How did it come to be that every time I mention I'm not feeling well, the knee-jerk reaction from friends and colleagues is that I MUST be "with child"?
Is it not a perfectly normal reaction to throw up a little bit in my mouth after I've witnessed runny mustard poo leaking down my patient's leg?
Is it not a perfectly normal physiological response to want to up-chuck the contents of my intestines after examining a most foul-smelling macerated cess-pool of pus that used to be a scrotum before Fournier's Gangrene got hold of it? (Scrot-rot - in layman's terms)
Apparently, according to the four ovary-less-hairy-testicled type of doctors I worked with yesterday morning, it is a clear indication of impending mommy-hood.
Yesterday, the day of constant nausea, I also had my blood drawn for HIV testing as I've now finished my course of ARV's. Happy to report, the test was negative.
YAY!
No more condoms necessary during sex with my long-suffering husband!
Yet, my aforementioned male colleagues were more interested in my obvious pregnancy.
Mastermind MB, of course, used my HIV testing as an opportunity to phone the lab and request a quantitative beta-HCG (formal pregnancy test) on my blood...just to make sure...soooooo funny.
But it got me thinking...
What if I WAS pregnant? I don't know anything about being a parent!
But then I rememembered...
Just take lessons from your patients Dr S!
Over the last two shifts these are the parenting lessons I've picked up:
1: When your twelve year old son gets thrown over a fence by some bigger boys, and tears open his scrotum on the barbed wire, bring him in to the hospital at night, and then leave him there all alone.
Let him open up a folder by himself.
Let him suffer the pain of having his ballsack sewn closed by himself.
Do not leave your cellphone number for the doctors to call you when he is repaired. Tell him to walk home, in the dark, through the most notorious ganglands in Cape Town, by himself.
He is a whole twelve years old after all.
(We ultimately called the police to take him home)
2:When your seventeen year old son's eighteenth birthday rolls around,just before matric final exams, do not remember it.
When he reminds you that it is his birthday, tell him you don't care.
When he asks you if he is not important to you, agree that he isn't.
When he tells you that he might as well then kill himself, encourage him to do it.
When he overdoses on 50mg of benzodiazepines in a desperate attempt for your love and is rushed in to the casualty unit by the paramedics, show him he is indeed not worthy of your love by not visiting him.
(He survived,thank heavens)
3: Drive like an asshole and hit a twelve year old child. Don't bother stopping, even though the kid has flown halfway across the street and is lying on the road motionless. Oh no, what one does in this situation is put your foot on the accelerator and drive away as fast as possible, leaving the helpless child for dead.
(The paramedics who brought him in to be intubated on his way to the children's hospital told us that in a fantastic intervention by karma - the car's licence plate had been left on scene!)
I'm writing all of these lessons in my little book of things to do when I get pregnant.
(Which I'm not. Test turned out to be negative.)
Saturday, November 7, 2009
Wednesday, November 4, 2009
PIGS AND PATIENTS
We arrived on shift at 4pm last night with twenty patients already waiting to be seen, and a constant stream of ambulances pulling up outside the trauma unit.
Yay!
Dr MB and I had still not recovered from this recent weekend of nights:
Friday, Saturday, and, Oh-my-God-shoot-me-in-the-head Sunday.
The reason Sunday night deserves adjectives is because our new Registrar, Dr KL, ALSO had a needlestick injury and unlike me was developing nasty side-effects to the ARV's. Knowing what it's like to be sick and at work, we sent the poor man home for some TLC from his wife.
HOwever, this meant that just MB and I were left to man the unit on a Sunday night, on Halloween weekend, on the end-of-the-month-I've-just-got-paid-and-will-thus-get-smashed-and-stab/shoot/beat-someone-close-to-me weekend.
40 severely injured patients later,and by the time the Monday morning ward round rolled around, we had both, understandibly lost our minds.
MB attempted to stay awake during the round by performing strange, sporadic,forward leg lunges .(Don't ask). I was so tired I did not know whether to cry or vomit, and so to prevent both, I focused on ridiculing MB enough to spur him into some sort of retaliation. This usually involves hair tugging, pinching or "reminders" about his superiority and general world dominance. Sometimes I respond with a witty comment. Sometimes my response is to stab his testicle with my pen. This is how we help each other stay awake. We literally fight to survive the long shifts.
