MAD MEDICINE: A Dr's dose of Mayhem

Hiatus

2010-07-14T12:52:00.000+02:00

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...

2010-06-08T22:20:00.004+02:00

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

2010-05-30T18:05:00.000+02:00

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:

After one month of trying she was still not pregnant.
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

2010-05-25T19:29:00.007+02:00

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

2010-05-18T20:44:00.010+02:00

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

2010-04-02T19:46:00.007+02:00

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

2010-03-27T16:42:00.004+02:00

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.

2010-03-18T19:57:00.011+02:00

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!

2010-03-17T19:50:00.003+02:00

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

2010-03-14T22:45:00.004+02:00

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

2010-03-03T17:55:00.008+02:00

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

2010-02-26T17:07:00.010+02:00

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.

2010-02-23T23:09:00.003+02:00

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

2010-02-23T20:15:00.006+02:00

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?

2010-02-17T00:00:00.001+02:00

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

2010-02-10T18:51:00.005+02:00

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

2010-01-18T18:48:00.005+02:00

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

2010-01-10T15:14:00.003+02:00

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

2010-01-06T23:12:00.004+02:00

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

2010-01-05T07:29:00.004+02:00

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

2010-01-03T10:37:00.007+02:00

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 *

Ode to a Torturer....

2009-12-22T21:00:00.005+02:00

For six months I've been at the mercy of a relentless tyrannical torturer.

Yes, you Dr MB.

I arrived at this secondary hospital in July, expecting to belong to a team of caring superiors who would teach me medical secrets at every corner.

Instead you educated me in how to most annoy your colleagues, how to brew evil pranks involving patient's bodily fluids and gave me a daily lesson in torture.

And in the way a victim comes to expect and almost have an affinity for their abuse, and in the way that a cat tortures it's pray before it kills it, you killed me today when you left to go back to that cold country of yours.

I'm taking comfort in the fact that I at least managed some sort of revenge over the last few months, and for this I'm very grateful.

So here's my thanks:

•Thank you for helping me save lives...and thank you for reminding me, every day, all shift that you are a hero, have a superior intellect, are the best doctor in the universe and furthermore are generally the alpha male in all situations blah blah blah blah blah.

•Thank you for not letting the psych patients injure me while trying to sedate them...like when you unintentionally/intentionally eye-gouged a poor mentally ill music professor who wanted to make me his woman and tried to capture me.
FURTHERMORE - thank you for injuring me in resus and leaving massive bruises on both my person and my ego thus injuring me irreparably for which I will probably require a few years of therapy to recover from...and then...thank you again... for referring me to the psych department on my birthday for the aforementioned therapy.

•Thank you for being a walking textbook of medical knowledge...thanks for adding extra chapters to my textbooks including such gems as “Dr S's Discharge Eponymous Syndrome: very smelly vagina, 99.9% fatality” Nice. Very nice.

•Thank you for looking after me when I was going through my HIV needlestick issues, thanks for then stealing my patient stickers and placing one in the logbook next to a diagnosis of: retained foreign body, ?sex toy!
Thanks also for thus inspiring my revenge, with your very own diagnosis of: ?Haemaphrodite. Vaginal Bleeding, Grade IV prolapsed rectum and dysmorphic buried penis. ( Never mess with Dr S!)

•Thank you for inspiring us to eat healthily and snack only on things like lettuce and nuts...thank you for being nuts and shoving a steel bucket on my head with plaster of paris leftovers after we had a lovely chat in the POP room and then claiming that it was a beautiful home-made hat and canning yourself stupid when the sister came in and found me lying on the stretcher with the damn thing covering not only my head but also my face and shoulders so that it looked like I was being RESTRAINED by the bucket NOT adorned by it .

•Thanks for dribbling water on my head while I was resting my weary head on the desk...thank you for then standing still long enough for me to deposit an entire coke bottle full of God knows what on your person and smacking you on the head with the thing when it was empty. (HA HA! I win!)

•Thank you for making me coffee at the end of a long shift...and thank you for suspending me upside down and threatening to drop me on my head after I stole your coffee jar which was totally justified because you made me a prank cup consisting only of hot water and milk purely to piss me off.

•Thank you for letting me hide peanuts in your shoes...thanks for still eating them when you found them and thus not wasting food. (Weirdo!)
And on the subject of peanuts, thanks for throwing them at me across the doctor’s desk and making a massive mess on the floor. Thanks also, for NOT helping me clean it up when the head sister shoved the broom in my hand and forced me to start sweeping under threat of bodily harm.

•Thanks so much for being thoroughly evil and waiting until I was in resus with a smelly patient who had made a moerse foul smelling kak, and then locking me in the bloody room with her so that I could die a death by noxious fume asphyxiation while you looked on smiling and waving through the glass doors!!!!!

You're going to be terribly bored in the UK. You'd only done one chest drain in three years before you got here, and in the 14 months that you've been here you've done over a hundred...When you arrive in England, with three feet of snow to welcome you...I'm going to lie on our beautiful world-class beaches in the hot Summer's sun and think about you and laugh because I finally got the upper hand over you...

Not really.

I'll be sad.

I'll be teribly sad that my adopted sibling is gone and that there's no-one left to play with at work...

Back pain and Triple A

2009-12-12T13:57:00.009+02:00

At the entrance to the front room there is an old steel trolley that rules my life. On it lies the patient log book: The book of life and death. Every patient that requires our team's attention is recorded in this cruel master of the shift...

She is a terrible slave-driver, relentless in her ass-whipping...doling out her punishments with cruelty and wicked irony - throwing out the sucker punches of end-stage cancer/HIV/TB at one moment, and then blasting you with the shotgun shells of stabbed hearts, cracked skulls and eviscerated bowel post knifing. And then, right at the end of your twelve hours overnight, she cackles, and slaps you in the face with a flat, blue, not breathing baby that has just been delivered at home on the floor of the mother's kitchen.

Sometimes her torture is just slow and painful...like when she sends you the patient logged as "back pain".

Argh - the worst, the worst of the worst. What a vague awful random non-emergency type of complaint. Yes, there are life-threatening conditions that can present with back pain:ruptured abdominal aortic aneurysm, peptic ulcer disease, pancreas issues.

But mostly, it's the complaint of the the overweight or old and arthritic - and not exactly something I'm ever in the mood to deal with at three in the morning inbetween the heart attacks and incomplete abortions.

So what happens is that the back pain patient gets skipped over...and after sorting out one patient and approaching the book of life and death for my next beating, I purposefuly bypass the back pain for something I think is more worthy of my early morning attention. I know my colleagues are doing the same, and we are each secretly hoping that someone else will be the better doctor and go and sort that patient out, but are not willing to take the plunge ourselves.

We had exactly such a patient one day - and because she presented near the end of the shift she unfortunately was not seen by the time the handover round started. That morning, the consultant in charge of the handover was none other than the Godfather of medicine in the Western Cape, a legendary figure whose initials, Triple A,are both his nickname and the medical abbreviation for Abdominal Aortic Aneurysm...and he is just as deadly.

Triple A is renowned for his spot diagnosis and unparalleled clinical skill - having the uncanny and inspiring ability to diagnose a patient's condition from the end of the bed - sometimes by just looking at them, not even one question asked.

Not only is he an astute medical genius, but he is also a staunch atheist, a lover of incrediby rude jokes and also wholeheartedly committed to the poor patients accessing state health care.

The stories that circulate about him are the stuff of legend. One of them being that one morning on the hand-over ward round he developed chest pain, and went to lie down on the floor next to a plug on the wall.
When people asked him what was happening he replied that he was probably having a heart attack, and since the ECG machine was situated on the other side of the front room and that he knew there were no extension cords, he decided to lie next to a plug, thus could someone please go and fetch the damn thing and check him out. The poor intern did the honours, trembling all the while, not believing that he was bent over his grand master, and then exclaimed while reading the ECG that there were no classical ST elevatory changes to indicate a myocardial infarction.

Triple A, lying on the floor had a slug's-eye upside down view of the ECG and promptly exclaimed, "Fuck you, man, there's an R-wave in lead V1, I'm having an inferior infarction, get the streptokinase!". He then refused to be moved to another hospital, exclaiming that if he didn't have faith in his own place of work, then how could he expect his patients to do the same.

When we arrived at the bedside of the old, overweight lady with back pain, we presented her as an arthritis. But we might have been talking to the walls - Triple A wasn't listening. Ignoring us, he asked her to describe her pain, where it radiated to and what time she felt it during the day. That was all. And then he looked at us and proclaimed: "This woman has cancer of her pancreas". He hadn't laid a finger on her. We all balked. And there were mutterings that perhaps the senile dementia had finally got to him...But he insisted, she was sent for an ultrasound, and the report came back that there was a mass in her pancreas, most likely a malignancy.

We all felt like fools. Like shits. Like we knew nothing about anything worthwhile. Like we were mere amoebae in the presence of this medical guru.

Needless to say, I've changed my behaviour towards the back pain patient...and when the book of life and death throws that one at me, I'll accept the punishment gladly to try and atone for my previously wicked behaviour!

Retarded referrals (2): Surfer Doc

2009-11-25T13:22:00.006+02:00

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.
Satisfied?
Ok, let's continue...

Seriously.
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 out...it'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!

Macho man versus the Needle.

2009-11-21T17:12:00.007+02:00

CHEST DRAINS!

SNORE!

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 shift...it 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?

IT'S HILARIOUS!!!!!

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...

TIMBER!!!

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! Erm...you 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, erm...ja...you 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!

Retarded Referrals (1)

2009-11-09T20:41:00.004+02:00

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.

Worry?
Genitals?
X-ray?
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???

2009-11-09T20:36:00.001+02:00

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.

Awaiting...?

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

Pregnant? The patient's guide to parenting.

2009-11-07T08:44:00.010+02:00

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.

YAY!

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)

3: 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.)

PIGS AND PATIENTS

2009-11-04T11:53:00.010+02:00

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.

Yay!

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!

THE C-WORD

2009-10-28T11:45:00.005+02:00

The fingertips of my right hand have been trained, over the past few years to pick up subtle irregularities in the examination of a patient.

The sensory information gained from these soft pads of palpatory precision, communicate via amazing electro-chemical pathways along my nerves, to send a message of alarm or calm to that central processing unit in my skull.

As doctors, we usually begin our examinations by using these sensitive fingertips of ours to feel pulses.

It's probably the first thing one learns to examine. I remember practicing on my fellow students after our first clinical skills tutorial, and bragging about who had the lowest heart rate and could thus claim supreme athletic fitness.

Such a simple thing, feeling a pulse.

And yet, at it's most basic of functions, it is an ultimate determinate of life, or death.

Lub-dub, lub-dub.

A rhythmical, cyclical affirmation of life, beating a constant reminder into my fingertips that, "Yes doctor, I am alive, don't give up on me yet."

Except that this time, the pulse lied...

She was logged in the book as "???oesophogeal cancer???"

That question mark prefix:

Mostly an indication that the diagnosis is still being worked up.
Often a symbol of hope that our suspicions are unfounded.

I drew the curtains, armed with my cheery and hopeful, yet concerned bedside manner.
The one I've developed over the years to try and lessen the terrors of being in a state hospital and the threat of a disastrous diagnosis.

But I was no match for the enemy that confronted me.

I was physically shocked. My years of service have brought me face to face with the destructive forces of disease and trauma, yet I have never been this physically moved.

There it was.

Present.

I did not need to touch her to know what I instinctively felt.

Cancer.

I could hear it cackling at me, callously thrilled to have so viciously ravaged her body.

So confident in its permanence that it willingly revealed itself, showed its hand, tortured me with its unquestionable impending victory over her life.

She lay there, motionless, except for the slow sad movements of eyes sunk deep into the despairing depths of her skull.

In a defeated and very small voice I introduced myself to her.

She responded after a few seconds with only a painful exhalation.

Touching her made me shiver with horror.

Her skin, like old leather that has been trodden on and left outside to be battered by the rain and sun, was stretched unwillingly over her skeleton. I looked at it listlessly collecting in the hollow that used to be her abdomen, and watched it tiredly continuing on its journey over her chest - her nipples the only hint of the breasts that fed the three children huddled around her bedside.

Her arms and hands were like the branches of a dead tree...thin, dry, reaching hopelessly into space.

I knew then that I had no weapons against such an advanced and evil adversary.

I could feel her spine when palpating her abdomen.

I was sickened.

And before feeling it, I saw her abdominal aorta pulsating, valiantly carrying on the physiological fight, regardless of the inevitable surrender.

Why did this lady only present to us at such a late stage?

Because she is poor? Because she doesn't speak English?

Why did the initial slow deterioration of her life not warrant ear-splitting sirens summoning sympathy and support and treatment?!

But it was too late for all of that. The cancer had metastasised.

Any further medical intervention would have been cruel and inhumane, and would only prolonged her torturous demise into death.

I gently informed the family of the very poor prognosis, and let them know that she would most definitely stay in hospital for the night while we tried to find a placement home for terminal care.

When her husband left, he bent over the skeleton that used to be his wife and kissed her forehead. He then turned to me and placed an old washrag and a bar of soap in my hands.
"This is her washrag." he said. "I'm the one who washes her every day with this washrag. Can I leave it here? Will someone wash her while I am away?"

Choking back the tears all I could manage was a nod of the head.

I handed over the washrag to the nursing staff, and finished my shift, dejected.
By the time I arrived the next day, she was gone.

But what remained with me is cancer's destructive power and our frightening inability to conquer this terrifying disease.

HIV, Will you get me? Not with the help of ARV's.

2009-10-11T15:17:00.010+02:00

So I'm taking ARV's.

A.R.V's.

Sounds like the latest gas-guzzling 4X4 from Pajero.
Or some super-cool new street drug that with one hit can send you on a round trip through the milky way, with a stopover in Heaven and possible delays in Hell.

But, nope.

ARV's are way cooler than that.

They are anti-retroviral drugs!

They can prevent the contraction of HIV, when a doctor exposes herself to it while she is taking blood, very diligently and gently and with gloves on, from her HIV positive patient who moved during the procedure resulting in the bloody needle piercing her thumb.

No biggy.

This is only like the fourth freaking time this has happened to me.

The first time was when I was a fourth year medical student doing my paediatrics rotation. The poor paediatrics registrar was struggling to gain intravenous access on a very sick neonate with veins smaller than the cannula diameter. I was helping her hold the neonate still while she attempted the procedure for the 20th time. After failing, for the 20th time, and understandably frustrated, she threw the needle into the sharps bin. Except that it didn't make it into the yellow sharps container. Instead I watched, in slow motion, as it did a spectacular somersault through the air and embedded itself, rather painfully, in my thigh.

I was distraught, and upset and got loads of sympathy from family and friends.
I started the ARV's immediately and sweated through the ensuing 28 days, petrified of sero-converting to HIV, and ultimately testing HIV negative. Phew!

That was five years and three similar events ago.

This time I didn't even tell my colleagues until someone saw me squeezing out the blood from my wound. It was near the end of the afternoon shift and I was completely disinterested in myself and my patients. (horror)
But my concerned colleagues forced me to go and open up a hospital folder, have my blood taken and start the ARV's.

So now I'm taking them. twice a day.

These drugs are brilliant, but can result in nasty side effects such as:

Diarrhoea
Vomiting
Skin Rashes
Anaemia
Bone marrow Suppression
Pancreatitis
Depression
Hepatitis
Lactic Acidosis

YAY!

Luckily I have only suffered mild nausea and muscle pains thus far.

Oh, and I've also suffered at the hands of Dr MB's torturous pranks.

After behaving very sweetly, and drawing my blood very gently, and phoning the laboratory for my initial test results before starting the ARV's...he then stole one of my personal patient stickers from my file, and stuck it into the front room's patient log book along with this made up diagnosis for all to see:

Patient: Dr S

Working diagnosis: Retained foreign body, +/- ?sex toy??

Hilarious.

I eventually got my own back though with this entry into the logbook:

Patient: Dr MB

Working diagnosis: ?Haemaphrodite. Vaginal Bleeding, Grade IV prolapsed rectum and dysmorphic buried penis.

Overkill? Maybe.
But that's my style.
I'm ruthless with my retaliations.

I guess that's one way of making fun of a ridiculous situation.

With almost every second patient that we see being HIV positive, it's inevitable that one of us will be accidentally exposed to the virus while trying to treat patients.

It's so common that I don't think I've met one doctor who hasn't been on post-HIV-exposure prophylactic ARV's.

Which is why I keep reminding my husband that he could have married a prostitute, as both doctors and ladies of the night run the risk of contracting HIV from their professions.

Comedy Crusaders

2009-10-06T10:13:00.006+02:00

Friday morning handover round.
08h00.
Our team ( The A-team) is handing over the numerous patients we've spent the last night seeing, to the new team coming on for the day.

Dr MB begins one of his patient presentations. The patient is curled up under one of the government issue blue hospital blankets in the fetal position.

Dr MB: "This patient is a 28 year old lady admitted at 06h00 this morning for strange behaviour. She was brought in by her colleagues for bizarre delusions. She believes that she is a doctor and that she is at the hospital to help people get better. She is not a known psychiatric patient but currently displays signs of mania, psychomotor agitation and formal thought disorder..."

The consultant leading the round, Dr G, then decided to wake the patient, and moved over to the head of the bed. She lifted the blue blanket to reveal....

MY very own pretty little face giggling hysterically from beneath the covers.

I was so dog-tired after our long shift that while the rest of my team were busy presenting and discussing another patient, and with no further patients of my own to present, I decided to climb into one of the empty patient beds and rest my weary head. It seemed like the appropriate thing to do at the time.

Which is when Dr MB and I came up with the idea of presenting me as a patient on the ward round.

Luckily Dr G was a young, newly qualified emergency medicine consultant with a sense of humour. She laughed heartily , and then shook her finger at me for being crazy enough to risk catching patient germs in aid of a little comedy...

She doesn't understand the lengths we are prepared to go to for a laugh in this place.

Doesn't she know that every shift is a war between patients and our sanity?

Nonsensical frivolity is sometimes the only defence against impending work induced depression and despair.

Our next practical joke will involve elaborate co-operation from the nursing staff and fellow colleagues. We are planning on bandaging up my head just before the new team arrive at 08h00 for the next handover, and then shocking them with the story that I had been stabbed in the head by a psych patient and had to have my lacerated scalp sutured up and then bandaged.

I think we'll be able to pull this one off.

I am 100 percent certain that the new team will actually fall for it.

After all, similar incidents have actually happened in the past.

Voltaire said that the purpose of the doctor is to entertain the patient as the disease takes its course.

Hopefully, as a defence mechanism against depression and like some kind of comedy crusade, we'll always be able to entertain each other while our shifts run their course.

:)

Friday night Folly

2009-10-02T08:52:00.009+02:00

The following is an account of our end of the month friday night shift a few weeks ago. It's long. It has no structure. It might all seem a little pointless...

Which is pretty much a description of the evening itself:

My arrival at work is unfortunately not signalled by the large marching band, fireworks and a rip-roaring guitar solo played by a topless Greek God that I think I deserve.

