Avoid bad poetry like the plague

So much stigma now

This virus isolates me

Still, I crave cuddles

I made a flu haiku.
(You thought I was talking about HIV weren't you?)
It was inspired by the fact that The Husband refuses to come near me because I am as sick as a dog after being infected with influenza. I can't even eat off communal crockery. Or sleep in the same bed as him. Ridiculous!
I mean, its not like I have Ebola for God's sake! (Or ManFlu for that matter, which we all know is terminal but never fatal.)

But such is the fear, and stigma, surrounding the flu.

I understand it though..it can be so depressingly debilitating and there is no bloody cure so people avoid it like the plague. ( ho hum) But people with the flu are still people. And we deserve TLC too.

Anyway, being a patient sucks.

How is it possible that I can cut into someone's chest cavity to decompress their collapsed lung but I can't fix a silly old flu bug?

So I've resorted to treating the symptoms. Here are the friends I've been hanging out with over the last two days:

And I know what you're thinking, " WTF? Why does she need remicaine jelly that people normally put on their haemorrhoids or use for their burning pee-holes when she has the flu?!".
But relax, and stop being gross. I'm using it on my burning nasal mucosa you perverts!

Ray of hope, literally

Our EC ( Emergency Centre) is absolutely stunning. Without a doubt, one of the most beautiful ECs I've been in (Government-funded or private). It's a beautiful place, situated in an area with extreme poverty, extreme violence, and some of the highest HIV and TB rates in the world. (Yes, in the world)

If you peep through the windows of the resuscitation room, like I did last week, and look  past the electric fencing on the perimeter of the hospital,  you will see out over the, grey, sandy, treeless plains of this township. The  monotonous landscape is covered with a sprawling mass of informal tin shacks, and low-cost brick houses, home to an estimated population of almost 2 million. Far off in the distance,  40 km or more, the unmistakeable shape of Table Mountain reminds you that you are still in Cape Town.

The resuscitation room  is the most intense part of the EC, where the most severely ill patients are kept. Most are intubated and on ventilators, awaiting transfer up the public health system to a tertiary institution for specialist care or ICU.

The beds are normally arranged in specific ways. Except that on this day, one of the beds was at a bizarre angle, totally out of whack with the regimented bed-placing system.

In it, was a comatose women in fulminant, life-threatening liver failure. We weren't entirely sure why. She came in unconscious, and stayed that way.  We know she was on a cocktail of HIV and TB drugs, that although life-saving, can also be devastatingly liver toxic. She needed specialist care at the tertiary hospital on the other side of the highway. Except that they had refused to take her as their ICUs were full, and they had no beds to accomodate her.

So we kept her in our resuscitation room, giving her the best treatment we could, even though there was nothing more we could possibly do.

Dr W, who was stationed in resus that day, did what some of us are compelled to do when we feel there is nothing left to try: we do things that we know won't work, but try them anyway to make ourselves feel like we never gave up.

Which is why Dr W had moved her bed so that it was aligned perfectly with the shafts of afternoon sunlight beaming through the Resus windows.

Her bed, at odds with the other resus bed configurations, was positioned to gain maximal solar illumination.

Perhaps he wanted to make her stay in resus a bit more pleasant.

Or it may be that her helplessness reminded him of a newborn with neonatal jaundice that is treated with phototherapy, and decided to try it on her even though  phototherapy in adults  with liver failure has no proven benefits.

Touching, but also tragic.

A literal  final ray of hope.

One last luminous celestial caress - an appeal to the heavens for help because the doctors could do little else. 

She was still in a coma the last I heard. The African sun is no match for drug-induced hepatic encephalopathy.

Chocolate septic balls ( to paraphrase the cook in Southpark)

When your wife suspects you of dipping your ding dong in the pretty young thing next door...you end up as a diagnosis in the new-patient book as follows:

Depending on your views on justice and relationships...some might say she had a perfectly warranted sudden craving for nuts....?!!?!!!

Normality is positivity. Philosophy 101 (taught by a mental case)

I was always sad that my MBChB didn't involve any philosophy courses.

But there are teachers of the philosophical arts everywhere.
They are even present on the Psychiatric Island...

The Isle of Psych is the northernmost corner of our massive emergency unit. A non-officially designated far-flung corner of the EC to gather and herd the acutely psychotic patients.
We do not have a cushioned, calming space to keep the constant stream of psychiatrically disturbed patients contained, so we created  the Psych Island. ( We learn to make it work around here.)