Anyhow. That recent weekend of horror was the reason we were still exhausted when we returned to work for the Tuesday 4-midnight shift. As expected, it was insanely busy. Why wouldn't it be? And in the middle of the shift three policeman walked into the unit and informed me that they had brought a very violent and aggressive psych patient for admission. When I asked them where he was they said that they had left him in the van outside and that I should see him in the back of the van.
This already pissed me off. I weigh 52kg. I am not particularly strong or tall. These three policemen had biceps bigger than my waist. What in God's name did they expect ME to do with a very violent psych patient in the back of a police van? I demanded that they bring the patient into the unit where we could, with their help, immobilise him on a bed and thus facilitate proper sedation. They strode off sulkily, obviously not happy with being told what to do by a little lady doctor.
They returned with the violent young man in handcuffs who was complaining bitterly about being manhandled by the police, and shouting obscenities at everyone.
I took a deep breath and approached the patient. I noticed that he was bleeding from his leg.
"Oh you poor man!" I began in my sweet, soothing, comforting voice,while stroking his hand," You have been so badly hurt, how terrible. I'm sure you must be in a lot of pain, will you let me take a look at that and give you a nice injection to make it better?".
This is my sneak attack tactic when it comes to psych patients. They do not expect someone to be nice to them and are then usually caught completely off guard, and thus more amenable to cooperation. Destroy them with kindness. Being severely lacking in the brawn department, the only weapons I have at my disposal are my smooth tongue and powers of persuasion.
"Let's ask these nice policeman to uncuff you so you can lie on the stretcher comfortably, hey? What do you say?" He nodded his head obediantly. But the policeman refused.IDIOTS!!! Could they not see that I was busy working my magic here? Play the game with me you brain donors! I eventually managed to communicate non-verbally to the policemen that the cuffs need to come off so I could sedate him. Which I eventually did, with 20mg Valium and 10mg Haloperidol. The poor patient started swaying after 30 seconds at which time I informed the policemen that they needed to help me get him onto the bed properly in the next minute before he collapsed on the floor.
They jumped into action immediately by... staring at me with blank expressions. I caught the damn patient myself when he fell, and was assisted by the elderly aunty of a radiographer who happened to be walking by at that moment. The two of us struggled to pick the patient up off the floor and put him on the bed while the policemen played with each other's assholes.
Yes, I'm all for the empowerement of women, but why should that empowerment and chivalry be in competition?
Sometimes a girl just needs men to act like men.
Then again,how silly am I expecting those pigs to behave like men?
Like Bonnie Tyler said, in one of my favourite epic 80's rock songs:
"Where have all the good men gone
And where are all the gods?
Where’s the street-wise Hercules
To fight the rising odds?
Isn’t there a white knight upon a fiery steed?
Late at night I toss and I turn and I dream of what I need
I need a hero
I'm holding out for a hero 'till the end of the night
He's gotta be strong
And he's gotta be fast
And he's gotta be fresh from the fight
I need a hero
I’m holding out for a hero 'till the morning light
He’s gotta be sure
And it’s gotta be soon
And he’s gotta be larger than life
Larger than life!
Yay!
Dr MB and I had still not recovered from this recent weekend of nights:
Friday, Saturday, and, Oh-my-God-shoot-me-in-the-head Sunday.
The reason Sunday night deserves adjectives is because our new Registrar, Dr KL, ALSO had a needlestick injury and unlike me was developing nasty side-effects to the ARV's. Knowing what it's like to be sick and at work, we sent the poor man home for some TLC from his wife.
HOwever, this meant that just MB and I were left to man the unit on a Sunday night, on Halloween weekend, on the end-of-the-month-I've-just-got-paid-and-will-thus-get-smashed-and-stab/shoot/beat-someone-close-to-me weekend.
40 severely injured patients later,and by the time the Monday morning ward round rolled around, we had both, understandibly lost our minds.
MB attempted to stay awake during the round by performing strange, sporadic,forward leg lunges .(Don't ask). I was so tired I did not know whether to cry or vomit, and so to prevent both, I focused on ridiculing MB enough to spur him into some sort of retaliation. This usually involves hair tugging, pinching or "reminders" about his superiority and general world dominance. Sometimes I respond with a witty comment. Sometimes my response is to stab his testicle with my pen. This is how we help each other stay awake. We literally fight to survive the long shifts.
