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?
Showing posts with label death. Show all posts
Showing posts with label death. Show all posts
Wednesday, January 6, 2010
Monday, November 9, 2009
Saving lives???
16 years old.
Intubated and ventilated by the doctors on the previous shift.
No beds available in the High Care Unit at the back of the hospital, so he was under our care in the front room for the night.
Not that there was much more we could do for him.
TB meningitis. Severe. Untreated. Currently brain dead.
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.
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.
Wednesday, October 28, 2009
THE C-WORD
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.
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.
Sunday, July 26, 2009
TLC
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
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
Friday, June 19, 2009
Little Pink Shoes
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
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
Sunday, May 31, 2009
Ghost Stories
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!
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