Ode to a Torturer....

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...

Macho man versus the Needle.

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!

The write way to kill your friend

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...

Last night-call last night.

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.