I spent the day on The Island today. I don't know what I did to piss my boss off, but I was banished there for 9 hours, and given the sole job of sifting through the complicated mess of certification forms, and transfers to the correct psychiatric facilities.

One inhabitant of the island, was a peace-loving rastafarian. He was a lover of Mary-Jane, and he told me that, as a medical professional, I should know that all medicines contain a trace of marijuana and if doctors are using it then it should be legalised.

I know some doctors who have used heroin. So his logic is kind of dangerous.

I asked him why he thought he had been brought to hospital.

He told me that it was because people do not want to listen to the wisdom that was bestowed upon him by Jah above.

Intrigued by his reason, I asked him, "Well what is wisdom, my brother?"

He replied, "Wisdom is humility".

"Ah" I said. (humbly, because I am wise)

"Doctor," he said, " I really shouldn't be here. Can't you see that I am normal?"

"What is normality, my brother?" I asked him.

"Normality. All that it is, is simple. Normality, it is positivity, my sister".

Normality is positivity. Yes!
I was now starting to doubt this diagnosis of mental illness a little bit. And while it may have been the strangeness of a busy day spent on The Island and not having had time to eat lunch,  this guy was suddenly starting to sound like a true sage of infinite widsom.

So I said to him, " But sometimes, we feel very negative, and that causes problems. We can't be positive all the time can we?"

To which he replied, " No, my sister but we can try all the time. And time is a healing power, that marches inexorably towards love."

Holy shitballs!! There was no way I could certify this patient as crazy. This patient was a philosopher come to teach me the all-encompassing ancient truths of the universe.

I was suddenly in love. Mostly because never in my 7 years of being a doctor has a patient ever used the word  "inexorably" .
Actually, nobody of all the people that I know has ever used the word inexorably in a conversation.

Swoon.

I  told the boss that I had discovered a philosphising oracle on The Island and thanked him for putting me there today.

He ignored my excitement and told me that actually the patient was a forensic psychiatry case and was referred to us incorrectly by the local courts. He had sworn at the judge during trial, and behaved bizarrely in court so had to be assessed for mental fitness.

Hmmm.

No matter. I wasn't gutted. This meant that I was off the hook, and did not have to officially declare my Rastafarian guru as a loony tune.

"Peace be with you", he said as he left with the policeman. That made me feel warm inside. And I immediately forgot about the dreariness of the long day. I walked out at 17h00 with a smile on my face thinking that truth is perception and experience. So yeah, ok fine,  that judge thought Rasta guru was a mental case because he swore at him and only answered his questions with parables. Fair enough. But after a day dealing with angry and frustrated psych patients,  my interaction with him left me feeling like I had smoked some of the happy tabaccy.

I floated out of the unit remembering one of my favourite quotes from a beloved childhood book:

"...And above all, watch with glittering eyes the whole world around you because the greatest secrets are always hidden in the most unlikely places.  Those who don't believe in magic will never find it."

 - Roald Dahl, The BFG

Adversity Ninjas

Friday, +/- 10:00am

Any normal 16 year old would be at school.
This young lady was sitting across from me in the EC.
She had a 7 cm gash in her head, that was sending bright red rivulets of blood down her exquisitely beautiful face. It was, in a Quentin Tarantino way, quite a striking scene.
Luckily there was no underlying skull fracture.
I knew this because I stuck my finger in the wound and rubbed it carefully along her bony skull to check.

She was talking, had walked into the room, and was not vomiting on my shoes.
So far so good.  Danger signs covered, I could start taking a proper history.
"So my dear, how did you end up here with me today instead of learning about trigonometry?"

And then she said something I haven't heard in my 7 years of being a doctor:

"My grandmother beat me on the head with a thick piece of iron."

Her grandmother has escorted her into the room and was sitting in the chair next to the consulting bed.

"WHAT IN THE HELL!?" I glared at the grandmother, forgetting that I am supposed to be calm and collected.
" WHY DID YOU BEAT YOUR GRANDCHILD WITH A PIECE OF IRON?" I demanded.

" No, no doctor!"  The grandmother pleaded. "I am the mother of her father, it was the other grandmother, the mother of her mother who beat her."

Oh. Right. Ok. Excuse me.
I apologised, continued with the interview and started the procedure of suturing up her head.

Turns out, exquisitely beautiful 16 year old had found out that Evil Granny was using the social support grant she was getting from the government to buy alcohol, instead of food.  So when exquisitely beautiful 16 year old decided to go and live with Good Granny, Evil granny lost her alcoholic mind and tried to beat some sense into her.