Anyhow. That recent weekend of horror was the reason we were still exhausted when we returned to work for the Tuesday 4-midnight shift. As expected, it was insanely busy. Why wouldn't it be? And in the middle of the shift three policeman walked into the unit and informed me that they had brought a very violent and aggressive psych patient for admission. When I asked them where he was they said that they had left him in the van outside and that I should see him in the back of the van.
This already pissed me off. I weigh 52kg. I am not particularly strong or tall. These three policemen had biceps bigger than my waist. What in God's name did they expect ME to do with a very violent psych patient in the back of a police van? I demanded that they bring the patient into the unit where we could, with their help, immobilise him on a bed and thus facilitate proper sedation. They strode off sulkily, obviously not happy with being told what to do by a little lady doctor.
They returned with the violent young man in handcuffs who was complaining bitterly about being manhandled by the police, and shouting obscenities at everyone.
I took a deep breath and approached the patient. I noticed that he was bleeding from his leg.
"Oh you poor man!" I began in my sweet, soothing, comforting voice,while stroking his hand," You have been so badly hurt, how terrible. I'm sure you must be in a lot of pain, will you let me take a look at that and give you a nice injection to make it better?".
This is my sneak attack tactic when it comes to psych patients. They do not expect someone to be nice to them and are then usually caught completely off guard, and thus more amenable to cooperation. Destroy them with kindness. Being severely lacking in the brawn department, the only weapons I have at my disposal are my smooth tongue and powers of persuasion.
"Let's ask these nice policeman to uncuff you so you can lie on the stretcher comfortably, hey? What do you say?" He nodded his head obediantly. But the policeman refused.IDIOTS!!! Could they not see that I was busy working my magic here? Play the game with me you brain donors! I eventually managed to communicate non-verbally to the policemen that the cuffs need to come off so I could sedate him. Which I eventually did, with 20mg Valium and 10mg Haloperidol. The poor patient started swaying after 30 seconds at which time I informed the policemen that they needed to help me get him onto the bed properly in the next minute before he collapsed on the floor.
They jumped into action immediately by... staring at me with blank expressions. I caught the damn patient myself when he fell, and was assisted by the elderly aunty of a radiographer who happened to be walking by at that moment. The two of us struggled to pick the patient up off the floor and put him on the bed while the policemen played with each other's assholes.
Yes, I'm all for the empowerement of women, but why should that empowerment and chivalry be in competition?
Sometimes a girl just needs men to act like men.
Then again,how silly am I expecting those pigs to behave like men?
Like Bonnie Tyler said, in one of my favourite epic 80's rock songs:
"Where have all the good men gone
And where are all the gods?
Where’s the street-wise Hercules
To fight the rising odds?
Isn’t there a white knight upon a fiery steed?
Late at night I toss and I turn and I dream of what I need
I need a hero
I'm holding out for a hero 'till the end of the night
He's gotta be strong
And he's gotta be fast
And he's gotta be fresh from the fight
I need a hero
I’m holding out for a hero 'till the morning light
He’s gotta be sure
And it’s gotta be soon
And he’s gotta be larger than life
Larger than life!
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, October 11, 2009
HIV, Will you get me? Not with the help of ARV's.
So I'm taking ARV's.
A.R.V's.
Sounds like the latest gas-guzzling 4X4 from Pajero.
Or some super-cool new street drug that with one hit can send you on a round trip through the milky way, with a stopover in Heaven and possible delays in Hell.
But, nope.
ARV's are way cooler than that.
They are anti-retroviral drugs!
They can prevent the contraction of HIV, when a doctor exposes herself to it while she is taking blood, very diligently and gently and with gloves on, from her HIV positive patient who moved during the procedure resulting in the bloody needle piercing her thumb.
No biggy.
This is only like the fourth freaking time this has happened to me.
