? Huh? Because you were HIGH?

Panga's: The gift that keeps on killing.

Tra la laaaa! ( That's me warming up my voice for the Cape Flats Casualty Christmas Carol)

Ready? Here we go:

On the weekend of Christmas, those shifts they offered me:

One dead child
Two thoracotomies
Three gunshot abdomens
Four beaten wives
Five drunk drivers
Six stabbed chests
Seven drug-induced psychotics...


Can you tell that I was not impressed by the Christmas weekend's holy shitstorm and emphatically not overcome with the spirit of Christmas joy and love?


So here's a tip for next year, Santa Claus: Rudolph and that gang, me thinks it best to leave them at home. That red nose of his is like a shiny conspicuous beacon, and that jolly red suit of yours - BURN IT!

To achieve successful delivery of the goods, without getting stabbed or forced to feed on narcotics, you need to blend in man!

First, remove your two front teeth. ( This will have the added benefit of making you sympathetic to the plight of those cute freckle-faced munchkins who desire just that waiting for them under the christmas tree.)

Next, get a tattoo of something obscene on your forehead. Something like, "I kill for fun and rape for joy". That's just a little something I read on the face of one of my patients a while ago - maybe you could use that one.

Learn some choice phrases in Afrikaans to throw them off the scent that you're actually a do-gooder come to bring light and joy to the dark corners of the Cape Flats.......you know the filthy vulgar ones I'm talking about.
No?
Go back a few posts and have a little read - you'll be sure pick some up from those.


This way - you can wander around the freaky scary place our patients call home and offer those in need some assistance. Your goodie bag may need to be slightly different from the one you're traditionally used to. If you can fit in one first-class education system, a health system run by competent people and some regular nutritious FOOD for the poor...perhaps I'll reconsider your current low-ranking on my list of favourite people of all time...

At the moment you are down there with the Easter Bunny ( who dropped mandrax laced eggs over the Easter Weekend) and the Tooth Fairy - who went rogue and is making a killing off the lessor-incisored natives of this crazy town, used her takings to start smuggling drugs and is now known on the Flats as...the Tik Fairy...*drum roll *