Oh no...instead I am greeted with that age-old traditional greeting, peculiar to the lesser-incisor'ed native of the Cape Flats:
"Jou ma se poes!" (your mother's cunt!).

Seems that one of the psych patients has escaped from the front room, and is currently freaking out in the parking lot outside the unit, screaming obscenities at everyone. He is wearing a hospital blanket and shoes. As I walk past him into the unit, the security guards rush past me to try and capture him...but this one is a wily little bastard who immediately dropped the blanket, exposing his naked buttocks to the world and took off running like a man escaped from prison into the darkness...They might catch him, they might not.
Judging by the pendulous belly on the security guard, my money is on the patient.

I walk into the unit giggling...but this false sense of fun is soon arrested when I realise that there are no other doctors to be seen. Alarm bells start ringing when no-one is in the front room, it's a sign that they are somewhere else. And that somewhere else is usually in the resuscitation room, where there is probably some major shit going down.

I sheepishly shrink off to the tea-room to deposit my things, before braving the carnage I'm certain is waiting for me.

I'm not disappointed.

Dr MB and Dr Mommy are busy doing CPR on a morbidly obese lady in one corner.This happens in the resus room all the time. HOwever, what is peculiar about this is that they are performing this potentially lifesaving manoeuvre on the floor! Hospital is at capacity so no more stretchers available. Silly me to expect stretchers, in a fucking hospital.

What's that Department of Health? Oh, you don't give a shit? Tell me something I don't know.

Oposite them, Dr K and the surgeon are frantically trying to gain intravenous access on a patient. This man has been shot through his chest, possibly through his heart/aorta/lungs/trachea/oesophagus....blood pressure is dropping very quickly and things are looking pretty grave over there...

I notice the medical intern at the back of the room struggling to intubate one of his patients in severe respiratory distress...Looks like that's where I'm needed most, so I make my way over to help.

However, my efforts are thwarted by the head nurse who thrusts a fat folder into my hands and tells me that there is an old man having a heart attack in the waiting room. ARGH!

Sorry little intern...you're on your own.

As expected, the old man is of the Kentucky Fried Chicken-loving kind, and I can see the nicotine-stains on his teeth. According to his clinical symptoms and ECG he most definitely is having a heart attack.

By this time the resuscitation on the lady on the floor has been called off.
We couldn't save her and she couldn't save herself. Call the family. Break the bad news and move her out of there. My heart attack guy needs a bed in resus so that we can initiate treatment and try to save what's left of his myocardium, so that he can get to work on destroying that too .

As I wheel the old man into resus the gunshot wound patient is being wheeled out of resus to the trauma theatre...
He doesn't make the few metres to the operating table, and goes into cardiorespiratory arrest in transit.
All efforts to resuscitate him fail.
I wonder why he got shot? Was he the bad guy or the good guy? I suppose it doesn't really matter..

I stabilise Heart Attack Guy ( we speak about our patients in terms of their diseases, rarely bothering to learn their names) and hand him over to the medical team.

What a start to the shift! As I walk out of resus and back into the front room I am confronted with a warzone.

The front room looks like it has been the site of a recent explosion, people shouting, people wandering around aimlessly, people crying, people everywhere.

In five years time I am gong to have post-traumatic stress disorder and then I'm going to have Vietnam-war-like flashbacks to this moment.

I am immediately cornered by the staff from the ambulance vehicles who have brought us five patients involved in an MVA. Where in God's name are we going to put these people? As I wearily start accepting the patients I hear the door creak open to reveal the paramedics wheeling some more people in on stretchers.

Doesn't it ever end?

Despite the ambulances dropping off new patients, there are still about twenty unseen patients names in the book from the previous shift. Some of them have been here for more than six hours waiting to be seen. They are scattered all over the front room. standing, sitting, lying on the floor. There are no more stretchers available and the super-intendant is taking forever to close the hospital despite being at full capacity. I secretly want to curse the previous team for leaving us with so many to see, but I know that they were just as busy as we are and that I can't really blame them.

A little while later I hear a commotion in the corner, and look up as the police escort two violent psychiatric patients into our unit for assessment. While trying to wrestle them to the ground, the policemen are sending impatient looks our way as they wait for one of the three of us on for the night to sedate the patients so they can carry on with their jobs. I ignore them.

Almost immediately some traffic officers join the party and escort in three drunken drivers for blood alcohol testing. I most definitely ignore them.

Christ almighty I'm seriously hungry. Not sure when I'll get a chance to eat.
While contemplating how many patients could have been seen in the time it takes for me to eat supper, I notice an old demented granny using the dustbin to poo in.
After I shouting at her not to do so she stops, mid-poo and trundles back to her bed...dripping the rest of the interrupted evacuation in neat little puddles on the floor behind her.

I have suddenly lost my appetite.

Straight ahead lies an epileptic patient who is confused after having a seizure. He promptly whips out his penis to pee on the floor next to the bed. Some of it splashes on the escort of the patient lying next to him and a fight ensues between the escort and the confused epileptic.

Inhale. Exhale. Inhale. Exhale.

I try to comfort myself with the fact that I'm gaining invaluable experience tonight that I probably wouldn't have learned anywhere else.

What I'm actually learning from these patients is how to make the most of one's Friday night:

Get drunk, drive a car, crash and fracture your pelvis. Get drunk, walk through the ganglands alone at night, get stabbed multiple times. Get drunk, get high on tik, walk in the middle of the road and get hit by a car, fracturing you tibia in three places. The fact that you are too high and drunk to realise that your leg is moving in the most sickening paradoxical motion unintended by nature's design is a testament to the analegesic effects of beer. I can feel the pieces of your shattered tibia grinding against each other while applying the plaster of paris. I think I'm going to vomit.

And what about you lady? What lesson will I learn from you? I see that you are lying face down on the stretcher and you have decorated yourself with long curly braids, earrings, and a large knife handle protruding from your back. I assume that the blade is stuck somewhere in your chest cavity. Tell me, what style of knife handle is in fashion now? MUST get myself one of those for the summer.

Luckily for you, the knife gods divined that the blade should only penetrate superficially under your skin so I can proceed to cut the thing out of your back.

Cool! At last something fun to do!

And...oh...here we go right on time at 04h00 hours. It's the nightly on-call entertainment, performed by the resident nutjobs.

Settle in y'all ! Grab the popcorn! Tonight it's a gut-wrenching caterwauling ballad from psych patient number 6 of the evening. The verse is an ecclectic mix of beautiful arabic verse sporadically punctuated by "Julle vokken holnaaiers". (you fucking bumfuckers). The chorus consists of her screaming obscenities as we wrestled her to the ground to sedate her.

Furthemore her insane soliloquy is manifested by an interpretive movement piece performed by psych patient number 5.
He has been pacing around the big doctor's desk in the middle of the front room incessantly for the last half an hour.
Round and round and round on a mission to nowhere, wearing nothing but a hospital gown and a cool leather hat on his head.
It's impossible to stop him circling.
I dodge bumping into him for the nth time that evening, as I bend down to take blood from another patient (who is lying on the floor). As I do so,the flesh above the back of my jeans is unintentionally revealed. This sets the psych patient into a maniacal hypersalivatory state, resulting in him screaming at me to:

"sit jou hol weg. Maak toe jou hol! Dis MY hol, net ek kan jou holle sien!!!Die ander mans kan gaan kak!" (Put away your bum! Close up your bum! That's MY bum, only I can see your bum! The other men can go to hell!)

And that's when we rugby-tackled him, stapled a note that said "please abort" to his forehead and injected enough valium to send him straight back to his days as a fetus in the womb. Hopefully his mom would read the note and take our advice.

My sense of humour is nonexistent at this point and EVERYTHING is irritating me.

Even this poor 17 year girl who was depressed enough to try and take her own life by ingesting shampoo, hair gel, and toothpaste.

Even this 20 year old girl with multiple bruises after being beaten up by her boyfriend, and claiming that it was her fault she got hit.

Even the very frustrating fact that the nurses are only taking the temperatures of every second patient and not testing anybody's urine.

Speaking of urine - I should have gone to pee three hours ago.

But I'm NOT using the front room toilet. I don't care that I'll probably develop a urinary tract infection or an atonic bladder from keeping it in, but the last time I went in there, there was a delirious patient pissing all over the walls. And there was runny poo in the bowl.

The night is almost over anyway, I'll just keep it in until I get home and then burn a hole into the porcelain when I do eventually relieve myself.

Soon the new team arrives. I barely make it through the handover ward round, mumbling through my presentations of the numerous patients I don't remember that I've seen...I'm sure the consultant thinks I'm a retard.

Bleary-eyed and hypomanic from sleep deprivation, I stumble through my front door.
How did I get home? Did I drive? I can't remember.

While undressing I discover a huge blood stain on my sock. With no sign of injury to my foot I can only assume that the blood belonged to one of the trauma victims I saw last night.

What the FUUUUUUUCK!?!?!

What other bodily fluids have been deposited on my person that I don't know about?!?!

YUK!

I scrub myself raw with nuclear waste just to make sure I killed whatever was lurking on my skin.

I then collapse into bed like a boneless toneless fleshy lump. The most I can manage is to open my mouth while my husband feeds me breakfast...

I'm barely alive, but I survived the Friday night nastiness...

Only ten hours till I'm back for the Saturday night slaughter...

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

2009-09-18T22:57:00.016+02:00

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.

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...

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

2009-09-02T17:34:00.006+02:00

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:

"WHO ARE YOU?!!!"

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

She goes on:

"ARE YOU A FUCKER? OR ARE YOU A LOCKER?"

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

Thankfully she made the decision for me.

"I KNOW! YOU'RE A FUCKER!"

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" !?!?!?!

WTF-"er"?!?!

The write way to kill your friend

2009-09-02T11:58:00.007+02:00

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...

Horror at the Hospital!

2009-08-23T12:48:00.009+02:00

My application form to University read as follows:

Application to read for the degree of:
1st Choice: MBChB (Academia. Medicine. Doctors. Patients. Studious. Saving lives)
2nd Choice: BA Film and Media.(Actress. Glamour. Oscars. Broadway. High heels. Fabulous)

No jokes.
Those were my two career choices.
Of course, I was more than fully qualified for both, being both studious and superglamorous.

However to my drama teacher's dismay, and to my hard-working parent's delight, I swapped Broadway for a different kind of theatre, the operating theatre.

And where my actress colleagues were cabaret-ing down the path to stardom, I was dragging my weary feet up and down hospital corridors for hours on end.

"Don't worry darling," my mother cooed, "You can always sing and dance for your patients! After all, they're the ones who need the entertainment the most."

*Which I've tried to do! For more info see my post entitled TLC*

A truism indeed,dear Mum, but not one which will bring me closer to my dream of making out with some hot Hollywood male lead!

Sometimes, when I get particularly nostalgic about being on stage, I go on a little journey into my mind to that happy place where I was adored by applause at the end of each show.

And sometimes, when I'm alone in the eerily quiet front room, it truly does seem that I'm involved in some kind of hospital horror flick...

*Insert MGM theme tune here*

Based on a true story...
The shocking blood-curdling tale of...

HORROR AT THE HOSPITAL!

Three am.
Graveyard shift.
Dr MB and Dr K are snoring in the tea room.
Things are unusually quiet.
Most of the patients are sleeping and the psychs are still heavily sedated.

A lonely little doctor keeps watch.
She sits forlornly at the large desk situated in the middle of the unit.
The temperature is bordering on freezing, so she has wrapped one of the blankets normally reserved for patients around her shoulders.

She can forget about closing the windows.
With the scourge of Tuberculosis ravaging the community she serves, it is better to risk hypothermia than catch TB by closing the windows and concentrating the dreaded germ in one space.

From her position she can spy on all parts of the front room, except for the small, dark chamber at the back of the unit where the psychiatric patients are kept.

Bad things have happened in there. Very bad things. Things the hospital has forgotten about yet which are still talked about in hushed tones, behind locked doors.

Suddenly she spies movement at the entrance to the psych patient chamber and an involuntary reflex forces her pretty head to look in that direction.

What she witnessed will forever be burned onto her retina.

A dark, vile creature had emerged from it's slumber and was crouched on the ground staring menacingly in her direction. Saliva dribbled incessantly from it's fangs and bubbled with each threatening growl.

It stood up, and stretched out it's arms. Gnarly filthy talons pointed in the small doctor's direction.

It spoke.

"Woman!" It hissed through its rotten mouth. "Woooman! Wooman!"

The beast took one giant step forward in her direction and began thrusting its festering groin in what could only be interpreted as a beastial mating movement.

"I want woman!" it screamed as it lunged in mad lust for the helpless beautiful health worker!

But luckily she was possessed of some mad ninja-type skills which greatly assisted in her evading rape by a psychiatric patient.

She managed to awaken her sleeping colleagues who took great delight in tackling, and maybe unintentionally eye-gouging, the beast to the ground, whereafter she got her own revenge by sedating it with 30 mg of Valium and 10mg of Haloperdol intravenously.

Suck on that, you psych beast bastard!!

Nobody get's near my goodies without my permission!

That was a true story, and not the only one involving narrow escape from physical bodily harm by psych patients.

The "beast" was a bona fide, hypersalivating, utterly psychotic psychiatric patient,namely Mr MX

The "two sleeping colleagues" were played by Dr MB and Dr K, who enjoy nothing more than a bit of psychiatric tackling sports.

And of course, the protagonist, the "stunning lonely doctor" played be me,Dr S.

*And...bow. Smile. And...bow again.*

All the world's a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages.

(W.Shakespeare, As you Like it)

Screw being an actress!
My reality is way more entertaining right now.
Who needs the flashing paparazzi lights when you've got the flashing ambulance siren signalling an incoming life-threatening emergency?

Theatrical emotionally draining diva's? I've got soul-sucking whiny still-smoking-asthmatics to deal with.

Drama, Comedy, Horror, Romance? Why, I can get all of that and then some in one patient alone.

Perfect Hollywood endings? Well, we don't always get those. Most of the time our endings are tear-jerkers.

But sometimes, we watch patients who were rushed in on stretchers on the brink of death, walk out of the hospital smiling.

And that's all the applause I need to ensure that I keep coming back to work, shift after shift, after show, after show...

Brothers, Sisters, and the Godfather.

2009-08-22T10:58:00.013+02:00

I spend more time with my work colleagues than with my own family.

This happens when one is a mean, lean, life-saving machine working night shifts when everyone is sleeping, and is sleeping when everyone else is working.

I'm spending so much time at work that it's like my work colleagues are starting to become my family.

It's inevitable.
The team effort it takes to piece together a polytrauma victim, take down a violent psychiatric patient, or resuscitate a patient back from imminent death is certainly a bonding experience.

Witnessing one's colleague being vomited/urinated/shat/bled/spat on are all priceless moments of hilarity that provides the fodder for friendly family-type banter.

Spending four nights on call in a row with the same people provides insight into their characters which would otherwise not have been learned during polite dinner conversation.
Sleep deprivation is like being drunk, it loosens the tongue and disinhibits the mind.

What I'm saying is, we're getting way too comfortable.
It's only a matter of time before we start farting around each other, and then rating those rectal whistles like real siblings.

Here's the family breakdown:

Dr D: A specialist neuorologist. She does locums in our trauma unit sometimes to supplement her income. She's like everyone's mum. She doesn't hesitate to dole out the "mama treatment" when you've screwed up or are pissing her off, but is also quick to praise, offer advice and soothe.

Dr MB: You've read about him and his drunken exploits already. He gets to play the role of the mischievous older brother.

Dr S: That's me - taking centre stage as the misunderstood, brilliant, beautiful and slightly insane little sister.

Which leaves us with Dr K to play the role of father.

Except that Dr MB and I are convinced that he should actually be playing the role of Godfather.
And by Godfather I mean the scary Sicilian-mafia-gangster-type godfather, not the sweet loving I'll-take-care-of-you-when-your-parents-die-and-raise-you-in-the-name-of-Jesus type godfather.

There have just been too many incidents pointing to the fact that Dr K could currently be, or previously have been, a gang-leader on the Cape Flats.

1: He has an expressionless face with cool green eyes.

2:He broods. A lot. And skulks around the unit like a moody killing cat.

3:Whenever the hardened criminals come in to the unit and start trying to cause chaos he manages to silence them by just looking in their direction.

4:He revealed that he goes to visit some of his "friends" who currently reside in prison!! He claims that these friends are actually really good people and that when they get out they will be staying with him.

5:He only wears tops with long sleeves and high necks. We're convinced that this is because his torso is riddled with gang tattoos which he can't reveal in public.

6:During an episode of "immobilise the violent psych. patient", I watched as he controlled the guy with a one-handed vice-like choke hold. When we mentioned that perhaps this was not the healthiest method of immobilisation, he simply informed us that this was indeed the best way because once they become hypoxic they stop struggling!!!!!!

7: Whenever a gunshot wound comes into the unit he can correctly identify the type of gun that was used and the calibre of the bullet retrieved.

8: It's possible that he's packing heat.

Do you get the picture?

I mean it's pretty cool to have the damn Godfather on our team right? Lord knows we need some extra protection in this gangland trauma unit.
So now my pseudo-family is more like a pseudo-familia

And I'm loving it.

Except, that I'm also slightly nervous that I might do something to seriously piss him off and then wake up dead the next morning....

Only 5 weeks to go until the registrars rotate and he moves off to another unit elsewhere in Cape Town.

So until then it's yes Dr K, no Dr K, please don't kill me Dr K!

Boozy Sunday Brunch

2009-08-05T17:42:00.010+02:00

Sunday morning 8am:

Arrive at work for the third time this weekend.
Dr K arrives shortly after that.
Dr MB is currently AWOL.

Sunday morning 9am.

In the short space of time that I've been at work, I've already drawn blood from three drunken drivers for forensic purposes. The police bring them in is as "DUI's" (driving under the influence). These patients are highly inventive and almost always create bullshit stories which are supposed to prevent me from taking their blood as evidence.

For Example: "I refuse to let you take my blood doctor, I'm a liver patient and the Professor of Livers at Groote Schuur said that you must be careful when taking my blood." Oh yes you most definitely ARE a liver patient my friend, being an alcoholic is compatible with destroyed livers. But I guess the liver is evil, and must be punished.

Or:"I have very thin blood doctor. And I have very thin veins. Don't take my blood or I will bleed to death. I don't want to bleed to death!" Oh yeah dude, I get what you're saying! You mean, you don't want to bleed to death like the people you could have hit while drunk driving would bleed to death? Good call, I wouldn't want to die that way either, you imbecile.

One of the three DUI's happened to be a police officer, caught drunk, on duty, while driving the police vehicle at 8am that morning.
This genius, after I shook my head at him, tried to convince me that he had just been working a very long shift and that he was so tired that he merely appeared drunk!
By the time I was done listening to how simply tired he was, I was getting simply drunk off the concentrated alcohol fumes emanating from his rancid mouth!

Sunday morning 10am:

Dr MB currently NOT at work.
Have received text message from him saying that his flatmate has parked his car in front of his and has lost his keys, thus resulting in his lateness.