The first time was when I was a fourth year medical student doing my paediatrics rotation. The poor paediatrics registrar was struggling to gain intravenous access on a very sick neonate with veins smaller than the cannula diameter. I was helping her hold the neonate still while she attempted the procedure for the 20th time. After failing, for the 20th time, and understandably frustrated, she threw the needle into the sharps bin. Except that it didn't make it into the yellow sharps container. Instead I watched, in slow motion, as it did a spectacular somersault through the air and embedded itself, rather painfully, in my thigh.
I was distraught, and upset and got loads of sympathy from family and friends.
I started the ARV's immediately and sweated through the ensuing 28 days, petrified of sero-converting to HIV, and ultimately testing HIV negative. Phew!
That was five years and three similar events ago.
This time I didn't even tell my colleagues until someone saw me squeezing out the blood from my wound. It was near the end of the afternoon shift and I was completely disinterested in myself and my patients. (horror)
But my concerned colleagues forced me to go and open up a hospital folder, have my blood taken and start the ARV's.
So now I'm taking them. twice a day.
These drugs are brilliant, but can result in nasty side effects such as:
Diarrhoea
Vomiting
Skin Rashes
Anaemia
Bone marrow Suppression
Pancreatitis
Depression
Hepatitis
Lactic Acidosis
YAY!
Luckily I have only suffered mild nausea and muscle pains thus far.
Oh, and I've also suffered at the hands of Dr MB's torturous pranks.
After behaving very sweetly, and drawing my blood very gently, and phoning the laboratory for my initial test results before starting the ARV's...he then stole one of my personal patient stickers from my file, and stuck it into the front room's patient log book along with this made up diagnosis for all to see:
Patient: Dr S
Working diagnosis: Retained foreign body, +/- ?sex toy??
Hilarious.
I eventually got my own back though with this entry into the logbook:
Patient: Dr MB
Working diagnosis: ?Haemaphrodite. Vaginal Bleeding, Grade IV prolapsed rectum and dysmorphic buried penis.
Overkill? Maybe.
But that's my style.
I'm ruthless with my retaliations.
I guess that's one way of making fun of a ridiculous situation.
With almost every second patient that we see being HIV positive, it's inevitable that one of us will be accidentally exposed to the virus while trying to treat patients.
It's so common that I don't think I've met one doctor who hasn't been on post-HIV-exposure prophylactic ARV's.
Which is why I keep reminding my husband that he could have married a prostitute, as both doctors and ladies of the night run the risk of contracting HIV from their professions.
A.R.V's.
Sounds like the latest gas-guzzling 4X4 from Pajero.
Or some super-cool new street drug that with one hit can send you on a round trip through the milky way, with a stopover in Heaven and possible delays in Hell.
But, nope.
ARV's are way cooler than that.
They are anti-retroviral drugs!
They can prevent the contraction of HIV, when a doctor exposes herself to it while she is taking blood, very diligently and gently and with gloves on, from her HIV positive patient who moved during the procedure resulting in the bloody needle piercing her thumb.
No biggy.
This is only like the fourth freaking time this has happened to me.
The first time was when I was a fourth year medical student doing my paediatrics rotation. The poor paediatrics registrar was struggling to gain intravenous access on a very sick neonate with veins smaller than the cannula diameter. I was helping her hold the neonate still while she attempted the procedure for the 20th time. After failing, for the 20th time, and understandably frustrated, she threw the needle into the sharps bin. Except that it didn't make it into the yellow sharps container. Instead I watched, in slow motion, as it did a spectacular somersault through the air and embedded itself, rather painfully, in my thigh.
I was distraught, and upset and got loads of sympathy from family and friends.
I started the ARV's immediately and sweated through the ensuing 28 days, petrified of sero-converting to HIV, and ultimately testing HIV negative. Phew!
That was five years and three similar events ago.
This time I didn't even tell my colleagues until someone saw me squeezing out the blood from my wound. It was near the end of the afternoon shift and I was completely disinterested in myself and my patients. (horror)
But my concerned colleagues forced me to go and open up a hospital folder, have my blood taken and start the ARV's.
So now I'm taking them. twice a day.
These drugs are brilliant, but can result in nasty side effects such as:
Diarrhoea
Vomiting
Skin Rashes
Anaemia
Bone marrow Suppression
Pancreatitis
Depression
Hepatitis
Lactic Acidosis
YAY!