But exquisitely beautiful 16 year old was already very sensible.

So sensible that, despite losing her dad in a gang shoot-out when she was 8 years old, and losing her mum to AIDS when she was 14, she was still doing well at school.

Doing so well that she was performing at the top of her class in grade 11, and had big plans to become a microbiologist so that she could learn about the virus that killed her mother.


This is not a movie script, people.

Luckily she couldn't see my eyes well up because she was face down on the bed to give me access to the wound on the top of her head.

So, ja.

I told her she was my hero and that I thought she was an amazing human being and ninja.


She said she didn't know what a ninja was but thanked me anyway.

I wanted to tell her that she was the best kind of ninja, a ninja that had kicked the shit out of adversity.
Instead I just let Good Granny take her home and was simultaneously impressed and enraged, at what our children must endure to practice their basic human right to education.

I am in awe.

I hope she ninjas the shit out of her microbiology degree too.

I have more faith in the scalpel.

Snippets of a particularly intense "conversation" one evening...

" uh...I think your brain would benefit from a therapist." He said.

"No!" I cried. 

" No!"
" My brain doesn't need a therapist...my MIND needs a neurosurgeon!"
 "Cut it out! Cut it out! Cut it out!"

Wouldn't life be grand if you could surgically remove your troubles...?

T.I.A.

Driving home from work along the busy N2 highway ( the site of many pedestrian fatalities), I was happy to see a pedestrian actually using the overhead pedestrian crossings instead of the life-threatening mad dash across the road that usually happens. So I took a picture....

Sorry did I say pedestrian?
I meant COW!
A cow.
A COW strolling like it ain't no thang across the overhead walkway.
WTF?!?!
Apologies for the poor quality photograph...but it was the best I could do while travelling at 120km/hr.
Moments like these always remind me of Leonardo Di Caprio in blood diamond. T.I.A. mofos, T.I.A.
Understand T.I.A. here

Disarming your doctor

My last patient of the day was a middle-aged man who had fallen in the street and injured his left knee.
Pretty boring as far as this Emergency Centre is concerned.
When I called his name, he emerged from the thronging waiting room with a good natured chuckle and limped towards me smiling.
And I thought,  well that's something  delightfully rare...a happy patient!
Especially, especially rare as this was a happy patient who was also missing his left arm.

The chuckle and toothy grin he gave me when he walked into the consulting room was so disarming (sorry, couldn't resist) that I felt I needed to get to know this character a little better.

So I told him that I would promise to fix his knee only in exchange for the story of how he lost his arm.

And as I suspected he would, he obliged immediately, and launched with well-rehearsed devilish relish into the rather gruesome details:  

...that he was travelling home by railway one afternoon....that he was robbed on the train by "skollies" ....that said "skollies" then threw him out of the moving train.... that "luckily for me, doctor" he was already in the third last carriage when he exited so he only had to watch the wheels of two carriages butcher through his trapped arm while he concentrated on keeping his head out of the way ...that once the train had passed, he stared at his severed arm and fingers still twitching along the railway line searching for their beloved armpit...and realising that his limb was destined to become rat food, then stood up, bleeding limb-remnant and all, and WALKED the 20 minutes along the tracks to the next station where he fainted and a policeman took him to the hospital.

"Do you want to see my stump, Doctor?" He asked me with ghoulish glee.

"Oh yes please!"I cried.

And needing no further encouragement he pulled all 10cm of it from his sleeve and contracted that little stump so that it performed a freaky little stompie dance show for me.

When I clapped and giggled in appreciation, he suddenly looked very confused and also a little disappointed.

"You mean you are not scared of it?" he asked incredulously.

"What? did you expect me to scream?" I replied.

"Yes!" He said, with a mischievous twinkle in his eye. "The little kids always scream and run away when I do that!!!"

I apologised profusely to the man for not being sufficiently petrified, as my patients that week had exhausted my entire scream quota......you know.....like that one patient with scurrying squirmy maggots eating her necrotic foot, and the one before that with brains leaking out of his head that had been shot through in a gang fight, and the one before that, a young boy with a gangrenous penis who had a traditional circumcision performed under non-sterile conditions in the bush over the festive period, and the one before that, the grandmother from the Eastern Cape with a fungating septic cancerous mass in her breast that had been there for two years...and the one before that....and oh! that other one that had that seriously gross....


Dammit, it's good to be back.

XXX