I attend to a patient with multiple stab wounds. This guy is still trashed from last night. Too trashed to feel the pain of the, fortunately superficial, gashes on his scalp, back and torso.
He proceeds to blame the stab wounds on his wife. Apparently he was out drinking last night with his friends, when she came looking for him to drag him home. On their way home they were stabbed and robbed by gangsters. Stupid wife is clearly to blame,of course, and should have rather let him drink himself into a coma.

Sunday morning 10:30am:

While still busy suturing the lacerations, the cleaner stumbles into the room and stands next to my suturing trolley. He sways slightly while informing me in slurred speech that I need to throw the unused instruments in the special bin placed outside the room.
"Why thank you cleaner dude, I know this, but thanks for reminding me anyway!" I say. Cleaner dude now needs to leave me alone to finish suturing. Yet, he continues to stand there swaying to the rhythm dictated by the alcohol pumping through his veins, and stares intensely at the instruments on my trolley.
As a little bit of drool starts seeping down the side of his mouth onto my sterile field he begins again, "You know doctor, you must throw these instruments into the bin outside when you are finished, because that is where the dirty instruments must go."

Yes I know you drunken fool! Now take your alcoholic self off to the nearest dark corner and help us all by sleeping off last night's party before attempting any further brain function!

Sunday morning 11:00am

Still no sign of Dr MB. I'm starting to get worried. This is South Africa after all, and these foreigners from the UK don't understand words like, security, and hijacking and trellidoors and safety!

At this point I notice Dr MB's flatmate walking through casualty happily jangling his car keys...Dr MB is not in tow.

Thus my hijacking fears are allayed. Me thinks that Dr MB, like everyone else in casualty today, is also suffering the after-effects of drinking the devil's drool!

Sunday 11:30pm

The paramedics wheel in a morbidly obese lady with no past medical history other than being a known alcoholic. I get the feeling that in the last few months she has been sober less times than she has been able to view her own genitals beyond her massive stomach. She is currently comatose. It could be that she has drunken herself into a stupor or that she has suffered some other major pathology. First rule of intoxicated patients: Do not assume that all their symptoms are attributable to the intoxication. So after some major resuscitation, we send her off to Groote Schuur for a CT scan of her brain. My friend texts me later from Groote Schuur to inform me that she has suffered a massive sub-arachnoid haemorrhage*, whose initial symptoms were probably not picked up due to her having imbibed satan's sap all weekend. Brings new meaning to the term, "smashed out of your skull".

Sunday, midday:

Dr MB arrives, body intact, in the casualty unit. Hoorah!

He looks more like a patient than a doctor:
I begin my examination....
No evidence of hijacking noted, thankfully.
On observation though, possible evidence of a rough Saturday night: hair unusually unstyled, face slightly puffy and red, eyes glazed.
Clothes noted to be dishevelled: having fallen asleep in them last night is highly likely.
Non-purposeful wandering around trauma unit: a clear indication of hangover. That and the fact that he is periodically pressing his palms to his temples and moaning softly.
Patient delusional: Believes that he got two flat tyres on the way to work and thus had to spend the best part of the day sorting it out. Patient even promises to show me the receipts.

Patient forgets that I am female, have two brothers, am a wife, and a doctor. I can smell bullshit from kilometres away.

Never mind, Dr MB. I'll forgive you seeing that after your IV caffeine treatment you perked up and saw most of the patients for the rest of the day, while the rest of us slacked off a little.

I was just annoyed that EVERYONE was enjoying a boozy-Sunday-brunch style afternoon in casualty EXCEPT ME!!!!

It was then that I decided that I needed to get my own back.
Come Monday morning, I would stumble into work stoned, drunk, high on tik, still wearing last night's clothes and screaming like a lunatic that somebody needed to get me another drink...

But I didn't. I remained the diligent little girl that I am, had a good Sunday night's rest and arrived in good spirits, unfortunately not methylated spirits, for work the next morning...

Good little Dr S, always doing the right thing. I have terrible luck though. Knowing me, if I did ever try any nonsense I most certainly would be the ONE person in the unit to get caught, reported and probably disbarred.
Wait...hold up! Being disbarred means I never have to work as a doctor again right? Pass me that crack pipe!!!!

Brain Transplantation

2009-07-30T17:08:00.007+02:00

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

2009-07-26T13:49:00.009+02:00

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!

2009-07-25T19:52:00.003+02:00

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.

2009-07-16T10:44:00.006+02:00

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

2009-07-15T13:38:00.004+02:00

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

2009-07-10T19:00:00.007+02:00

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.

2009-07-10T18:02:00.005+02:00

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...

2009-07-01T20:09:00.006+02:00

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...

WE'RE ON STRIKE!!!

2009-06-29T17:40:00.006+02:00

I never ever thought this day would come...

But if one examines the history of state health service in this country, the current strike was a long time coming.

I have two days left at the Community Health Centre I work at - but I did not go to work there today.

A decision was taken at a meeting on Friday to strike for a better future in state health care, for patients and doctors. The meeting occurred at our tertiary referral centre, and we decided that all day hospitals would close down, and that the state doctors from those centre's would go and help out at their secondary and tertiary referral centres. We decided to keep only the essential services running at these hospitals.

Thus, the Western Cape Province is only running emergency services, like casualties and trauma units, labour wards and ICU, for life-threatening emergencies. All non-essential clinics and elective surgeries have ben cancelled.

Of course, defining what actually constitutes a life-threatening emergency is difficult. Do we stop giving chronic disease patients their antihypertensives? They are not technically an emergency case, but not having their meds might result in an emergency. Do we continue running the anti-retroviral clinics for the HIV patients? It's really hard having to deny patients care in this way. But we are completely fed up, and have no other recourse. The government has exploited our humanity for too long. They know that we will always put ourselves above our patients. But who puts us first?

Why are we actually striking?

We are fed up with the current pathetic state that our Health Care System is in. We are shocked by the government's lack of urgent action to remedy the situation. All of their children and relatives must be using private hospitals. Nobody in a position to change things could just stand by if they knew exactly what was going on at the state hospitals.

We are saddened that we cannot provide the quality of health care we know we are capable of due to the fact that our resources are so limited. Some hospitals do not have sterile gowns in the operating theatre. I have often had to man the trauma unit without an ECG machine or an oxygen saturation monitor. I have colleagues, at my level, working up-country who have to do three jobs at once. And by that I mean: Putting the spinal anaesthetic into the pregnant patient themselves and making sure she is stable - then scrubbing up and performing the caesarian section themselves - then resuscitating the child after delivery - then rescrubbing to close up the wound from the caesar-then monitoring the patient in the recovery room. They're supposed to be working as COSMO's ( community service medical officers) like me - instead they are the anesthetist, paediatrician and obstetrician all at the same time! IT'S RIDICULOUS! And dangerous. And unfair to the patients.

Furthemore - we are insulted by our current salaries. Compared to other government employees - Dr's are undepaid by up to 50 percent. This is not a comparison between South Africa and other countries - this is a comparison with our OWN government employees. A judge at the highest level gets paid 50 percent more than a chief medical specialist. Despite that medical specialist having worked longer hours, and trained for longer. A bus driver's basic salary is the same as an medical intern's basic salary without overtime. How does this make any sense?

We are striking for an increase in our wages to ensure that our doctor's stay in this country we love, and not be forced to move overseas due to better working conditions there and greater financial reward.

The government was supposed to implement the wage increase last year in June 2008. But since then, nothing has been done about it. The strike, started in Kwazulu-Natal Province, forced the Government to begin talking about our wages again, and begin implementing them. Recently the government thought they were clever, and presented us with an offer - claiming that they had increased our salary by 30 percent. But it was nonsense.All that they did was collapse our rural allowances, scarce skills pay and overtime into our basic salary. The actual increase worked out, for some of us - in the region of an extra R300 a month.

I was one of only two doctor's from our community health centre who decided to strike today. The rest don't seem to be interested. And my clinic ran as usual today with no change. Perhaps they feel that things are running smoothly. Perhaps they have been suffering too long to stand up for change. I'm not sure. Perhaps they just can't leave the patients. All I know is what I've experienced and what I've experienced has been shocking.
I might get into a lot of trouble for staying away, I might not. I don't know. But someone has to do something.

So today about 300 of us from hospitals around the city, toyi-toyi'd and marched and sang. All the media were there. It was hectic.

I am seriously frightened for the future of health care in this country - it's stressing me out.

I start as a medical officer in the trauma/casualty department of a secondary hospital on the flats on Wednesday. As this falls under emergency services I will definitely be going to work then....

We'll see what the future brings...the bargaining chamber is still hot with discussions as to what the Department of Health should offer us... so far what they've offered has been akin to a slap in the face.

Michael Jackson

2009-06-28T19:52:00.007+02:00

Michael Jackson died on Thursday night.

I am distraught.

When I was little I was completely obsessed with him.
I used to dress up like him, wore plasters on my fingers like him and curled my hair like him. Sometimes I believed I was him.
I used to sneak his tapes into class and listen to them surreptitiously on my walkman. Once, I was caught being naughty, and was told to stand up and explain myself in front of everyone. To prove a point, my eleven year old self climbed on top of the desk and danced like Michael Jackson instead.

What does this have to do with medicine? Not much. I just wanted to remember him on my blog. He was a huge part of my childhood. And I'm going to miss him. Despite the scandals he was the most phenomenal artist. Ever. We will NEVER see the likes of him again.

Heal the world.

Here is a little story I'd like to share with you, which does actually relate my Michael Jackson mourning to the community health centres...

My colleague and dear friend, Dr MJ ( yes, her initials are also those of Michael Jackson's) was my clinical partner and great friend throughout medical school. Thus, I have been privy to the bizarre behaviour she displays when having to go long periods without sleep.

Most of us get tired and grumpy, Dr MJ gets silly. Really goofy and silly.

She was on call, at a day hospital similar to the one I work at, not too far from ours, on the night that Michael Jackson died.

At about 4am, manic from lack of sleep, she decided that it was her duty to walk into the waiting room and make an announcement.

This is how it went:

Dr MJ: "Verskoon my, maar is julle bewus dat Michael Jackson gister aand gesterf het?"

Excuse me , but are you aware that Michael Jackson died last night?"

The patients,some on IV lines, some with possible heart attacks or twisted bowels, were more shocked that the doctor was in the waiting room than by the actual news. They seemed to forget their woes and just nodded there heads sadly, "ja dokter, ja dokter" (Yes doctor, yes doctor.)

Not satisfied with their bland response she then went on...

Dr MJ: "Kan ons aseblief nou 'n minuut stilte hou vir Michael Jackson"

Can we please now have a minute's silence for Michael Jackson.

AND THEY ACTUALLY OBEYED HER! They all sat there quietly, bleeding and aching at 4am in the morning, for one full minute.

Dr MJ is officialy my new hero(ine).

How peculiar is that?

Such is the greatness of Michael Jackson!
Long live the King of Pop!

McGuyver Deliveries.

2009-06-23T20:35:00.008+02:00

I'm in the tabloids!

2009-06-23T19:20:00.004+02:00

Listen up people! In the world of the public health system - there are strict rules.

The first rule is this: There shall be a gross understaffing of all units, and a severe lack of working equipment.

The second rule is this: This means that to receive the free health care you want, you will have to wait.

The third rule: Being brought in the ambulance, or arriving before another patient, does not mean that you will be seen first. There is a triage system - stabbed chests, heart attacks and the likes get seen before chronic back pain and boils on your bum.

If you do not like this, please go and visit the GP down the street who will take your money and send you back here for an x-ray anyway.

No matter how many times I have to explain this, you still don't get it do you?

Maybe I should say it in Afrikaans.

Die dag hospitaal is 'n wag hospitaal!

What's that, oh you don't like this system? Why don't you put some effort into your complaint and write a letter to the government? Oh wait ,the clever previous Government, they didn't prioritise education for those living on the flats, so you can't write!

What did you say? My mother's what?

Oh and now you're threatening to sue me and put me in the tabloids? Which one, may I ask?

The "Daily Voice", is that right?

Come on man, don't be cheap, I'm worth more than that, put me in the Cape Times!

My poor patients, frustrated up to their eyeballs by the long waits they have to endure, have this one recourse - to threaten those of us actually working in the system with a call to the tabloid to "expose" us. The "Daily Voice" is a very popular community tabloid. Some buy it for the "information" it contains, some for the page three girl. Either way, it costs somewhere in the region of R2. Which means that it is cheaper than toilet paper.

Poor Paramedic

2009-06-23T18:46:00.006+02:00

Bleee Blaaaa! Bleeee Blaaa!

That is simultaneously the sound of the ambulance van approaching and the sound that my brain makes after a heavy night of......the trauma unit.

The ambulance uses it to signal some heavy incoming trauma traffic.

Brain uses it to signal to the rest of my body that there will be NO MORE outgoing neuronal traffic, because being awake for 30 hours is incapacitating. All efforts from the quivering grey jelly in my skull are then reduced to maintaining vital organ functions, and movement towards a horizontal position.Preferably on a soft mattress. Without fleas.

A few days ago - one of the ambulance drivers arrived at the trauma unit.
My heart usually sinks when I see them as I know that they usually only bring me one of two things:

#Cold, green cases ( infected toenails, chronic constipation, flu, and even flea bites. Yes, somebody called the ambulance at midnight for flea bites.)

#Heavy red/orange cases requiring resuscitation or referral to another clinic.

This is not their fault, they are required by law to bring everything that is called in, to the trauma unit. The patients know this and abuse their rights, using the ambulances as taxi's instead of the highly equipped emergency vehicles staffed with highly trained professionals that they are. In this way the ambulance services are backed up with transporting bullshit when the real emergencies are left waiting...dying...

This time, however, the ambulance driver WAS the patient.

She was on her way through the townships to start her nightshift, dressed appropriately in her ambulance jumpsuit. Suddenly a large mob abducted her and took her to an area where a man was lying prostrate on the floor. He was dead. But the mob refused to listen to what she was saying, and threatened her with stoning and stabbing should she not do what they say, and bring him back to life.

So she performed CPR on the dead man.
For two hours.
Under threat of death.
Eventually the ambulance van showed up and fooled the crowd into thinking that they were taking the dead man to hospital.

She was distraught and hyperventilating from the episode.

I suppose in a twisted way they were offering her the highest compliment, by believing that she could bring people back from the dead with her holy paramedic skills.

That poor lady. I wonder if she'll be one of the many moving overseas to work in safer, more respected working conditions?

She is not forced to help you, she does it because she wants to help and because it is her job. Her working conditions are bad enough as it is. She has no real support from the department of health in trying to change things, but she sticks it out anyway to make sure you're ok.

So was it really necessary for you, you bastard, to threaten her with her life? Could it be that she may have willingly helped you, if you had simply just asked her?

Little Pink Shoes

2009-06-19T21:59:00.010+02:00

I have tried for four weeks to write this post.

It's been difficult.

I feel as if I have an obligation to tell it, but every time I try I don't know how to write it so that it has the most impact. Whichever way, it's a story that needs to be told, because it is the story of many in South Africa.

This is the best I can do...

Despite the 5am darkness and freezing rain, she was grateful for the job that forced her to get up at this hour.
It provided an income, without which she wouldn't be able to clothe and feed her, beautiful 2 year old daughter Zandi*.

Her little sulky Zandi, she's always grumpy at this hour,and protests bitterly at being forced from the warm mattress they share.

She hugs her and speaks softly in Xhosa, 'get up my child, I have to go to work and you must go to the Aunty's house while I'm gone'.

While getting ready in the tin-walled, leaking shack they live in, she worries about her HIV positive status. Yesterday the clinic doctor told her that her cd4 count was low. She didn't really understand because the doctor spoke only English, but she could tell by the way the doctor spoke that this was not a good thing.

Suddenly scared, she offers a silent request to the ancestors that she will stay healthy long enough to support her child into adulthood. After all, there was no-one else to do it.
Her parents were dead and the father of the child just a distant, regrettable memory.

When she moved to Cape Town from the Eastern Cape, it was difficult as a single mother. But luckily she found a job as a domestic worker in Claremont. An old lady in the township offered to look after her child during the day for a fee of 30 rand a week. That lady was a very clever business lady. She looked after many children during the day for 30 rand a week each. No wonder she had a radio AND a TV in her place.

Dropping Zandi at The Aunty's house was always a difficult part of her day, what with Zandi always crying and pleading with her not to go. Today though, Zandi just looked sad and watched her leave with watery eyes. Perhaps she was beginning to accept her daily fate at the Aunty's House. Her daughter looked thin and small standing in the doorway.

But, there was no time to feel guilty, the queues for the taxi's had already started forming and The Madam is always very upset if she arrives late.

The Madam's house was enormous. And her children had so many toys! She spent most of the day cleaning up after them. Scrubbing floors, making beds, washing windows. It was tiring, but she thought of her daughter and persevered.
If she just managed to keep her job and earn enough to send her daughter to school, their luck would turn around. It was her wish that Zandi do better then her, and be the first in her family to get her matric certificate!

Maybe if Zandi got a good matric, she could get a bursary to university! But that would only happen if she had enough money to send her to school and to pay for all the books and school clothes.

While working in the kitchen, her cellphone rang. The Madam had given it to her. It was an old one that her son did not want anymore.

It was The Aunty."Your daughter is not well", she said.

"What is wrong with her?", she asked.

"She is breathing fast, You must take her to the hospital.". And then the line went dead.

The Madam was very upset when she asked to leave early and did not seem to believe her story. But she had to go. She took the train and a taxi back to the township, and eventually after an hour and a half of anxious, worrying thoughts, arrived at The Aunty's house. There she found her little Zandi lying on the floor, eyes wide open and gasping for air...

I arrived at 5pm that day for the start of my night shift. Merely ten minutes into the shift, I noticed a mom walking calmly into the unit with a little bundle in her arms. As I was busy with another patient, I let the Sister do the triage.

The Sister opened the bundle and immediately called for a resuscitation.

I jumped up and ran over to the bed where the little bundle was now placed.

What I saw was an absolutely beautiful two year old girl, neatly dressed in a pretty top and pants, with a little pink jacket and matching little pink shoes.

She looked like a perfect factory-formed little doll.

And just like a doll, she was unresponsive. Only her little respiratory system showed signs of function, when it made one desperate effort and she gasped twice. She had no pulse. I also had to note that her pupils were fixed and dilated.

However she was still warm. Most of the people brought in from outside needing resuscitation have been adults, who were sickly looking and had cool peripheries. This little girl was well-looking and warm, and despite my doctor's senses screaming at me that this girl had a poor prognosis, the fact that she was warm was playing havoc with my mind.

We started the resuscitation. We called all the other doctors to come and help, even those busy in the clinics. I refused to stop. How could we stop when the mother was waiting just outside the door?

Eventually, when it became clear that we were losing the battle for her life, I knew that any more resuscitative efforts would be inhumane and in vain.

So we stopped.
And Zandi died.
Dressed like a doll in her matching pink shoes.

Her mother looked at me with hope and despair as I approached her.
I could do nothing but confirm her nightmare; her little girl had died, despite us trying to do everything. She cried and cried and cried. And I sat with her for half an hour listening to her cry. I refuse to cry when telling the family. It's not fair on them. I'm not the one who lost a child, so I really have no right to burden them with a blubbering doctor on top of everything.
So I just swallow really hard and take a deep breath.