Luckily I have only suffered mild nausea and muscle pains thus far.
Oh, and I've also suffered at the hands of Dr MB's torturous pranks.
After behaving very sweetly, and drawing my blood very gently, and phoning the laboratory for my initial test results before starting the ARV's...he then stole one of my personal patient stickers from my file, and stuck it into the front room's patient log book along with this made up diagnosis for all to see:
Patient: Dr S
Working diagnosis: Retained foreign body, +/- ?sex toy??
Hilarious.
I eventually got my own back though with this entry into the logbook:
Patient: Dr MB
Working diagnosis: ?Haemaphrodite. Vaginal Bleeding, Grade IV prolapsed rectum and dysmorphic buried penis.
Overkill? Maybe.
But that's my style.
I'm ruthless with my retaliations.
I guess that's one way of making fun of a ridiculous situation.
With almost every second patient that we see being HIV positive, it's inevitable that one of us will be accidentally exposed to the virus while trying to treat patients.
It's so common that I don't think I've met one doctor who hasn't been on post-HIV-exposure prophylactic ARV's.
Which is why I keep reminding my husband that he could have married a prostitute, as both doctors and ladies of the night run the risk of contracting HIV from their professions.
Tuesday, October 6, 2009
Comedy Crusaders
Friday morning handover round.
08h00.
Our team ( The A-team) is handing over the numerous patients we've spent the last night seeing, to the new team coming on for the day.
Dr MB begins one of his patient presentations. The patient is curled up under one of the government issue blue hospital blankets in the fetal position.
Dr MB: "This patient is a 28 year old lady admitted at 06h00 this morning for strange behaviour. She was brought in by her colleagues for bizarre delusions. She believes that she is a doctor and that she is at the hospital to help people get better. She is not a known psychiatric patient but currently displays signs of mania, psychomotor agitation and formal thought disorder..."
The consultant leading the round, Dr G, then decided to wake the patient, and moved over to the head of the bed. She lifted the blue blanket to reveal....
MY very own pretty little face giggling hysterically from beneath the covers.
I was so dog-tired after our long shift that while the rest of my team were busy presenting and discussing another patient, and with no further patients of my own to present, I decided to climb into one of the empty patient beds and rest my weary head. It seemed like the appropriate thing to do at the time.
Which is when Dr MB and I came up with the idea of presenting me as a patient on the ward round.
Luckily Dr G was a young, newly qualified emergency medicine consultant with a sense of humour. She laughed heartily , and then shook her finger at me for being crazy enough to risk catching patient germs in aid of a little comedy...
She doesn't understand the lengths we are prepared to go to for a laugh in this place.
Doesn't she know that every shift is a war between patients and our sanity?
Nonsensical frivolity is sometimes the only defence against impending work induced depression and despair.
Our next practical joke will involve elaborate co-operation from the nursing staff and fellow colleagues. We are planning on bandaging up my head just before the new team arrive at 08h00 for the next handover, and then shocking them with the story that I had been stabbed in the head by a psych patient and had to have my lacerated scalp sutured up and then bandaged.
I think we'll be able to pull this one off.
I am 100 percent certain that the new team will actually fall for it.
After all, similar incidents have actually happened in the past.
Voltaire said that the purpose of the doctor is to entertain the patient as the disease takes its course.
Hopefully, as a defence mechanism against depression and like some kind of comedy crusade, we'll always be able to entertain each other while our shifts run their course.
:)
08h00.
Our team ( The A-team) is handing over the numerous patients we've spent the last night seeing, to the new team coming on for the day.
Dr MB begins one of his patient presentations. The patient is curled up under one of the government issue blue hospital blankets in the fetal position.
Dr MB: "This patient is a 28 year old lady admitted at 06h00 this morning for strange behaviour. She was brought in by her colleagues for bizarre delusions. She believes that she is a doctor and that she is at the hospital to help people get better. She is not a known psychiatric patient but currently displays signs of mania, psychomotor agitation and formal thought disorder..."
The consultant leading the round, Dr G, then decided to wake the patient, and moved over to the head of the bed. She lifted the blue blanket to reveal....
MY very own pretty little face giggling hysterically from beneath the covers.
