Avoid bad poetry like the plague

So much stigma now

This virus isolates me

Still, I crave cuddles

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

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

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

Anyway, being a patient sucks.

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

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

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

Ray of hope, literally

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

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

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

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

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

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

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

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

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

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

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

Touching, but also tragic.

A literal  final ray of hope.

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

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

Chocolate septic balls ( to paraphrase the cook in Southpark)

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

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

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

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

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

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

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

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

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

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

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

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

He replied, "Wisdom is humility".

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

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

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

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

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

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

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

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

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

Swoon.

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

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

Hmmm.

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

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

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

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

 - Roald Dahl, The BFG

Adversity Ninjas

Friday, +/- 10:00am

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

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

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

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

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

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

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

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

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

But exquisitely beautiful 16 year old was already very sensible.

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

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


This is not a movie script, people.

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

So, ja.

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


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

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

I am in awe.

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

I have more faith in the scalpel.

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

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

"No!" I cried. 

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

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

T.I.A.

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

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

Disarming your doctor

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

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

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

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

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

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

"Oh yes please!"I cried.

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

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

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

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

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

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


Dammit, it's good to be back.

XXX

Hiatus

Dear Readers,

I am taking a hiatus from Mad Medicine.

I have instituted an employment ban on myself.

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

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

So for the next few weeks I have chosen unemployment.

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

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

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

Thanks for all the encouragment, criticism, and hilarity.

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

"I'll be back."

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

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

Sometimes one gets lucky.


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


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


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


The nurses here are few and far between.


But there are very, many, potatoes.


Everywhere I look:


One Potato,


Two Potato,


Three Potato,


Four.


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

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

The Secret Organ

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

An organ, shrouded in mystery and secrecy.

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

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

*I get carried away sometimes, forgive me*

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

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

All hail the Vagina!

Say it with me: VAGINA.

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

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


"Oh my!" I  hear you sigh...

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

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

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

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

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

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

And they believed that she was infertile for two reasons:

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

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

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

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

Education is an Extreme Sport

This one's for Dr "Kitty" M.


Two weeks ago I threw myself out of a plane.



Willingly.


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

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


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

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

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



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

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

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


He died by bleeding to death on the operating table.


Fuck bungee jumping off Bloukrans.


Fuck skydiving.


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

EC Syndrome

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

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

No.

Far more severe than that.

Far more frightening.

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

To diagnose it is easy.

To cure it, an impossibility.

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

Something is not happening in the Eastern Cape.

Something is not happening a lot in the Eastern Cape.

And that something is health care.

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

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

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

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

These are they...

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

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

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

You will forgive me for being so dismissive...

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

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

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

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

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

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

Booty Plundering

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

One of them is a 16 year old boy.

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

(What I like to call Englikaans.)

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

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

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

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

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

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

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

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

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

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

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

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

However his answer suprised, and touched me.

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

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

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

"How beautiful?" I asked him.

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

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

"So what happened?" I encouraged him

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

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

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

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

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

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

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

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

Listen up, ladies!

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

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

These are the type of men you should be dating!

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

*drum roll*

Why I did not become a dentist

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

I don't know anything about teeth.

I refuse to know anything about teeth.

I hate teeth.

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

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


My treatment plan included:

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

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

Survival of the drunkest.

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

For example:

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

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

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

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

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

I could understand this completely.

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

And that scene would go:

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

GP VICTORIES!

Gastro for a week?

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

Neck pain post rugby match. Cervical myalgia?

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

Normal period 4 weeks post last menses?

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

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

NO! It's actually a classic ecthyma!

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

Woop Woop!

:)

A Private Problem

I remember puberty.

(Unfortunately)

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

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

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

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

They're all just organs to us.

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

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

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

He eventually reluctanctly relented.

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

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

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

In the words of Homer Simpson, DOH!

Baby Fat

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

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

When I looked at the child I nearly fainted.

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

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

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

This kid was the size of three kids.

What in the hell were they feeding this child?

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

And she had that hungry look in her eyes.

I examined her very quickly with my left hand.

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

The right was too precious to risk.

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

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

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

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

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

Baby fat is cute.

Obese fat baby monsters are not.

Show and Tell: Crabs

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

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

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

Totally top secret.

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

Like James Bond.

Oh yes!

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

I just proved that doctors are cool like James Bond.



Uh...Oopsy...sorry!

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

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


What I mean to say is this:

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

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

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

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

"Hi crabs." I said.

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

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

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

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

Reminds me of being at pre-school.

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