She told me the story of how she had no-one here to support her and that she had no family left. She had moved to Cape Town for better treatment of her HIV, and for a better future for her Zandi. She told me how she ran to the taxi rank with Zandi in her arms, and begged them to let her jump the queue to get to the hospital quicker. She truly believed that Zandi would be ok. But now she had nothing left. I gave her all the money I had with me and let her use my cellphone to call a friend for help.

I finished my shift that night unaffected. After all, there were others waiting to be treated.

But, as soon as I got home the next morning, I remembered the little pink shoes and the waste of a little girl's life. I cried and cried the whole day.

I knew that Zandi was already gone by the time she got to us, and that there was nothing more I could do. The real tragedy lay in the situation of poverty her mother was in. The desperate lady had no recourse but to find a flipping taxi to get to the day hospital, while her child was busy dying in her arms all the way. This is what our patients face.

If Zandi had been born to a rich family, the signs of her illness would have been picked up earlier. The mother would have been able to stay at home and look after her. And if anything happened they would have called their private ambulance or got in their fast car to bring the child speedily to the emergency unit.
And the child would probably have lived.

Now every time I see little pink shoes I can't help but think of Zandi, and be reminded of the tragic situation our nation's poor patients are constantly battling against. It's too sad to contemplate. Mostly I just ignore it in order to function at work. And so far it's been the best way of going about things.

Zandi and her little pink shoes for forced me to open my eyes again and confront the horror.

*Name changed

Last night-call last night.

2009-06-19T18:39:00.007+02:00

Last night was my last night on call at the Primary Health Care Trauma Unit.

After 30 crazy nights on call in this spirit-crushing, armour-building, crazy-wonderful place, I am amazed to admit that it was a bittersweet experience.

While being in a fantastically good mood all evening, ( even tolerating the swearing from our disustingly rude patients), the evening was nevertheless tinged with nostalgia for the night-calls past.

I was expecting the Fates to weave a kitten-clawed tangled mess for my last night at the trauma unit.

Yet, they must have taken pity on me, and as a reward for surviving six months of primary health care hell, deemed my last night to be a peaceful one.

The only interesting bit was the hour between 10pm and 11pm - whereby not less than three stabbed chests with possible pneumohaemothoraces* rolled through the door.
Which resulted in me performing mini-surgery and inserting three chest drains* consecutively.

By three am it was unusually dead quiet and we spent the rest of the night reminiscing about the past six months, laughing at the ridiculousness of the situations we've faced, and sympathising over the particularly emotionally tough cases we've had to treat.

I was on call with a fantastic team of Sisters, some of my favourites:

Sister B - a nursing sister with a constantly jolly spirit, absolute commitment to her cause of helping those in need, and one who operates as everyone's mother. She baked banana loaf, date loaf and fried samoosas for a midnight feast in celebration of my last night. What a darling!

Sister S - most famous for her "finger of doom" and short-temper. A brilliantly skilled lady, she can also reduce grown men to tears when she is irritated by their behaviour or health ignorance. You know you're in for an ass-whipping when Sister S pulls out her "finger of doom" and starts pointing it in your face. There is more threat in that first finger on her right hand than the entire nuclear threat in North Korea. My most prized compliment from the day hospital, was when she herself told me she became a little bit frightened of me after I unrelentingly berated a patient for their rudeness towards the trauma staff. I told her that she was my inspiration.

And then there's Sister M - the sweetest Sister of them all. Quiet, competent, unassuming and never, ever threatening in any way.

As they are all working night shift, last night was the last time I'll ever see them - unless I come back to do locum calls later on in my career.

I'm so ever grateful to them for making my stay at the day hospital tolerable. Despite the pathetic working conditions they face, and paltry salaries - they are committed to helping their communities, never fail in their happy working spirit, and are ever-ready to support and guide the frightened new doctors. All of which makes them the best nursing staff I've ever worked with.

In my mind they are giants and heroes, and I will miss them greatly when I finally leave here at the end of the month.

So in the messed-up way that a victim falls in love with her captor, so have I become very attached to this crazy place.

Isn't that called Stockholm Syndrome?
Well, I have it.

But don't worry my readers, this being my last night here does not mean the stories will end.
On the contrary.
I'm off to work at the most notorious secondary hospital in the whole of the Western Cape, and maybe South Africa at the end of June.

And I'm 100 percent sure that the stories from there will not disappoint you!

*haemopneumothoraces: the plural for haemopneumothorax - blood and air in the space around the lungs, causing compression of said lung and compromising breathing. Usually caused by external penetrating injuries of the chest wall.

*Chest drain - having to cut through the skin, subcutaneous tissue, dissect through the rib space and puncture the membranes surrounding the lung on the affected side, and then inserting a tube attached to a drainage bag to decompress the lung by draining off blood/air.

I'll just die if I don't get my hands on that jacket!

2009-06-15T09:46:00.007+02:00

I'm a fashionista.

I'm obsessed with clothes.

I'm a woman so this is not really that suprising, but sometimes I even amaze myself at the outfits I come up with. Can I just brag a little bit and say that I've won two best-dressed awards in the last three years: the first being at the end of medschool,( Best dressed student) and the second at the end of internship (best dressed intern).

That being said - not even I would go to the lengths this guy, my patient, did for fashion:

My patient last night was absolutely distraught. He was crying when he told me that while he was walking home he was held up by five men who demanded that he give them his money.

This he did willingly.

They then did the unthinkable horrific thing of asking him to hand over his wool-lined leather bomber jacket.

*insert blood-curdling-fashionista-scream here*

This man absolutely refused.

So the assailants pulled out their gun,and held it threateningly to his head.

Despite impending death, the man still refused.

Was this jacket a family heirloom? No.
Was it the last thing his father wore before dying a hero in the war? No.
It was just a really good-looking well cut real leather jacket.

The enraged gunmen, then used the back of the gun to butt him on the head, and forcibly removed his jacket.

My patient, instead of thanking his lucky stars that they did not shoot him, ran after them screaming and demanding that they give his jacket back, which is when they decided to stab him.

Did I mention that my patient was gay? Not that it's of any significance, other than the fact that only a very fashionable gay man could have more passion for clothes than a woman.

If only I had my awards with me last night I would have instantly, unthinkingly and ceremoniously presented them to this man.

Some women will kill for clothes. Some gay men , apparently, are prepared to die for them.

p.s. This post is dedicated to my mom, from whom I inherited the style gene.

Money Hungry ( Human ATM)

2009-06-11T20:41:00.005+02:00

Hello. I just got back from gym. Random. But just thought I'd let you in on the fact that I gym.

So I'm guessing none of you know what the yellow drip is yet. Too bad. I'm not telling.

I will tell you this though; that a frantic mom rushed into the unit the other day, dragging her breathless ten year old behind her.

The ten year old was choking.

I kind of had my hands full with an epileptic fitter.

But Sister B wasn't worried.

Her well-practiced and experienced hand suddenly popped out of nowhere and violently smacked the centre of his back.

The unsuspecting child instantly coughed up a five rand coin.

The mom, completely confused with relief, then smacked her child again presumably to teach him a lesson.

"That was our taxi money!" She screamed at him. She then fished the five rand coin out of it's phlegmy pond on the floor, turned on her heel and marched him out of the unit refusing to waste any more time.

Everyone just shrugged their shoulders and carried on with their duties. Nothing unusual about that, just another normal occurrence in the trauma unit.

I must say that I secretly wished I could give birth to a child that would produce money every time I smacked it. Like a human ATM.

That kid would be black and blue by the time it was five.

p.s. my sister wants me to say that she was the one who "coined" the "money hungry" title for this post. Thanks sis.

Ode to the yellow drip

2009-06-11T18:17:00.003+02:00

Oh Yellow Drip!

How magical you are!
News of your powers have certainly spread far!

When the curse of "no power" strikes.
You, Oh Yellow Drip, help us to fight!

Vomiting, diarhhoea, TB and AIDS,
When they see the yellow drip,
Their severity fades!

Nothing is better than your strength and power.
Not even president Zuma's Aids shower!

That was for the medics in the audience.

I know you guys know what I'm talking about.

I know you're probably ROFL right now.
And I know that you're laughing for all the wrong reasons.
I also know what those reasons are, which is why I'm laughing.

If there are any non-medics out there who know what I'm talking about - say so and you WIN a lifetime's supply of yellow drips to keep you healthy.

Ciao!

At least three nutcases a day.

2009-06-11T16:23:00.003+02:00

My god, is everything on this blog going to be about my psych patients?
They do provide most of the entertainment though.
Not one single day passes without us having to admit at least three psychiatric patients for acute psychosis.

No lies.
At least three.
Every day.

Makes you wonder about that kooky guy at the corner shop that everyone says is "eccentric" hey!?

The psych patients that are part of our primary mental health care clinics somehow feel safe at the hospital, and regularly use it as a place to visit on their days off from harassing their families. These are not scheduled visits mind you, but operate more like pleasant outings for them.

They visit regularly, thus we get to know them, and they get to know us. Most of them are just well enough NOT to be admitted, but ARE unwell enough to cause disruptions of varying severity.

The two most famous are as follows:

Mr P who suffers from schizophrenia punctuated by religious delusion:

He believes that he is the holiest pastor that has ever lived. His commitment to religion is spectacular and frightening. He can rapidly, incoherently, and without taking a single breath deliver entire sermons in ten seconds, spewing spit and dental caries as he goes.

Every single morning at 6am without fail - he is at the hospital. He is fervent in his daily mission to preach to the hundreds of sick patients in the waiting room. He says bizarrely prophetic things that may or may not make sense, depending on your analytical talents.

For example:

"Gister het julle mense gaan slaap, maar julle het nie vanoggend opgestaan nie! Praise jesus!"
(Last night you people went to sleep, but you did not wake up this morning! praise jesus!")

or

Inappropriately pointing out the scarf-wearing muslim patients and saying," Jy moet jesus vra om jou leef te het! Luister na die venster van vredeheid!"

You should ask Jesus to love you! Listen to the window of freedom!

Often he starts singing praise songs at the top of his voice, and dancing to the tunes in his head, completely oblivious to the fact that the tired, hungry, sick patients are not at all interested.

Often one of the patients, whose stabbed-scalp-and hangover induced headache is made worse by the mans caterwauling, shouts out some profanity like, "hou jou bek." or "gaan kak."

shut up or go and take a shit

I find this paradoxical mixture of extreme religiosity and swearing quite hilarious.

Then there's Mr G who pays the trauma unit a visit every week,to tell us that he is leaving for London very soon.
He has been doing this for the last three years.
He always dresses up very smartly and insists on shaking hands with every staff member before moving on to the rest of the hospital.
Sometimes he pulls out an official "letter" to prove that he is going to London. It's so official that he wrote it himself on a piece of fullscap in blue ballpoint pen.
We play along and wish him a safe flight.

Those are two of many. The staff treat them as part of the family and tolerate their visits with a friendly smile. They tolerate their antics as they know that these random visits help to make these normally ostracised patients feel as if they are a part of a community that cares about them.

This morning though, a psych patient started kicking up a huge fuss because he wanted antibiotics for a sore throat.

He was not frankly psychotic, being one of the few who were compliant on their meds- he was just being rude.

So we decided to ask security to escort him off the premises as he was being disruptive. He went quite gladly, and without resistance, all the way to the police station, and then returned to the unit with a form. The man had convinced the police station that the security guard at the hospital had assaulted him and they gave him a medical certificate for me to fill out so as to open up a case. I was legally bound to interview him and complete the damn thing...but cleverly and legitimately moved his non-urgent folder to the back of the queue.

He eventually got tired of waiting, forgot why he was there and left...singing merrily on his way out...

Sometimes the best medicine is no medicine.

Argh! There are so many more psych stories I want to tell you from today!

But I'll give you guys a break for now...maybe in two or three posts I'll bring you back here..

Sneaky psychs.

2009-06-05T10:58:00.005+02:00

This was truly bizarre.

The security guard wheeled a young man into the unit at about 19h00 last night. This man was totally unresponsive and slumped lifelessly in the wheelchair.

He did not look chronically ill. He was not bleeding. He had no bruises. He had no broken bones. Also, he had no escort with him.

Thus - we had absolutely no history other than that the security guard found him lying on the floor at the entrance to the hospital.

The man was warm, and alive. Blood pressure, pulse, respiration, temperature, oxygen saturation, haemoglobin, urine and glucose were all perfectly normal. But patient was totally unresponsive.

We tried all the cruel ways they taught us of trying to elicit a response:

Deep pressure on the fingernail beds,
knuckles pressed hard into the sternum,
pinching the skin under the tricep,
and my worst - twisting the nipple.

Alas, he gave us nothing to work with.

We have no other tests available to us after hours, so we referred him to a secondary hospital for further investigation. While waiting for the ambulance to arrive we kept him on the stretcher in the unit.

Whilst processing the constant supply of patients, we kept monitoring him. But he stayed horizontal and unresponsive, mouth agape and eyes open.
I became worried about his corneas so I taped soft pads over his eyeballs to protect them from drying out.

The health factory continued to process patients well into the night.

At about 23h00, we were suddenly shaken by a huge commotion.

Our unresponsive friend had, in a spectacular and violent manner, suddenly jumped off the stretcher, pulled his drip out and was swearing that we should stop "putting shit in his veins". He was a very tall, well built man who was by then frothing at the mouth and glaring at all of us with mean intent. He climbed onto the desk and proclaimed ominously while gesturing around the unit: "All of this is mine. I want it. It's all mine."

The security guard in trauma tried to coax him down, but he bolted, and ran through the hospital in his underwear and hospital gown screaming, until he got outside where he began trying to open the doors of the cars in the parking lot.

It took four security guards and an electric tazer to take the man down.

They then "escorted" him to the police station next door and I didn't see him again.

Bizzaro!

What a sneaky psych patient!

Such strange things happen in this part of the world. This man must have been psychotic. He did not display any classical signs of delirium, or dementia. This was psychiatric...I'm beginning to develop a sixth sense about these things.
They seek me out these psych patients.
My colleagues are calling me the psych whisperer.

I'm still not sure what exactly happened there...no use dwelling on it though. No doubt I'll get a similar case in a few weeks time. History repeats itself often in this trauma unit.

Fact: An abortion is not the same as a pregnancy

2009-06-05T10:26:00.011+02:00

The last twenty minutes of the trauma shift are nerve-wracking for me.

I've usually managed to sort out most of the emergencies by then , and am just waiting for the next doctor to arrive. I'm on edge in those last twenty minutes because without fail, always, always, always, some crazy emergency comes rolling through the door. This ensures that I will be tied up dealing with it way past gong-home time.

Like this morning. At 06h40...

Uncle of patient comes into trauma unit, says that Niece had an abortion in January, and now is complaining of tummy pains. "Did the patient have the abortion in our clinic?" we ask. Uncle says yes, and that she just has some tummy cramps that have been going on for a month.

Clearly not an acute emergency.

Niece gets sent to the line to wait for the doctors in the consulting rooms.

Uncle comes back to unit 5 minutes later, saying that the patient is now having a baby.

Confusion reigns.

We insist that Uncle brings Niece into the unit for examination.

Niece is clinically 8 months pregnant, in fully fledged labour with a fetal head crowning between her legs.

Niece is adamant that the tablets she was given for the abortion in January have only started working now in June.

*this is what's known as - "a lie"*

Doctor S and nurses rush the patient on a stretcher through the hospital to the Midwives Obstetric Unit next door, as we do not have the correct instruments for delivering babies in the trauma unit.

Niece "aborts" a full term healthy baby girl. Congratulations Niece!

The whole truth is that Niece wanted a second trimester abortion in January and was referred to a secondary hospital for the procedure. Our hospital only does first trimester abortions.
Niece never went, but still believed that the abortion would happen, somehow.
Niece was in denial for 9 months. Niece thought she could "believe" the baby away.

Niece did not know the difference between an abortion and a pregnancy.

This was not Niece's first pregnancy.

Niece had already been through two pregancies.

The power of denial is mind-blowing.

Doctor S only left her trauma shift at 07h40.

Saving lives, one gross act at a time....

2009-06-05T09:24:00.004+02:00

Some of my friends have recently confided that they love gross medical stories. The more gross the better, and they are always probing for revolting tales of yuckiness.

Unfortunately/ Fortunately - having been constantly exposed to patients and their bodily fluids for a few years now, my gross-o-meter has been rendered completely useless. I am not sure what is actually revolting or yucky anymore!

I rely on other people's reactions to my stories and then realise afterwards that, "oh yes, that festering pus-filled abscess probably was pretty gross!"

One thing these fascinated non-medics cannot fathom, is the concept of the digital rectal exam. The mere mention of it sends their facial muscles into disgusted spasms.
(Which manifests in their mouths pursing up to look something just like the aforementioned revolting sphincter. So cute!)

May I just clarify - the anus ( that's right, ANUS, say it out loud) is an amazing organ.

It. Is. Amazing.

It is a very complicated piece of machinery that involves an external and internal sphincter, and nerve endings which are sensitive to pain, touch, temperature and stretch. It has lubricating glands which help to lubricate the stool on its way out of the body. It has a voluntary and involuntary part, thus allowing one to maintain dignity when desiring defecation.

It is the last border post between digestion and the porcelain throne. It can allow air to pass through it in the form of a beautiful sometimes thunderous rectal whistle, while simultaneously holding back solids.
Like I said, amazing.

Furthemore, the digital rectal exam is a LIFESAVING PROCEDURE!.

lifesaving.

One can tell loads from the rectal exam. One can diagnose haemmorhoids, one can assess neurological function by the tone of the anal muscles, one can determine intestinal bleeding by the contents of the rectum - and in fact determine the site of the bleeding depending on the consistency and colour of the blood on the glove. One can assess the state of the prostate and screen for cancer. One can assess posterior wall of the vagina.

Sometimes one can even determine the state of the thyroid. (Just kidding)

Consolidate it: the rectal exam is lifesaving and the anus is amazing.

Get over it.

What I must mention though is that very rarely - I do encounter things that stimulate my barf reflex.

Yesterday, a rectal exam was indicated on an eighty year old man with urinary obstruction. At the point of actually wanting to perform the digital rectal exam, I noticed that my finger was obstructed in its purpose by a large wad of toilet paper covered in old faeces still stuck,fiercely, between the man's gluteii.

The man was completely oblivious of this fact.

I threw up a little in my mouth and spared him some embarrassment by not saying anything,and removing it myself before proceeding with the examination.

Satisfied now my buddies - was that gross enough for you guys?!?!

Not much induces my vomit centre anymore - but day old loo paper, post -use, most certainly does the trick!

Please my dear patients, us doctors don't mind probing in supposedly disgusting places. Really, we'll do what it takes to keep you healthy. But you must also play your part. Endeavour to make things a bit easier for us.
Like wiping properly.
It's the right thing to do.

Prison games

2009-05-31T21:09:00.007+02:00

It is really not fun in the trauma unit.

From the broken filthy chairs we sit on, to the never-ending supply of emergencies to deal with...it's not what one would call a healthy working environment, or a good night out.

So, we find ways of surviving the onslaught, just to make sure we don't get too depressed and blow our own brains out.

One of these ways is inventing games to play while at work.

This particular game can only be played when the police bring in a prisoner with non life-threatening injuries.

Nobody knows I'm playing the game - that would be unethical of course - I play it with myself and it's all undercover. Under the cover of my skull and inside my own brain.

The opponents are myself, and my cynicism.

What I do is, I don't say anything to the police, except asking them to seat the handcuffed patient in front of me.

Then I play the role of the doctor and ask the patient where it hurts, where it's bleeding, how I can ease suffering etc.

Standard and correct doctor behaviour.

Once I've built up a rapport with the patient, I like to ask how they got their injuries.

Note - I don't ask why they're in handcuffs - just how the injuries happened - for documentation purposes.

What follows is usually a very long story about how the patient was just minding his own business on a street corner when he was attacked, and that the police got confused and arrested the wrong guy.

The prisoner is , without fail, always incredibly polite, well-behaved and upstanding.

I listen, and take all this in. I force myself to believe everything they tell me - hoping and praying with all my heart that this is the complete and utter truth.

Then, comes the crunch point. I interview the police to hear their side of the story.

And I can tell you, they NEVER have the same story. Never.

Mostly , the prisoner was doing exactly the opposite of minding his own business and was either beaten up by the community who caught him, or physically reprimanded by the police while being arrested.

The hard part of the game is not judging the patients when they tell me their story. I like to see how long I can hold off my skepticism. It's especially hard when I examine a prisoner and find the frightening gang tattoos covering his body.

I've seen some insane things tattoed on people's bodies, but these two particularly stand out.

1: If you fuck with me I will kill your wife.

This was tattoed on this guy's FOREHEAD! It had the hangman drawing next to it for further emphasis that he meant what he said. Scary.

2: I rape for fun and kill for joy.

This was tattoed on this man's torso. I could only imagine what he'd done to his victims. Turns out he had been a criminal for many years, until somebody gave him a taste of his own medicine and stabbed him with a sharpened bicycle spoke in his spine. He is now a paraplegic and thus rendered completely unthreatening.

Karma? You've got to believe it.

Unfortunately in this bit of trauma unit fun - Cynicism wins all the time.

I have never won this game.

Which is, I think, exactly why I keep playing it, to force myself to have faith in humanity, despite the gross misbehaviour of its citizens toward one another.

I pulled that last bit out of my subconscious. I don't usually like to go there. There are things in there I've worked long and hard to keep well buried. That was just a little taste. Don't expect a full meal. If you're reading a post and there's a lot of psycho-babble - you know I've gone there and am probably hugging my laptop and blubbering in a corner.

Ghost Stories

2009-05-31T12:54:00.020+02:00

I do not believe in ghosts.

Fundamentally - no, I do not think they "exist".

Did you see what I just did there? I made the words do tricks. exist vs dead vs the living dead. I'm an awesome word manipulator.

I have friends who tell me their great aunts or friend's sister's uncle's mother in-law could communicate with the dead.
While I secretly wonder as to the possibility of this, mostly I just find these stories hilarious.

During Thursday night's tea break - the sister's and receptionist staff were entertaining me with ghost stories from the hospital. These included stories of:

*An old hospital clerk haunting the filing room,moving chairs around and switching lights on and off etc.

*Seeing old patients sitting in corners of the trauma unit observing the goings on.

*Hearing the screams of aborted foetuses while sleeping in the on-call-room ( which is actually the termination of pregnancy counselling room during the day)

and so on and so forth.

WHATEVER!

I'm not scared of the dead. I'm scared of the living.

Some of my patients actually are the living dead.

Those COPD patients with secondary heart failure who are still smoking...walking dead.

Those sugar-saturated diabetics with an insatiable appetite for cream cake and a practiced ignorance of their limb-threatening periphral vascular disease...living dead . ( they can't be the walking dead because they've usually had their legs amputated.)

Those sallow yellow alcoholics with liver disease and portal hypertension and oesophageal varices who won't stop drinking despite bleeding from their intestines...once again...living dead.

By the way, do you think that when an alcoholic dies they become a methylated spirit?

Ha Ha! I just made that up. Seriously.I crack myself up.

I had a patient yesterday who was not mentally unsound.

He was just really really drunk. He was so drunk he did not even know why he was at the unit.

He was so drunk every cell in his body was drunk with him. Even his blood corpuscles were drunk-driving through the clearly demarcated road map of his veins and arteries -and took a wrong turn - ending up pouring through the large laceration in the left side of his head.

He apparently was assaulted with a bottle which is why he had a big gash in his scalp.

For some reason I really liked this guy. He was not one of those angry drunks, or sad drunks. He was just a happy-go-lucky peace-loving homeless drunkard.
We were having a quiet evening, so instead of asking the sisters to do it, I stitched him up myself.

Normally we are so busy that we have to ask the nursing staff to suture, and as it has been a while, I'd forgotten how much I enjoyed it.

Aahh...the sterile instruments, the meticulous piecing together of flesh with correctly spaced sutures, the utter practicality of it, the fact that no-one can bother you because you're performing mini-surgery. I love it.
I also enjoy having the patients to myself to chat to while I work. This is usually when I hear the most interesting stories. For instance...

This guy started off our conversation by telling me that he was dead.

"Oh don't worry sir," I explained,"Wounds on the head always bleed a lot, even when they're very superficial. You'll be alright. This is not a life-threatening injury."

" I know doctor, " he said, "but I am actually dead. I'm a ghost."

OK..umm...what? I've only been trained in the field of medicine for living non-apparitions. I do not know the correct suture for a wounded spectre's head.

What I have been taught to do is keep the living, living.
Do I do the reverse in this case?
If so then what method should I use to keep the dead, dead?

Me: "Explain, sir. Explain immediately what you mean...because ghosts don't bleed dude. Ghost's cant get hit in the head with a broken bottle. I've watched TV. The bottle goes through the ghost's head because he has magic ghost powers. Next you are going to tell me Demi Moore is your girlfriend."

That last joke went over his head.

Ghost: "Well I definitely died the last time I was here. My friend stabbed me in the neck and then I died. When I woke up I was back on the streets, I don't remember the hospital or anything. That's how I know I am dead. So sometimes I come and say hello to everyone here."

I didn't say much further after that. Didn't think either. Was he a loony tune or a member of the after-life? Who knows...not for me to ponder. I just got on with the job, sewed him up and sent him back to his favourite haunt.

He winked at me on his way out.

That's when I knew he was fucking with me.

Or not.

And then I wondered...Did I just communicate with the dead, like John Edwards. I hate John Edwards, and now I had become him. Oh Shit! I should have asked him more questions about the after-life! Another opportunity missed.

In the words of Alice in Wonderland, this job just gets curiouser and curiouser.

Humans are fascinating aren't they?

I'm just interested...if you die and become a ghost - do you have to haunt the place that you died in? If that's true...it's fucking terrible. Imagine being stuck haunting the godforsaken trauma unit for the rest of eternity!

Remind me to go to Mauritius to die. Or the Seychelles. Or behind the scenes at an all-male modelling show, or in the audience at a west-end theatre so that I can be entertained by musical theatre for the rest of eternity!

Sloth and Competence and knowing when to use them.

2009-05-25T14:09:00.005+02:00

It's half past two in the afternoon.

I've just managed to teach my brain to communicate with my body again.

My brain was awake for an hour trying to convince my skeletal muscles that listening to what it has to say is a good idea.

Brain was saying that Skeletal Muscle should help Body get out of bed, hunt for food and evacuate the bladder.

Skeletal muscle was telling Brain to go fuck itself.

Brain won in the end, after a lengthy hour long debate.

Skeletal Muscle got it's own revenge though, and operated like a sulky teenager after being told to clean up it's room...apathetically, slowly, and with no respect.

Which is why I looked something like the illegitimate retarded offspring of Shrek and a three-toed sloth...slouching round the house half-blind, in last night's scrubs top, underwear and socks...mumbling incoherently while in search for the kitchen.

My keen sense of smell led me to the fridge - On which I pinned all my hopes and dreams for a nutritious lunch.

I opened the silver doors and the holy light from within flooded my sleep encrusted face ...

Aahhh *insert choir of angels here*

# Leftover pizza that someone ordered last night ( Score! It's mine now!)
# Crackers with gourmet prawn dip with real prawns from Woolworths.
# Zoo biscuits.
# And a jar of Nutella's spreadable chocolate.

This surely is heaven, and just reward for the shitstorm of last night. Thank you, Fridge Gods!

My call was insane. Which is why I was so tired that when I got home, I couldn't even perform my usual post call ritual of jumping in the shower and scrubbing off the evening's filth, until the top layer of my skin has washed down the drain.
I just shoved an energy bar down my gullet - took off my pants and collapsed on the bed.

The bullshit started out when the locum doctor, who was supposed to be on call with me, arrived two hours late.

While awaiting his arrival, I called the emergency contact number for the locum agency he was from to find out:

Exactly.
Where.
The fuck.
He was.

The middle-aged lady that picked up on the other end could possibly have been a product of incest.

Product of incest:"Oh, um, ja, who are you?"

Me: "It's Dr S from ________trauma unit. Where is the locum you are getting paid to send us tonight?"

Product of incest: "Oh yes, he called three hours ago to say he would be late. But, where is the other doctor for tonight?"

Me: "I AM THE OTHER DOCTOR. If you knew that he was going to be late - WHY HAVE YOU NOT INFORMED US of this fact timeously."

To which the product of incest replied...and wait for it...this really was her excuse..." I was in church!"

Me: "Being in church is no excuse for incompetence. You should stop using your religion to justify not doing your job properly. We'd all LOVE to be in church, or in mosque, or at home on the couch watching the Sunday night movie. But we aren't. We are here doing our jobs. "

I was too pissed off to listen to her ranting and raving that "being in church " was a valid excuse for letting us flounder in primary health care hell on a Sunday night without assistance. So I very politely put down the phone. That woman should take a good look at herself and pictures of her uncle/mothers cousin. There will possibly be very striking similarities.

When the guy eventually arrived - the tragic thing was, I realised that I was probably better off working alone as he was NO HELP whatsoever.

In total, we saw 100 patients from 17h00 to 07h00.
I saw 70. He saw 30.
He would do things like, send a patient off for a urine sample and then WAIT until the patient came back. One can see up to four patients by the time it takes a paralysed stroke victim to go to the bathroom and pee.

When a man walked into the unit and immediately collapsed while having a generalised tonic-clonic seizure, he just stood there and watched me ( 5o kg, petite female me) try to move the man onto a bed to begin treatment.
What a dick. I ended up asking the porters and security guards for help.
They were brilliant and knew exactly what to do - handing me the correct fluids and instruments for IV access.
Fuckwit doctor strode around the bed with hands in his pockets issuing instructions which I, of course, ignored. I don't take advice from brain-donor men who believe that they are automatically in charge - just because they own a penis.

The sisters and I spent the rest of the night ignoring him and swearing at him in Afrikaans. The guy was from Durban so had no idea what we were saying. They don't speak Afrikaans in Durban. Mean - but necessary.

The cherry on the top was when at o3h30 he announced that he had a plane to catch and would be leaving to get his things in order. He then asked the sister in charge to sign his on call sheet from 17h00 to 07h00 so he could get a full night's pay.

He clearly did not know about Sister CrL. She didn't sign his sheet at all. Good girl!

Can I just say - that as I am a community service officer - my rates are standard, very low and fixed regardless of how hard I work. These locums get paid more than double what I make as they are from the private agencies -so in effect I got paid half the amount and was working more than twice as hard.

Did I mention that it's five weeks and counting?

Jeez - just got a whif of myself while reaching over the table. I smell like the hospital!!! AAAAAAAAAAHHH!

I thinks it's time for that shower now...

This is not an entertaining post.

2009-05-22T18:08:00.004+02:00

This is a post full of complaints. It's not funny or entertaining in any way. It's just the truth.

Doctor's are currently picketing and toyi-toying in their lunch hours in South Africa.

We are sick of the pathetic working conditions we suffer.

We are tired of the ridiculous hours we are forced to work.

We are insulted that compared to other government workers in similarly highly educated fields in this country ( the judiciary for example) - we are getting paid 50 percent less .

We are emotionally drained by the sheer volume of patients we are under pressure to "see" every day.

This disheartens us as we are unable to provide the quality of service we know we are capable of, simply as a cause of poor management.

We are tired of being told that we chose to be doctors, and that we should just deal with it as this is the way it has always been.

We are disgusted by the service we "provide" to our patients. It's unfair that this will be their health "care" experience.

Why are other fields not forced to do community service like us Good Samaritan medics?

Teachers could do community service in the township schools.

Engineers, lawyers, IT consultants, business graduates should all be forced to serve their communities in the way medics are.

The members of those disciplines would be up in arms about it.

Not like us - we just blindly accept our fate, and continue pushing ourselves to our limits.

Why are doctors such pushovers when it comes to our own quality of life?

I'm certain it's a mixture of guilt, compassion for others and indoctrination by the heirarchy.

I'm very worried about the future of government health care in this country. There is no incentive for us to continue working for the government sector. Why would anyone continue here? The department of health only have themselves to blame for the "brain drain" of doctors emigrating for a better life overseas.

I get to work, and am scared because people get shot in the area that the hospital is situated in.

When I walk in the door - I'm immediately confronted with 200 or more patients crammed into the small waiting area - who have been sitting there since 4am to ensure that they are the first to get a number. The magic number that means you will be one of the patients lucky enough to be seen by a health professional that day. If you don't get a number - you are turned away and told to come back tomorrow - where it's not certain you will even be seen then.

The patients know I'm the doctor - despite trying to be inconspicuous - and immediately start harassing me with demands.

"When are you going to see me doctor?"
"I've been waiting for ever!"
"Please just rewrite my medication so I can get it from the chemist."
"Can you have a look at my foot please it's turning black"
"My baby, doctor, just listen to my baby's chest please!"

This occurs while just walking down the passage to the consulting room. Although one can't exactly walk down that passage - it's more like an obstacle course, having to step over people lying on the floor and children running around everywhere.

I have no safe place to leave my things - we are not issued with lockers or keys to the rooms. Even the tea room is unsafe - so wherever I go I have to take my bags and coat with me. Even into the toilet. Or across the hall to use the one phone in the whole hospital.

The nurses tell me that everything gets stolen - even your food out the fridge, even the plug socket coverings on the wall, even the metal plaques on the doors. everything!

By the time I start seeing patients they are already so pissed off from the long wait that they are not interested in a damn thing I have to say. They just want their meds and want to get the hell out of there.

If I even leave my consulting room for five minutes just to pee, the patients start grumbling...Where is she going? Is she going on lunch? How long will I have to wait NOW!? These doctor's don't care about us at all!. I don't make eye contact with them.

While on call in the trauma unit - all night, despite having worked a full day as well, we deal with violence on an unimaginable scale. The doctor's from first world countries are shocked by the violence. I met a doctor from the UK who had seen one gunshot wound in his life. His first night in the trauma unit and we had five gunshot wound cases - one guy had 16 holes in his body.

While on call, the security guards supposedly protecting us have been beaten up by gangsters, the trauma unit has been surrounded by gangsters with guns and I've narrowly escaped assault by patients.

And if that's not enough. It is perfectly acceptable, after working a full day and night - NOT to be allowed to go home when the on-call shift ends. Oh no - it's law that you have to stay and see a certain amount of patients post-call before you go home.

Their thinking is that if you just went home, it would mean that you didn't actually work on the day post your call. Which is BULLSHIT as you actually already worked 7 hours of that day - from 00h00 to 07h00. Assholes.

How is this going to change? I don't know the answers - but it has something to do with making us feel valued. Pay us properly. Improve our working conditions. Give us a reason to stay here. Pump more money into education - so that we have a bigger pool of candidates to train to become health professional - thus alleviating the short-staffing.

Perhaps the fault lies with doctors themselves, who have allowed themselves to be mistreated for so long. Our dog's life is simply accepted as par for the course. Our way of coping is to put our heads down, and just get on with it. This is our normality. We don't know any better.

I'm very tired today. Last night's call was exhausting. And then I still had to deal with rude patients in the consulting rooms this morning. I had to restrain myself from shouting at them.

There - I've gotten all my moaning out my system. Will try make the next post entertaining. There were a few things from last night that stood out.

Have I mentioned that this blog is my catharsis? I figured it would be safer than being an alcoholic or drug addict. And certainly cheaper than therapy.

SNVL (Episode 2)

2009-05-20T17:49:00.005+02:00

One should always listen to one's inner voice. ALWAYS.

Today mine was screaming - "STAY IN BED! DO NOT GO TO WORK!"

I think the staying in bed part might have to do with the benzodiazepines (valium) I took last night.

No guys, I was not having a little private drug-addicted-doctor party in my bedroom. I was suffering from two days of intractable neck muscle spasm. And everything that I tried failed.

So last resort - benzo's - which I took, in the safety of my own room, after work, with my husband around to take advantage once I'd passed out. Naughty husband.

I was still sedated this morning. Which is why he had to smack me in the head to get out of bed this and effectively shut off that clever voice in my brain that said "Stay at home".

If you've read "SNVL (episode1)" You'll know what's coming next...

It's Winter now and it was pitch black outside by the time I arrived.
The car park was empty.
The red curtain over the trauma unit window glowed a sinister crimson from the outside.
It glowed the way one would imagine a window into Hell would glow... with the flames of Satan flickering through the window panes.

I've seen this Trauma unit many times before but this morning it looked scary. I should have known there would be a demon inside waiting for me.

The demon was patient three of my morning.

Patient three was brought in by her husband, Mr G. Mr G was talking to me but it was in a dialect native to the Cape Flats. Spoken through a gap in his front teeth, this dialect was made even more difficult for me to understand. Me, who over the last five months has been WELL educated in what I like to call, Cape Flats Gam.

He kept on screaming at me in this language and pointing to his wife, and then pointing fingers in my face and being rude. So I told him to get the hell out of the unit.

I then turned my attention to the patient - his wife, Mrs G. She was dressed in three dresses one on top of the other. Nicely colour co-ordinated in shades of red and orange. She also had a green t-shirt wrapped around her head. She wore a sandal on her left foot and a slipper on her right one.

This new style of dress is commonly known in medical circles as..."Fucked in the head fashion craze for crazies".

Oh but that wasn't the most exciting thing about her.
What she was screaming at the top of her lungs was terribly exciting, and possibly some of the foulest demon-possessed putrified verbal filth...

Don't say I didn't warn you....

Me: 'Hello Mrs G - how can I help you?"

Mrs G: "Jou ma se poes, jou fokken holnaaier! Moenie vir my vir 'n poes vatie! Ek isie mal ie? Jy's mal! Jy's almal fokken mal!"

Your mother's cunt, you fucking bumfucker. Do you take me for a cunt? I'm not mad, you're mad! You're all fucking mad!

Me: Ok Mrs G. You are right. I'm mad. Why do you think you're at the hospital today? What happened at home?

Mrs G: "Ek is hier om birth te gee vir my holy babas. Ken julle nie vir my nie? Ek gaan 'n honderd holy babas uitkram! Jou poes! Jou poes! Pasop vir my! Julle ken nie vir my nie - ek dra nie eers 'n panty langsaan my poes nie! pasop jong pasop"

I'm here to give birth to the holy babies. Don't you know me? I'm going to give brith to a hundred holy babies. Your cunt! Be careful of me - I'm not even wearing a panty next to my cunt!"

ME: I..

Mrs G: Fok jou! Julle willie vir my help me. ( starts sobbing hysterically and clutching onto the sister standing next to her.) Ek willie he my pa moet vir my slat nie! Hoekom skree hy soe vir my? Hy het nie vir my lief nie.

Fuck you. You guys don't want to help me. I don't want my father to beat me. why is he shouting at me like that? He doesn't love me!

and in the next breath:

Mrs G: Ek het baie respek vir u doctor. Baie respek.

I have lots of respect for you doctor, a lot of respect.

and in the NEXT breath:

Mrs G: Jy's a jintu! Jy wil my man naai. Ek ken vir jou - jy wys jou poes vir almal en jy soek net piel.

You're a whore, you want to fuck my man. I know you - you show your cunt to everyone and you are just looking for cock.

At which point she shot up out of the chair, lurched towards me with a fiercely clenched fist on it's way to connecting with my cheek.

But I'm quick like a ninja and dodged just in time, just as the sister grabbed her hand and surely averted a trip to the trauma unit myself.

Have I mentioned how the sisters are my bodyguards in this place?

Good God. We needed six people to hold her down while I injected lorazepam, valium and haloperidol into that one. Maybe a little bit of overkill, but - she was dangerous - and like every good ninja knows - hit them hard and hit them fast.

Back to the loch with you, Nessie!

I mean, straight to the loony house with you, lady! I did feel a little bad though - seems like all of this, like with most of the crazies, stemmed from a terrible childhood.

But anyhow...Phew! Nearly came home with a black eye today!

And that set the theme for today's trauma unit adventure - I saw seven crazies today. SEVEN that were so psychotic they needed admission.

Must be a full mooon or something. Or just Satan playing tricks on me again.

I laugh in the face of chinese torture

2009-05-18T19:23:00.007+02:00

Oh my God.

The clinic is a very very special kind of torture. Very very special.

45 to 60 patients a day.

Today 3 doctors were absent from work. But dutiful, competent little me was unfortunately not one of them. I can be really annoyingly dutiful - this is very much to my own detriment I think.

THUS... guess what awaited me today at work...???
EVERYTHING.
Everything was waiting for me.

Oh it's no problem though! I simply waved my magic stethoscope and miraculously all my patients looked like male models.
So that was cool - examining 45-60 well-oiled well-defined torsos, not a bad way to spend the day. I went home satisfied that I had a great career and thanked my magic stethoscope for a job well done.

I wish.

Every single patient today, despite their normal uncontrolled hypertension and diabetes - brought a freaking SHOPPING LIST of problems to their consultations. The clinic has specific days for certain issues. Today was diabetic day. They knew this, having been diabetics and attending the clinc longer than I've been alive.

Yet they saved up the last 25 years worth of niggling medical problems, shoved them in their green pick 'n pay shopping bags and then poured them all out onto the desk in the consultation room. With 45- 60 patients, and a few hours in the day - this is NOT FAIR!

Not fair on me! Not fair on the patients waiting to be seen. NOT FAIR MOMMY NOT FAIR!

PEOPLE! I'm here to assess your Diabetes and it's side effects.

I'm not here to:

*Apply for a disability grant. You have no grounds for a grant. Unless obesity and non-compliance count, you do not qualify!

*Write letters to the freaking traffic department so you can park in the disability bay right next to the mall entrance. LAZINESS is not a medical condition. Stupidity maybe - maybe I should write you a letter for that.

*Diagnose the skin tag that has been present on your ass for the last 12 years.

*Listen to you moan that you don't have taxi money and that I should give you some so you can get to the referral centre I'm sending you to...when ACTUALLY you are spending up to 40 bucks a day on cigarettes. NO. NO. A thousand times NOOOOOOOOOOOOO!!!

And so on. And so forth...

inhale.
exhale.
inhale.
exhale.

stay away from the sharp scissors.

Today was horrible. I think it's getting to me now. I have 6 weeks left in this place. Must stay sane until then...

By the way - did anyone see the new Star Trek movie? I have never even watched ONE episode of Star Trek but I totally loved it. I especially loved the doctor and the cool things he got to treat in space. I want to be a doctor on a spaceship in space! Someone invent time travel already so I can go there! I'm sure there's no diabetes in the spaceship in the future.

Thank you for the presents!

2009-05-12T18:45:00.004+02:00

We love to complain that Medicine is a thankless job.

Often, we do awesome heroic things that look really cool like cardiopulmonary resuscitation, or inserting chest-drains, or putting intra-osseous lines in neonates.
I've been thanked maybe a few times for doing those things. Not that I really expect it - it's my job after all. (also - after forcing a tube through one's rib cage I doubt anyone's going to be that motivated in gratitude!)

HOWEVER....I have noticed that in the quiet of the clinic room - 9 out of ten times I get a sweet, "Thank you, Doctor" as the patient walks out the door. I get thanked for the little things more often. Mostly I get thanked just for listening, even when I've really done very little in the way of physical exam or medical treatment.

This is very touching. Anyone can listen - one doesn't need to be a doctor to do that.

Sometimes the patients go as far as giving me presents. I try to refuse as much as possible but never win. My patients are very poor so the presents are not very big, and so often it's more harmful to refuse the gift of a few sweets or a plum than to accept and make the patient feel good for giving, when they already have so little to give.

Sometimes the gifts are slightly peculiar.

Here is a list of the gifts I've received as a med student and as a doctor in the community.

1: peanuts, sweets, chips and fruit. (usually given by the old ladies. I love gifts of food because it means I have something to snack on during the long day as I often don't get a break for lunch. I'm always suspicious of the peanuts though, especially if they're unsalted. My dad once told me a story about an old age home where it was discovered that the inhabitants would lick the salt off the peanuts and then put them back in the packet, as they couldn't eat them due to their false teeth! Now every time I see unsalted peanuts I think of old people's saliva.)

2: religious verses ( I've been given copies of bible psalms, prayer strings, quranic verses - the works. They all always say they'll pray for me. Thus I am so well-connected now in all spiritual realms nobody can fuck with me!)

3: phone numbers from male patients ( the young ones always try their luck. seriously inappropriate!)

4: phone numbers from grandmothers who want me for their grandsons ( Despite me telling them over and over again that I am taken, and happy with the man I have! I even had one granny bring her grandson with her one day, pushed him into my office and left the two of us there to .....?? Not sure what she wanted us to do. The poor dude was so mortified. Sorry dude - you weren't bad-looking, just not that into 17 year olds!)

5:narcotics. ( that's right, narcotics. When I was a 4th year medstudent doing my obs and gynae rotation, we were delivering babies in the labour ward one evening. This particular couple had lost two children and were really counting on this delivery to go smoothly. Which it did - we did very little as the baby basically delivered itself. The dad, a Rastafarian, was so thankful that he took us behind the hospital and gave us a bag of dagga. I can't really remember if we kept it or not....)

That was probably the most insane gift.

Here is a list of gifts I would like to get ( but would probably have to refuse ethically)

1: 300 million British pounds,
2: 400 million British pounds,
3: 500 million Britishpounds,

you're getting the picture right....

Here is a list of gifts I really really want the patients to give themselves.

1: Compliance in taking their medication EVERY DAY!
2: Healthy sugar free diets, especially if you are DIABETIC.
3: CONDOMS! they're FREE you promiscuous bunny!
4: Exercise for the obese patiens.
5: NOT SMOKING!
6: Not taking tik when you are psychotic.
7: Not drinking, and then stabbing your friend or family member.
8: Leaving that asshole wife-beating husband of yours.

Oh yes, and before I forget did I say thank you to the nurses? It's NURSES DAY today! Thank you you hardcore beautiful lovely ass-kicking wonderful caring nurses!!!! You guys are the best most useful gift I could ever ask for at work!

What to do next year?

2009-05-10T12:49:00.004+02:00

There comes a time in every South African doctor's life which is very very scary. It induces hyperventilation, irritable bowel syndrome, anxiety and depression.

It's called the "What the hell do I do after Community Service???" conundrum.

You see - us medics are notorious for being a really responsible bunch. We go to school for twelve years. Study hard and get into medschool. Then we are handed the next six years of our lives in the form of obtaining our MBChB's. While we are doing this we watch the business graduates and BA students partying up a storm. We think really long and hard about changing to Bcom or business science - but then decide against it cos we're too far down that "becoming a doctor" road and what the hell are we going to do with three or four years of a six year course? Nobody is really going to give you credit for that, and there's no bridging degree!
After that we are instructed as to the next three years of our lives in the form of two years of internship and a year of community service. We accept all of this without question, and do as we are told.

So effectively - after school, the last almost decade of our lives have been set out for us, cast in stone, inscribed on our foreheads, tattoed on our eyeballs.

"You will do this, then you will do that and then you will do this!'

We haven't been in charge of our own lives at all! Our daily schedules, amount of free time, where we work - whether or not we can attend that birthday breakfast on a Saturday morning or not -- have all been determined by health authorities and on-call rosters.

But that's all coming to an end in under 7 months.

So now what?

What the hell are you people asking me to do? Actually make a decision for myself? That's LUDICROUS! You didn't teach us how to do that!

Now I have to make a decision on my own, and go and apply for jobs, and go for interviews, or not go for interviews and go overseas. Or not go overseas and stay in SA where the government is constantly finding novel ways to make our working conditions worse and having a rate-limiting fixed amount of overtime payment - despite working far more than the required overtime hours.

Also - what jobs should I actually apply for?

Should I specialise?

If I specialise then I'm committing to five years of hard grafting. Furthemore - what specialty should I choose? There are like three hundred thousand options. Actually 299 998 because I will never do paediatrics or obstetrics.

Should I not specialise and open up a gp practice?

Also - I have OVARIES. These ovaries are busy shutting down as we speak. If I specialise then it would be prudent to put off having a child until I've finished. But then I'll be 59 years old or something and my baby-making capabilities will have passed. Why don't men have to deal with this problem. Oh yeah - cos they can still inseminate when they're 79.

AND - do I actually want a child? (But that's another blog post waiting to happen.)

Deep deep sigh. All of these questions are now constantly lurking under the surface of my usually crystal clear pool of a mind. It's unsettling.

The hubby suggested we take two months off to travel through India. At the moment this seems like the most perfect option!

Any ideas, anyone?

Help!

Jive bunny, Jive granny.

2009-05-05T13:44:00.005+02:00

I once had an old lady in my clinic room.

This is not unusual. most of my patients are old.

This lady was unusual though. She was brought in by her daughter. Her daughter was already old , about 60, and the patient , her mom, was somewhere over 90.

Pretty cool I thought. To be 90. Also she had pink stockings on. I thought this was particularly cool.

I made a mental note to wear pink stockings when I was 90.

Anyhow - that's was not what made her unusual. She was unusual in that she was smiling! She was smiling and laughing and joking around with me. I loved it. I asked her daughter if she had any symptoms bothering her, and they both emphatically shouted, "NO!".
And she didn't.
All her bloodwork was normal, her blood pressure was fine and her glucose levels were acceptable. This lady, at 90, was the picture of health.

I must have had some kind of incredulous look on my face, because the old lady suddenly jumped out of her chair and said through her toothless mouth," Hey Doc, you don't believe me hey? Watch this!"

She suddenly started twisting away, like we did last summer, in my consultation room. All the while letting out whoops of delight and going , "Hay-yo! Hay- yo! Look at my hips, look at my hips! They've still got the mooooves. Look at my mooooves!" (she said moves, like that, with four O's.)

That was awesome. Oh man - I didn't want her to leave. This funny old pink-stockinged 90 year old grooving to the tunes in her head in my office.

I considered testing her for dementia. Then I thought, Nah, stop being a cynical doctor for a while, Dr S, and just believe that this lady still has a great zest for life.

I figured that if her daughter didn't mention anything then there wasn't a problem. I'm certain that once she starts grooving naked in the middle of the living room while guests are over I'll see her back in my clinic. Until then, I'd just add some supplements to her meds and spare her the barrage of testing...

You go Jive granny!

Verbal spankings

2009-05-05T12:01:00.004+02:00

Mostly - I love my patients. I really love them. People are so interesting and have such varied characters. I am also privileged to be able to learn intimate things about patients in a space where I try to make it easy to express themselves.

But sometimes , when in the clinic, one is forced to consult with that one hardcore poisoned apple of a patient. That patient manages to infect one's entire day with irritation and frustration, despite the fact that when you woke up that morning you promised yourself you would spread love and joy and compassion to everyone you met.

Of course, one tries hard not to let it show, but that patient - oh that cunning patient knows just how to get under your skin. There are a number of ways they do this - they can be rude, they can be sexist, they can be racist, they can be stubborn. Whatever it is they just know how to push one's buttons in a way that makes you want to start busting out some martial arts moves.
Of course, we can't inflict karate wounds on them. Even if we do know how to patch them up afterwards.

No see, WE have to be professional. WE have to suspend our human qualities and emotions. WE have to be the solid rock that despite being abused in all sorts of ways by our trade, is never ever allowed to be flustered. Doctors=saints=superheros.

Let me tell you about my button-pushing patient. Let's call him, Mr FU. Mr FU was patient three of the day. So there was no reason for me to be irritated. I was fresh from a good night's sleep. I woke up in time for a healthy breakfast. I even managed to watch a bit of morning news before heading off to work.

That day I endeavoured to be a healer. I would be a holistic wonderful western/eastern healer and heal physical and spiritual problems. I would do this by really listening to the patient and by being non-judgemental. I would be awesome.

However, in walked number 3, Mr FU. MR FU was about 66 years old. Average height, previously owned a farm in the Boland, was stinking of cigarette smoke and started sighing before I'd even greeted him.

"Oh shame", I thought, "this man seems troubled- perhaps I can get him to open up with my soothing voice and gentle nature."

Wrong babe. Wrong . Fail. try again.

I open up his file - a known hypertensive and diabetic. A smoker. ( that was obvious). Has already had two heart attacks and a triple bypass operation which probably cost thousands, but which he paid nothing for as he is now an unemployed pensioner. After being discharged post-surgery he had a team of specialists come up with a comprehensivve treatement plan. He has defaulted on this treatment for the past three years.

Oh-oh..I started to hear the clang of distant warning bells...

I began in my standard way.

Me:"Goodmorning, how can I help you?"

MR FU:"Agh Jesus man, just do what you is supposed to and write out my tablets? None of you doctors is even helping me. So don't blerrie ask me any questions. I'm sick of questions."

Right. Ok. This one was going to be a toughie. Not only because I wanted to correct his English but also because he was proving to be difficult from the get-go. But, No problem, I thought, I can handle this.

Me: Sir, I sense you've been very frustrated by our health service thus far, is there anything I can do differently to help you? Perhaps explain something to you that you didn't understand or maybe try to treat a symptom that is bothering you?

Mr FU: I has burning feet. You probably has no idea how to fix it so I don't know why I is even telling you this.

Me: Actually, I know exactly why your feet are burning and I AM going to try to fix it.

Mr FU stared at me for a few seconds, suddenly a little interested in what I had to say.

Me: Do you want to know why?

Mr FU: Ja fine. explain to me why my feet is burning.

Me: You have Diabetes. The sugar level in your blood is very high. It's affecting the nerves at the end of your body.I see you haven't taken your medication, and this is not helping you to keep the sugar level from affecting your nerves, you see....

Mr FU suddenly interrupts me: Um... doctor?

Me: Yes, am I going too fast for you?

Mr FU: Kry net klaar, my klimeid, en gee my my medikasie.

That was in Afrikaans. It's pretty damn rude in Afrikaans. In English it's the equivalent of saying, "Just hurry the hell up, and give me my medication, you little girl."

Except that the word he used for little girl, "klimeid" was a word used by the Afrikaners when referring to their Coloured housemaids or farm workers. It's pretty derogatory.

That's when I decided I'd had enough. Peace, calm and spirituality went hiding under the table.

Me(enraged, and with blood spurting from my eyeballs):

MR FU! YOU were the one who just asked me to explain this to you and now you're telling me to shut up!? Furthermore, you will not EVER speak to ANYONE in this hospital that way or we will refuse to see you. Jy is ombeskof! ( you are rude) WHAT exactly are you doing here? You've already had a triple bypass operation, that saved your life, but it doesn't seem like that made an impact at all.I do not have to treat abusive patients. So I'm giving you two choices now. You either leave my office immediately and go home to have another heart attack in your own bed, or you take off your shoes and get on my examination bed immediately so I can try to help you.

I expected, and unfortunately actually wanted, him to get up and walk out.

Amazingly - he obeyed my instructions and got on the examination bed. He was dead quiet for the rest of the examination and history taking. He was all, "Yes, Doctor. no Doctor, thank you , Doctor".

As I suspected, he had peripheral neuropathy and I managed to talk to him about how it was caused by his lack of glucose control. I also asked him if he wanted me to prescribe something for the burning sensation - which he did.
I asked him to come aback for a check-up in a months time - to which he agreed.

The clincher was that at the end of the consultation - he apologised to me and thanked me for sorting his problem out so thoroughly. He claimed I was the only doctor who took the time to help him. I'm not sure if he was being sarcastic or not. I have pretty good sarcasm radar - and mine wasn't going off.

Was I wrong in telling this man off? I think that in this case, no. The answer is no because the outcome was good. He actually came back and at that consultation his glucose level was lower and the burning sensation in his feet was less troublesome.

So what am I saying? I'm not saying we need to lay into all the non-compliant patients. And before you accuse me of wanting to bring back corporal punishment in schools and the death sentence, all I'm saying is that maybe, just maybe - people need a little verbal spanking from time to time to help them realise the seriousness of their behaviour.

We really have to try every angle to get through to our patients...a little whipping with words unfortunately DOES sometimes do the trick...

Welcome to theTrauma unit - what is your non-emergency?

2009-05-04T18:58:00.003+02:00

Sometimes, I really just don't know what is wrong with the patient, despite their best efforts, their really valiant efforts, at describing their symptoms.

For example, my patient who decided that she had a problem that needed urgent attention at 3am on a Monday morning.

This was our actual conversation. ( bear in mind that she actually sat and waited for 3 hours in the waiting room to see me with this problem. Also bear in mind that I was pretty freaking tired so if this makes sense to any of you, and you can come up with a diagnosis please let me know.)

ME: Goodmorning, what is your emergency? And please let it be a freaking life-or-death emergency because that's all I should have to deal with at this time of the morning. ( No, not really - but that's what I wanted to say. Instead I just said "Hello, what seems to be the problem?" like the good little doctor I am.)

Patient: Well, Doctor, you see I have this pain in my right back side of my head.

ME: how long have you had this pain?

Patient: 6 months

ME: What the hell lady! 6 freaking months and you are here at 3 in the morning forcing me to listen to your chronic issues! Do you know the meaning of emergency unit? Do you? ( Again, no not really...but you're getting the picture, right?)

Patient: Yes so it starts in the right back side of my head, and then it like shoots to my left part of my chest. But sometimes it doesn't go the the chest it actually is in my back. Not my whole back, no not my whole back - only here on my lower back.

Me: So there's no pain in your neck?

Patient: No man - I told you, only in my chest and my back.

Me: And there are no other symptoms you're experiencing - like headaches, nausea, vomiting, blurred vision or weight loss?

Patient: No,just listen doctor: I said it's on the right back side of my head. Oh yes, but that's only during the day. But it's not every day - it's only sometimes, like when I've been drinking a lot of milk. And then at night - it starts in my foot and goes up , all the way up to my back again. Is it because of all the milk , Doctor?

This lady had just managed to describe pain from the top of her head all the way to her feet.

I honestly had no clue what was wrong with her. And at three in the morning my brain was not functioning well enough to play medical detective games. I toyed with the idea of telling her that EVERYTHING was milk-related and that she should stay away from all dairy products for the rest of her life.
But that would have been unethical, and wrong. So I did what any COSMO ( community service medical officer) in my position would have done.I gave her some analgesia from the pain cupboard and told her to come back in the morning for tests and x-rays.

It was honestly all that could be done after hours, and I didn't even have time to feel bad about it due to the numerous emergencies starting to roll in.

She was not the first, and she won't be the last non-emergency a COSMO will have to deal with during their slave-years. Some of the one's I can remember visiting the trauma unit at God-forsaken hours are: constipation, fleshy tags, eczema, and normal monthly menstrual periods.
The best is always the lady who comes in with "something moving in her tummy". And then that something, after a simple bit of magic called peeing-on-a-stick, turns out to be a baby!

I must say, that's the one non-emergency I don't really mind "treating" at 3 in the morning...

On the subject of Sex Ed...

2009-04-29T17:23:00.005+02:00

Let's keep going with this sex-ed theme:

Last year, when I was a lowly intern, I worked in a similar, though much less busy community health care centre in the middle of Cape Town.

On my first day there, I was presented with my consulting room ( the tiniest one as I was way down at the bottom of the medical heirarchy.)

I wondered who I had inherited this room from - it was pretty shabby which was to be expected, but it seemed like it was equipped with the basics.

However, it turned out it was WAY more equipped than necessary, as while rummaging around on the back shelf for gloves, I came across an interesting package.

The package was long, and phallus shaped with a picture of a sexy girl in a bunny outfit on the front. I wondered where this package came from , but then it told me itself of its origins when I read the words "Adult World" printed on the front.

Curious, I opened the package, but my keen doctor's detective brain was already pretty sure of what I was going to find inside...and lo and behold, there was a large pink fleshy dildo complete with suction base just chilling out in the bottom of the box.

I suddenly felt very naughty. "Is this why the doctor's here are all so relaxed?", I wondered. How kinky! How inappropriate. I decided to report this matter to the senior doctor, who simply showed me the dildo on his back shelf which was much bigger and had testicles to go with it.

Typical, I thought, the intern always get's the short dildo, I mean straw.

Turns out they were bought as hospital aids to show patients how to put condoms on correctly!

How progressive! How innovative! I loved it! I pulled that dildo out in as many consultations as I deemed was appropriate. The scary thing was that most of my patients were really grateful as they honestly were clueless about condom application.

Now whenever I work in a new clinic I make sure I have a good rummage on the back shelf - who knows what one will find! So far it's just been dead cockroaches and mice droppings. That dildo was the first, and probably the last back shelf treasure I'll ever discover.

Sex Ed

2009-04-28T12:48:00.003+02:00

Gonorrhoea.
Syphyllis.
Chlamydia.
HPV.
HIV.

These are all nasty nasty genital diseases tramsmitted when doing the nasty nasty dance of love. They even sound nasty when you say them.

I know that when I say them it feels like I have yellow green pus dripping out my mouth instead of words. Eeeugh! I think the words affect me in this way because I've actually seen these things up close. ( And no, my darling hubby, while diagnosing patients, not myself I assure you!)

The awesome awesome thing is though...that they can all be prevented by that simple invention - the condom!

Apparently condom use is being taught in schools as part of sex education or life skills or guidance class or whatever it's being called nowadays.

Apparently, it's even being taught in preschool. Yes, preschool.

How do I know this? Because during the clinic, one of my hypertensive diabetic patients brought her 4 year old grandchild into the consulting room with her.
This child, petrified that I might bring out a long needle to inject into its bum, sat very still and did not say a word. That is, until the end of the consultation, when he walked past a box full of government issue prophylactics, turned around beaming, and gleefully shouted, "Condoms! Yay!"

Granny was very proud as she marched him out of the room.

What?!?!?! Is this normal? For a four year old to know what a condom is? Should I be happy that our kids are so well educated about sex or should I be sad that they have a very small chance at innocence before reality blows that out the water.

I don't know, I'm very confused right now. To take my mind off it I googled the different names for condoms and this is what I found, it's too hilarious:

Bob - (why Bob?)

Cock Sock (apt)

Condominium (hee hee)

Condomus Maximus ( oh yeah sure buddy, it's the biggest we've EVER seen)

Dick-Sock

Dinger

Dobber

Franger

French Letter ( so elegant)

Gentleman's Jerkin

The Goalie ( ha ha! I love this one, can you see the goalie frantically trying to prevent millions of soccer ball sized spermatazoa from entering the cervix? I love it.)

Hats

Hazmat Suit

Jimmie Hatz

Jimmy

Johnnies

Johnny Bag

Love Glove

Love Sock

Mr. Prevention

Nodding Sock

Poshie

Prophylactic

Raincoat

Robber

Robber Johnnies

Rubber

Rubber Magic

Rubber Straitjacket

Rubber

Salami Sling

Sex Shark Warmer ( what?)

Sheaths

Snake Charmer

The Tour Guide

Willie Hat

Willie Warmer

"English Riding Coat."

Denmark - Gummimand "Rubberman,"

Hungary - Ovsver "Safety Tool,"

Hong Kong - Pei Dang Vi "Bulletproof Vest,"

Portugal - Camisa De Venus "Venus Shirt,"

Nigeria - Okpuamu "Penis Hat,"

Indonesia - Koteca "Penis Gourd,"

Spain - globo "Balloon."

courtesy of: http://inventorspot.com/condom_many_other_names

Hardcore Chicks

2009-04-26T15:32:00.002+02:00

Goodness Gracious Golly Gosh!

Has it really been ten days since my last post?

My humble apologies.

I'm back, this time with an embarrassing story about me.

I like to think of myself as a pretty independant chick. My parents like to remind us of the blood sweat and tears they lost while raising us to be in charge of our own destinies , to rely on ourselves and to be educated enough to be financially independant. They also raised us to take no shit from any man, ( to my dad's dismay, he forgot that that included himself).

So there I was, living that dream they had for me, when I was on call in the trauma unit last Thursday.

It was rough, I had the usual severe and life-threatening asthma attacks, fitting children, heart attacks etc. I also had the interesting case of two brothers who stabbed each other in the chest after drinking too much. The one had a particularly vicious stab that resulted in me having to cut through his chest wall and insert a drain into the space around his lungs to drain off the 300ml of blood that was impairing his breathing.

I was exhausted and bloodstained by morning, yet I was starting to think that maybe I could start calling myself hardcore.
Hardcore and cool like the doctors on TV (see earlier blog posts).
Awesome and strong like WonderWoman who can kick the ass of any man she meets.

Except that I wasn't because as I got to my car I saw that my tyre was flat and was mortified when I realised that I DID NOT KNOW HOW TO CHANGE IT!

How could I not know how to do something as simple as change a tyre? Why was this not part of my practical skills training? I was flabbergasted that I knew how to drain blood off a dying man's chest but couldn't even change a tyre!?

So I did what we women do in these situations,
I reverted back to my silly feminine self and fluttered my eyelids helplessly while attracting the help of the closest manly man to help me.

Turned out Dr R was my unsuspecting victim. Luckily for me as in my smelly, post-call state I doubt I could have elicited the help of a man other than a friend. He said not a word, and changed my tyre in about ten minutes. Sweet guy, Dr R.

I went home and demanded that my husband teach me how to change a tyre like a real man. My goal is now to be able to do it in five minutes with a blindfold and one hand tied behind my back.

Then I'll be on my way to being tough.
I just have to learn to to fly a helicopter, change a plug and kill a spider without screaming.
Then I can really earn the title of Hardcore Chick.

Miracles happen TWICE at Easter

2009-04-15T16:23:00.002+02:00

All I have to say is, that there was no leftover Easter carnage.

I had a fantastic peaceful day in the "trauma unit" with only the usual MI's, asthma attacks etc to deal with.

So what does this mean?

Did god decide to show up this weekend?

I'm not convinced.

I reckon that most likely it has to do with the recession and people not having enough money for alcohol.

Then again, I'm pretty cynical.

Miracles do happen at Easter!

2009-04-13T18:48:00.005+02:00

A miracle happened this Easter.

Unfortunately nobody rose from the dead.

(Did that offend some of you? Its just that I am still trying to teach patients to do that but they just don't want to learn. So far I've been unsuccessful at waking them once they've passed on...Sister C says it's because only Jesus is allowed to do that. I told Sister C that if that's so then Jesus is selfish. She was too mortified to respond and ignored me for the rest of my last trauma shift.)

No, the miracle was that for the first time in 5 years I have not been on call over the Easter weekend. FIVE BLOODY YEARS!

This meant that starting from Thursday afternoon I had exactly four whole days free. FOR FREE! I didn't even have to ask for special leave.

So the hubby and I packed our bags and drove like two tortured bats out of hell down the N1 to the peaceful town of McGregor. A sleepy charming village in the Breede River Valley, where the green and white houses are neatly arranged and the gardens are full of blooming bouganvilla and luscious iceberg rose bushes. There is one main road, two cafe's and a dam. There is no hospital or clinic. There isn't even a pharmacy. What bliss!

We stayed in a luxury self-catering cottage. And that's all we did. We stayed there. We never left it. It was even better than our honeymoon in Vietnam because we didn't feel compelled to sight-see. In fact, we could sight-see the whole of McGregor while sitting on the front porch in our underwear chewing braaivleis.

For four days I experienced what the rest of South Africa looks forward to every April. And there are people out there who get to do this EVERY year? Lucky bastards.
There are also those people who get to do this every year, who go completely overboard.

These people celebrate by getting drunk, doing drugs, raping, shooting and stabbing. They usually come and tell us about it in the trauma unit.
This is a holy weekend after all, someone's gotta give us something to pray for right!?

I'm back in Cape Town now and I'm getting that nervous pre-work feeling.

My lovely facility manager has put me in trauma tomorrow from 7am to 5pm.
It will be the first day after the Easter weekend carnage.
I'm trying hard not to think about it.
I'm going to go to work with positivity and enthusiasm.
I'm going to defend myself from the work stress it took four days of doing nothing to get rid of.
I hope it lasts the whole day.
It probably won't and tomorrow evening you'll most likely read about how to have the joy sucked out of you by the government health system.

Sweet dreams!

Mind your language (1)

2009-04-06T19:49:00.004+02:00

I just thought I'd share this with you.

I consulted a diabetic patient today who had a septic wound on his toe. I couldn't see it under the masses of bandage so I asked him to describe it before I released that purulent festering wound from its swathy prison.

He began thus: "Well doctor, you know I has a pasta in my foot."

This man did not look like an Italian.

Pasta foot? What the hell?

Hmmm...I suppose that would be graded in terms of severity by its al dente'ness?

What would I find when I opened this wound?

Linguine? Hopefully that's all it is as that's the mildest most non-fatal form of pasta foot.

Fettucine? Severe, but still treatable with garlic and sundried tomatoes.

Panzerotti!? Oh god no, please let it not be panzerotti! There's no coming back from panzerotti!

"No man Doctor, a pasta, like when it is having an infection."

Then I got it. He meant like pus. A pus-like infection. A yummy pus-filled pasta sauce.

I forgave this man his mishap because English is his 4th language.

They always did compare certain pathologies to food at medschool:

TB necrosis - cottage cheese

Meckel's diverticulum - red currant jelly

Bleeding gastric ulcer - coffee grounds

Bon appetit!

coMEDIC. (get it?)

2009-04-05T20:23:00.004+02:00

In the last hour of our shift yesterday I tried to make things FUN! for the poor peoples and their childrens who had been waiting so long to see me.Fun fun fun! I must have been delirious after twelve hours of non-stop work.

There were a few X-ray waiting to be reviewed that belonged to patients with possible fractures.

I picked up the first folder and was about to put the X-ray film up on the lightbox...X-ray FILM...!!! Suddenly I had a bright idea

I went out to the waiting room and called for the owner of the X-ray.

"Would Mrs XYZ please be so kind as to join me at the premiere of her right leg's debut show?"

Mrs XYZ looked at me like I was on crack, but said nothing, as I wheeled her into our unit.

I positioned her nicely in front of the lightbox and began the show.

"As you can see madam, I have procured fantastic front row seats for you to this spectacular moment in your right leg's history. The title of this show, 'Does Mrs XYZ have a broken tibia?' "

I hummed the theme tune to 20th Century Fox as I placed the radiograph on the lightbox.

Her tibia was completely intact.

"Oh dear Mrs XYZ, " I said, ( her face fell, expecting bad news)

"Unfortunately this is a very boring movie as your bone is not actually broken! Hoorah!"

Mrs XYZ didn't get it and was looking around the unit nervously for someone normal to explain to her whether her bone was broken or not.

I thought I was being awesome. The patient thought I needed admission to the psych ward. Oh well. Seems I failed at bringing joy and laughter into the unit. Turns out it wasn't that hilarious. Clearly I need to work on my material.

:)

Dr R gone bad.

2009-04-05T14:52:00.008+02:00

Let me tell you about my community service colleague, Dr R.

Dr R and I have been working together for three years. We did our two years of internship together at the same hospital and are now both based on the cape flats at this community health centre.

We have been nicknamed the "A-team" by the trauma staff purely because we are both always working in trauma on days when things get particularly crazy.

Dr R is possibly one of the nicest doctors I know. Soft-spoken and gentle. Non-confrontational. The opposite of me.
He wants to be a psychiatrist once our compulsory government service is finished, so you can imagine the amount of patience he has.

However, I have noticed that after only three months in this place he is beginning to develop a bit of a nasty, frustrated edge...

It's happened to all of us, it's unavoidable. We are working in shocking conditions, it's dangerous, it's unhealthy. We live with the threat of developing tuberculosis as we are on the front lines diagnosing it on a daily basis. Some of our colleagues have had to have lobectomies after contracting the disease. The patients are poor and uneducated. This particular community can be incredibly violent and rude in the trauma unit. We are constanty working under the pressure of a jam packed waiting room full of patients. We have ancient equipment. We are dealing with unimaginable tragedy every day. No matter how hard we try we can't help everyone but despite that we are constantly having to field complaints that we are not working hard enough. We see about 100 patients a day in the trauma unit.

It takes its toll, we have to develop souls of steel and try as we might to remain empathetic, sometimes we snap. It doesn't happen often. But it does happen. It even happened to someone as sweet as Dr R.

Dr R was consulting with a recent geriatric stroke victim. The stroke left him paralysed on one side. However, he was in our unit for the problem of a two month cough that was productive of blood-stained sputum. (the TB bell clangs loudly when these symptoms are expressed.) The man was coughing violently in Dr R's face and made no effort to turn his head away.

"Please sir, could you put your hand in front of your mouth when you cough." Dr R asked politely.

The man responded with another sputum-spraying coughing attack. He did not use his hand to prevent infecting everyone with the disease, as so nicely asked by Dr R.

Dr R wiped some goo off his face and then lost his temper.

"I TOLD YOU TO PUT YOUR HAND IN FRONT OF YOUR MOUTH! YES, YOU HAD A STROKE, BUT SO WHAT?"

He picks up the paralysed hand and lets it drop limply,

"This hand may not work but your are NOT paralysed on the other side! your other hand is still functioning so PUT YOUR FUNCTIONING HAND IN FRONT OF YOUR MOUTH WHEN YOU COUGH!!"

Oh dear, Dr R. I see not even you are immune to the personality changing effects of this place.

Three more months to go...Good God, what kind of people will we be like then?

.

Nought to chaos in 15 minutes.

2009-04-05T13:49:00.004+02:00

In the space of fifteen minutes, and with a waiting room already jam-packed with patients waiting to be seen by myself and my colleague, these patients rocked up at the trauma unit yesterday. Some brought by the ambulance, some from the street. All pretty serious.

1: A man who had been stabbed in the neck "for no reason" by his brother.

2: An unconscious man found in the road by the police with a large bleeding wound from his head.

3: A lady who was sad that she had had a miscarriage so tried to kill herself by dousing her house and herself in paraffin. she survived but had 50 percent burns to the front part of her body including her face.

4: Another man stabbed in the neck and pouring blood from the wound.

5: A lady having a ?heart attack/?asthma attack/? pulmonary oedema

6: An unresponsive fifteen year old boy found in the bath by his mom and brother.

Six emergencies in 15 minutes, 2 young doctors with only three years experience each, and four nursing sisters. Does this make mathematical sense to you? And this is supposed to be an urban setting. I'm not even based in the middle of the Eastern Cape, or somewhere South of the Mozambiquan border.

The worst of them all was the 15 year old boy. He was carried in by his mom and brother after they found him sitting in the bath, completely unresponsive. They placed him on the bed and we assessed the situation. He was small for his age. He had no known medical history. Was not abusing drugs. No pills found lying around the the bathroom indicating an overdose.

He had no pulse and no respiration. His pupils were fixed and dilated. He had a flat line on the heart monitor. He had cold peripheries. In short, he was a DOA. (dead on arrival).

I had to go and tell the family who was waiting outside. There's no easy way to do this. One just has to say it. This was not the first time I've had to tell someone that they've lost their son, but the mother's screams always rip right through me and I have to try really hard not to burst out crying as well.

I'm 27 for God's sake! How the hell did I end up here dealing with all of this tragedy? This was not part of the plan. The plan involved me being fabulous, being famous and having people remove the green M & M's from my constant supply of sweeties.

African Acupuncture

2009-04-05T12:31:00.002+02:00

She was standing at the door of the trauma unit.

Just standing there.

A 20 year old Xhosa girl she was, beautiful, except for the damage done to her face.

I'd never seen anything like it before. Her face and neck were covered with hundreds of tiny superficial scratches. The scratches were all perfectly evenly spaced and only ran vertically. They were about 5mm in length and looked very fresh as some of them were oozing blood slightly.

What on Earth was this? This was certainly not in the dermatology handbook of skin diseases.

"My dear," I asked "what happened to you?"

She just stared at me blankly and then said that she didn't know.

"What do you mean you don't know? Did somebody hurt you?" Negative response.

"Did you do this to yourself?" Exasperated negative response.

"I told you doctor I don't know! I went to sleep and when I woke up this was on my face! I was asleep for a long time, nobody was in my house and I didn't feel anything.It was just there"

I could sense a distinct change in the trauma unit atmopshere after that statement. Creepy...sinister...fear of the unknown...what the hell was going on here?

Then a Xhosa nursing student clears my confusion.

"It is the evil force, doctor. We must not make play with these matters. She is a cursed. You must help her with her spirit."

Oh for God's sake, I was most certainly NOT equipped to provide spiritual counsel to this woman. And besides that, I didn't believe any of it. Evil spiritual forces, my ass! One thing was certain, a most non-spiritual REAL human being was behind this facial vandalism.

At this point, the Sister in charge got fed up and fired off a terrifying tirade in Xhosa. You didn't need to understand it to realise that she was asking the girl to cut the crap and tell the truth.

Turns out, the patient had been suffering from headaches and had gone to a sangoma (traditional healer) for help. He put her to sleep with a magic muti and then while she was out, decorated her face with these pretty scratches.

Problem was though, that she still had the headache. I felt sorry for her and was about to examine her properly, but the Xhosa sister in charge refused, gave the girl a box of panados and chased her home with a warning that if she came back telling lies again we would not see her.

Homeopathy, naturopathy, aromatherapy. They're all very popular alternate healing therapies nowadays, particularly amongst the middle to upper class variety of our nation.

Somehow though, I don't think we'll see the superwealthy 4X4 driving excessive brunching mommies booking sessions with the sangoma before fetching Darling Girl from private school for this form of African Acupuncture.

SNVL (1)

2009-04-02T19:43:00.003+02:00

Now, not much shocks me anymore. However, every so often one of my patients manages to elevate themselves to stellar plateaus of indecency.

So this is episode one of SNVL. If you are a sensitive reader...abort this blog post immediately.

The police brought this particular gentleman into the unit one morning. He was a known Schizophrenic who had defaulted on his meds. Did I mention that he was also self-medicating with TIK ( crystal meth) and was completely cooked when he came in.

He was impossible to interview as he was psychotic and screaming at the top of his lungs. Not an unusual occurrence, however, the content of his speech was something like aural rape.

What he said was in Afrikaans slang, so the shock factor is slightly depleted upon English translation. I'm going to enlighten you anyway...this is what he was saying...don't say I didn't warn you...

"Ek naai net die wit vrouens! Ek naai net die wit vrouens"

I only fuck white women. I only fuck white women.

"Ek naai hulle in hulle bekke in"

I fuck them in their mouths

"Dan lag ek as hulle will opgooi"

Then I laugh when they want to throw up

"ek likes it as my saad agter in hulle bekke slat"

I love it when my seed hits the backs of their throats.

"dan trek ek my piel uit en ek mors op hulle gevriete."

Then I pull out my dick and mess on their faces.

At this point, the policeman decided that he'd heard enough and apologised to me for the patient's behaviour. I watched him take that guy outside the unit. I'm not sure I want to know what happened after that, but when he returned the patient was no longer an aural irritation and behaved quite decently. For five minutes. Then it started again....

"ek naai net die wit vrouens..."

This is no Teddy Bear's Picnic

2009-03-30T21:07:00.008+02:00

My apologies for the severe lack of posts. I'm sure this one will do two things: that is, make up for it, and explain the blog silence:

Please sing this in the style of the Teddy Bear's Picnic song:

If you start work in the trauma unit,
You're in for a big suprise,
If you start work in the trauma unit,
You'd better be in a doctor's disguise!

For every doctor that ever there was,
Is frightened of that moment that comes,
When you have to do something that you've never done befo-oore!

Last Friday...oh no no no...wait! Let me first set the scene...

It was a gloomy grey Friday afternoon, and a lonely young lady doctor was the only medical service available to a very large, poor, sick community...

This was the first time ever since I qualified three years ago that I have been the only doctor at an institution. Everybody pisses off early on a Friday and the poor schmuck left in trauma has to be the heroine/villain until 5pm when the night staff arrive.

The trauma unit was pretty busy, and in the midst of the mad mayhem, the undertaker arrived with the request that I certify a patient that had died at home.

On my way out to the undertaker's death van, I am immediately accosted by a frantic nurse from the Midwife Obstetrics Unit. (MOU)

The MOU is a unit providing basic obstetric care for mums who have uncomplicated pregnancies. They have their antenatal care visits there and give birth there. There are no doctor's involved, it is run entirely by midwives. Although the MOU is on the premises, I avoid it at all costs as screaming mothers in labour, amniotic fluid, placentas and the like are really not my cup of tea.

I see the nurse gesticulating wildly and hear those dreaded words: "Come now! Emergency!". She disappears back into the unit.

My brain goes into paroxysmal neuronal short circuitry as it computes that, oh shit, I'm probably going to have to deal with one of two things. A dying mom, or dying baby.

Please let it be the mom,please let it be mom, please be mom, please be mom...the last time I dealt with dying babies was two years ago...

Nobody hears my plea.

As I burst through the MOU swing-doors, I'm confronted with a just-delivered, 5 minute old neonate. The baby is blue, gasping for air and barely moving.

The Mother looks at me with desperation in her eyes.

The Midwives visibly relax as I arrive, "safe" in the knowledge that "the doctor" is here and therefore everything will be ok.

The Doctor ( that's me) is silently freaking out as I have NEVER resuscitated a neonate before in my life. Oh in theory yes, I've been taught how, but have never actually had to do it.

"Today's the day sweety" , the evil bitch spinning my fated threads cackles, "let's see how you handle this!"

I. Am. it. there's no-one else to call. Weeks of pregnancy,a long difficult delivery and the parent's dream of a family are all riding on my next move.

I ask for the laryngoscope and intubation tube to pass through the baby's throat into it's trachea to help it breath. The nurse hands me the miniscule instruments and I try...

It's difficult, I'm working in a tiny space about 6 cm in diameter and the vocal chords are hard to see. Three, four five times I tried and eventually I got the tube in. At that moment the baby started making more of a respiratory effort and so naturally expelled the tube I'd tried so hard to insert. Dammit!

Should I try again? I check the baby's oxygen saturation and it is miraculously rising up from 50% to 70%.
Baby is no longer blue and is turning a nice shade of healthy pink. What is happening here? Did merely fiddling with the kid's breathing apparatus by trying to intubate stimulate it's respiratory drive? Shit I don't know.

I decided to apply nasal prong oxygen instead of trying to intubate again. O2 Sats picked up to 93%. By this time baby was pink, crying and although breathing quite laboured, was making better respiratory efforts.

Everyone looked at me like I was a genius. I felt like the village idiot. I wasn't exactly sure what I had done to improve this kid's situation, but whatever it was it worked.

Baby was stable so we called the ambulance and referred the child on to a specialised neonatal unit for further care.

I had been away from the trauma unit for an hour stabilising that baby. I wearily made my way back, but was hardly in the door when the patients start accosting me.

"Doctor! I've been waiting to see you since this morning!"
"Where were you, were you taking lunch while we were just sitting here being sick?"
"I'm so sick of this damn hospital, the service is terrible."

I take a deep, deep, deep breath, and look at the clock. Fifteen minutes left of my shift. I am hoping to collapse into my chair, but there is a lady patient sitting in it.

I look at Sister Em with confusion. She just shrugs her shoulders and says the lady is refusing to move. I ask her how I can help her. She says that she has been waiting for 11 hours to be seen.

I look at her folder and according to the triage notes she has a very minor condition that will not get seen before all the serious ones, which is why she was still waiting. I explain this to her, but she just looks at me and bursts into tears.

I exhale that deep deep breath and decide to break all the rules. Someone has to give this chick a break. I quickly diagnose her with the flu. I give her the box of panados from our limited stock that we'd go and buy at the chemist, but that she'd been waiting all day to get.

By now it's Five pm, but I'm too tired to be excited. I just pack my bags and get the fuck out of there.

Driving out I see that lady waiting in the rain... soaked, exhausted, and disappointed by our "health system". She is fumbling in her bag for a few coins and is making a forlorn phonecall.To whom, I don't know....maybe somebody who cares about her. Despite the almost dead babies, and general trauma, somehow this scene is the most tragic thing I've ever witnessed.

I can't be brave anymore. The enormity of this community's plight is suddenly and inexplicably triggered. The floodgates of despair open and I sob like a bereaved widow all the way home.

humans versus computers

2009-03-24T19:57:00.003+02:00

Once when I was a medstudent, I worked at an overwhelmingly busy trauma unit. Of the ten patients I admitted there one night, 8 of them didn't make it to the next morning.

I was slightly depressed by this. So gave the husband ( who was then just the boyfriend)a call for some sympathy.

"Eight of my patients died last night" I moaned.

"That's so very sad," he said, "I know how you feel,my computer died today."

Um...ja...it's not quite the same, baby. Last time I checked one can't exactly reboot a human.

Argh!

2009-03-24T18:47:00.005+02:00

There was nothing wrong with today. A pretty average day in the trauma unit. I mean, to be honest, all things considered, it was a pretty damn GOOD day. These are today's reasons to be grateful in trauma:

1: Nobody died.

2: We had clean linen on the examination beds.

3: There was...wait for it...pink liquid soap IN the soap dispenser!

4: AND you'll never believe it, actual paper towel for me to dry my hands with!

I am not making this shit up! It really happened.

And yet, I am as cranky as my tik-addicted patients on a Sunday morning come down.

Why?

I have no patience with the patients today.

They are all irritating me endlessly. Why ? Why? Why!!!!!

Why are you calling me "sister"? I'm the fucking doctor. Perhaps you didn't notice my white coat, stethoscope and badge that says DOCTOR. Yes, I have tits and a vagina. These types of people can also be doctors.

Why do you insist on calling me "sweetheart" and touching me inappropriately you toothless-possibly-impotent-lecherous old fart? Do I look like your girlfriend? OR do I look like a professional with 8 years of medicine behind her. I will stab you in the eye with my pen and then shove the biggest catheter I can find up your urethra and then you'll know not to flirt with a pissed off lady DOCTOR.

Why do I have to explain things five times and in three languages before you understand that you take TWO panados FOUR times a day and not FOUR panados TWO times a day.

Why is everyone on tik?

Why are you speaking to me WHILE I am busy examining a patient. Do NOT interrupt my consultation!

Why do you, Mr Diabetic, suffer for four weeks with a festering pus filled sore before you come to see me? Now I have to be the bad guy and tell you we might need to amputate.

Why are you asking me for sick notes when it says on your folder that you are unemployed? NO! I am not putting you off for three weeks just because you have an STD. STOP fucking around without condoms.

Why didn't you notice that your child had gastro so that I don't have to bring your kid back from the brink of a dehydrated death, AGAIN.

Why, you stupid woman, didn't you know that you were pregnant. Are you mentally deficient? Sex+no contraception+no period = BABY. Get it?

Why hasn't the damn doctor that has seen you every 6 months for the last ten years noticed that you have HEART FAILURE. His fuck up is now my problem. I HATE you you idiot doctor. When I find you, I will stab you in the throat for your sins.

Why is your husband beating you with an iron rod? Your arm is broken. Oh, I see that you've been here before with a broken pelvis...same story. LEAVE HIM - don't you see you're worth more than this shit.

Stop looking at me with such trusting hope in your eyes. I'm not God. I'm not an angel. I'm not a magician. I'm just a human. Please don't hate me for just being a human.

Stop complaining that you've been waiting for four hours to see me. It's not like I've been sitting on my ass playing with my navel while you were outside. Chronic back ache is not as urgent as meningitis. Take it up with our government.

And by the way FUCK YOU government. What are you doing to help these people. to me it looks like NOTHING. You promised to build a brand new state of the art facility with greater capacity for care. You published it in the papers. You gave us hope. We're still waiting...assholes.

Like I said...I'm very irritated today.

Sister B wants to know if she can test my urine. She's convinced my irritability stems from the fact that I'm probably pregnant.

ARGH!

.

Can I get a lift, anyone?

2009-03-22T07:47:00.006+02:00

Mr B's story:

I've mentioned before just how popular Sunday nights are in the trauma unit. Last Sunday was no different. I've often tried to understand why this is so? I've come up with these two answers:

1: By Sunday, the alcohol/drugs that were being consumed/injected/snorted since Friday have now worn off...and people are sober enough to realise that they are bleeding/limping/stabbed in the head.

2: Motivated by the awesomeness of the weekend, they are eager to extend it by just one more day, so invent random symptoms in order to get a sick note.

Mr B, however, was not one these patient's. He had just finished his late shift at Woolworths and was on his way home when he was assaulted and stabbed in the thigh.

He was stabbed in his right lateral buttock inferiorly and five cm laterally to the anterior superior iliac spine.

That is, nowhere near his abdomen.

However, despite the wound being less than 1cm in length and with no history of abdominal assualt, Mr B was groaning heavily about pain in his tummy.

We have no Xray facilities and no ultrasound in this trauma unit. We have our wits, basic equipment and our two hands. We noticed that Mr B's blood pressure was quite low, his heart rate was pretty fast, his abdomen was tender and that it was very slowly distending.

We quickly made a diagnosis of internal bleeding, put up two large bore IV lines to run in some fluid and called an urgent ambulance to take him to a secondary hospital. Ambulance control said they would send someone right away.

Mr B's vitals were currently stable so we kept a close eye on him while we waited for the ambulance and continued seeing other patients.

Two hours and numerous calls to the ambulance control room later, Mr B was still waiting, and his blood pressure was dropping. By this time, We were ready to load him into our own cars and drive him the fifteen minutes to the secondary care centre ourselves.

The damn ambulances kept on BRINGING us cases - nonsense non-emergency cases - but refused to TAKE our patients who needed to be transferred. When questioned, all we got was, "Sorry, take it up with Ambulance control, they decide where and what we do."
And then they'd leave, Mr B still waiting, his abdomen slowly getting bigger and bigger.

My colleague stepped outside for his first break in seven hours since starting work. At that moment, tired of trying to hold out until someone who cared came to fetch him...Mr B arrested. His heart stopped beating and he stopped breathing. We started the resuscitation mere seconds after his last breath...

Come on Mr B, you're 24 years old, you still have a long life ahead of you!

Endotracheal tube inserted, chest compressions begun

Don't give up now...I'm sure the ambulance is just around the corner!

IV adrenaline, IV atropine injected, continue manual ventilation and compressions.

Half an hours worth of CPR later there was still a flat line on the monitor and Mr B was showing signs of brainstem death.

We stopped resuscitating and cursed the ambulances to hell.

Mr B. died waiting for a lift. 24 years old, employed, only breadwinner.

We called his mother and asked her to come in urgently. We never give bad news over the phone. What was she thinking on the way to the hospital? Was she paralysed with the possibility of tragedy? Did her mind attack the fear with the weapon of hope?

The rest of that call was spent listening to her screams.

Cerebral Palsy is Dangerous

2009-03-19T19:56:00.002+02:00

Today,in the trauma unit, I got kicked in the groin by a child with cerebral palsy.

It was F@#$ing painful.

Not the child's fault, she had cerebral palsy, but really, it was f@#$ing painful.

The hubby wants to have sex. I tell him I can't because I got kicked in the groin by a brain damaged child.

He sighs, says I'm a very creative liar and that if I'm tired I should just say so and not make up stories.

Willie Wonkies: episode 1

2009-03-19T18:35:00.006+02:00

Penis. dick. willy. winkie. piel. tollie. stywe stokkie.

I've seen all of them. I've probably seen more tollies than the sluttiest nymphonmaniac prostitute.

I usually, very politely, and professionally REQUEST to examine the male jiggly bits at an APPROPRIATE time during the consultation, after an APPROPRIATE penile symptom has been experienced by my patient.

I am NOT usually introduced to the penis BEFORE I say hello to the owner of said penis.

A few weeks ago, at the end of a long day, an elderly Xhosa gentleman shuffled excitedly into my consulting room. Before I could finish my standard introduction "Hello, I'll be your saviour today, how can I heal you?", the gentleman had unbuckled his belt and dropped his pants with a flourish. He was then standing proudly in front of me, arms outstretched and beaming. Beaming, in a way that could only be interpreted as a facial manifestation of "Behold! This is my glorious penis!"

I was slightly confused. There was nothing particularly spectacular about this penis. It just looked like a regular old man's penis, shrivelly and flanked on either side by a very saggy wrinkled scrotum.

"Please sir," I plead, " pull up your trousers and let's talk for a while first."
( after all, I like a little chat before I go near anyone's genitals...it's only polite)

"Noooooooo Doctah!" he beams enthusiastically. "You see, I likeh the young gahls!"

English being probably his third language, his pronunciation was sightly off. I do enjoy that Xhosa accent. I couldn't do so at this consultation though, as I was distracted by this naked 60 year old Xhosa man, who was by that time excitedly slapping his penis from side to side and beckoning me to watch.

"He likes young girls?" I thought. I look like a young girl, is this some sick perverted way that old gentlemen get their rocks off? Pretending to be a patient with a penis problem so that a young lady doctor can touch their dicks?

I was too shocked to engage my three years of karate training. The man continued abusing his genitals, while I stared at him, mouth agape.

"I likeh the yung gahls Doctah! I likeh make sex with tha yung gahls. But my pinass, it does nahthing!"

"Look! You see? Look! You see?"

more enthusiastic penis slapping

" nothing is happeneeng!?"

" Why doctah? I am luckee. The yung gahls, they don't like yung man. Yung man is not good. Yung man have AIDS. They likeh old man likeh me. I say to them 'Come, come to my flat. I got a flat. I got a cah.' Then I want make sex with them but my pinass it does vokol nathing!"

That's when I understood. He has impotence. And it is severely impeding his sex life.
Now how can one be offended by a naked penis-slapping 60 year old Xhosa man after a story like that? I thought it was quite an ingenious way for him, a third language English speaker, to really drive the point home that I needed to fix his penis.

People have unbelievable faith in us medics. He had diabetes, hypertension, high cholesterol, was obese and was a smoker. If anyone was on a highway to impotence, it was this guy.

I felt sorry for him. In my broken Xhosa I explained to him that his diseases made his penis this way. The only thing I could do was refer him to the erectile dysfunction clinic where they would do embarrassing tests on his winkie and probably tell him that the way forward was a penile prosthesis as he would never get it up again.

Any men out there reading this? If the threat of a heart attack, stroke, kidney disease or blindness is not enough to motivate you off your ass to go to gym, eat properly and quit smoking, remember Xhosa man and remember impotence. Because I know you, young man. Soon you will be an old man, and then you will definitely be liking the "yung gahls". They, however, will not be liking you if you are :

15. 180 degrees shy of heaven

14. Performing with Flaccido Domingo

13. A few parts shy of an erector set

12. Sch-wing and a miss

11. Not rising to the level of impeachable offense

10. The Null Monty

9. Disappointing Miss Daisy

8. Taking the gold at the Lake Flaccid Olympics

7. Ascension Deficit Disorder

6. Bouncing the Check of Love

5. Less-than-Magic Johnson

4. All Doled up with nowhere to go

3. Welcome to Flaccid City. Population: You

2. Serving boneless pork

1. Unleavened Man-Bread

( from www.lotsofjokes.com)