I was so dog-tired after our long shift that while the rest of my team were busy presenting and discussing another patient, and with no further patients of my own to present, I decided to climb into one of the empty patient beds and rest my weary head. It seemed like the appropriate thing to do at the time.
Which is when Dr MB and I came up with the idea of presenting me as a patient on the ward round.
Luckily Dr G was a young, newly qualified emergency medicine consultant with a sense of humour. She laughed heartily , and then shook her finger at me for being crazy enough to risk catching patient germs in aid of a little comedy...
She doesn't understand the lengths we are prepared to go to for a laugh in this place.
Doesn't she know that every shift is a war between patients and our sanity?
Nonsensical frivolity is sometimes the only defence against impending work induced depression and despair.
Our next practical joke will involve elaborate co-operation from the nursing staff and fellow colleagues. We are planning on bandaging up my head just before the new team arrive at 08h00 for the next handover, and then shocking them with the story that I had been stabbed in the head by a psych patient and had to have my lacerated scalp sutured up and then bandaged.
I think we'll be able to pull this one off.
I am 100 percent certain that the new team will actually fall for it.
After all, similar incidents have actually happened in the past.
Voltaire said that the purpose of the doctor is to entertain the patient as the disease takes its course.
Hopefully, as a defence mechanism against depression and like some kind of comedy crusade, we'll always be able to entertain each other while our shifts run their course.
:)
Friday, October 2, 2009
Friday night Folly
The following is an account of our end of the month friday night shift a few weeks ago. It's long. It has no structure. It might all seem a little pointless...
Which is pretty much a description of the evening itself:
My arrival at work is unfortunately not signalled by the large marching band, fireworks and a rip-roaring guitar solo played by a topless Greek God that I think I deserve.
Oh no...instead I am greeted with that age-old traditional greeting, peculiar to the lesser-incisor'ed native of the Cape Flats:
"Jou ma se poes!" (your mother's cunt!).
Seems that one of the psych patients has escaped from the front room, and is currently freaking out in the parking lot outside the unit, screaming obscenities at everyone. He is wearing a hospital blanket and shoes. As I walk past him into the unit, the security guards rush past me to try and capture him...but this one is a wily little bastard who immediately dropped the blanket, exposing his naked buttocks to the world and took off running like a man escaped from prison into the darkness...They might catch him, they might not.
Judging by the pendulous belly on the security guard, my money is on the patient.
I walk into the unit giggling...but this false sense of fun is soon arrested when I realise that there are no other doctors to be seen. Alarm bells start ringing when no-one is in the front room, it's a sign that they are somewhere else. And that somewhere else is usually in the resuscitation room, where there is probably some major shit going down.
I sheepishly shrink off to the tea-room to deposit my things, before braving the carnage I'm certain is waiting for me.
I'm not disappointed.
Dr MB and Dr Mommy are busy doing CPR on a morbidly obese lady in one corner.This happens in the resus room all the time. HOwever, what is peculiar about this is that they are performing this potentially lifesaving manoeuvre on the floor! Hospital is at capacity so no more stretchers available. Silly me to expect stretchers, in a fucking hospital.
What's that Department of Health? Oh, you don't give a shit? Tell me something I don't know.
Oposite them, Dr K and the surgeon are frantically trying to gain intravenous access on a patient. This man has been shot through his chest, possibly through his heart/aorta/lungs/trachea/oesophagus....blood pressure is dropping very quickly and things are looking pretty grave over there...
I notice the medical intern at the back of the room struggling to intubate one of his patients in severe respiratory distress...Looks like that's where I'm needed most, so I make my way over to help.
However, my efforts are thwarted by the head nurse who thrusts a fat folder into my hands and tells me that there is an old man having a heart attack in the waiting room. ARGH!
Sorry little intern...you're on your own.
As expected, the old man is of the Kentucky Fried Chicken-loving kind, and I can see the nicotine-stains on his teeth. According to his clinical symptoms and ECG he most definitely is having a heart attack.
By this time the resuscitation on the lady on the floor has been called off.
We couldn't save her and she couldn't save herself. Call the family. Break the bad news and move her out of there. My heart attack guy needs a bed in resus so that we can initiate treatment and try to save what's left of his myocardium, so that he can get to work on destroying that too .
As I wheel the old man into resus the gunshot wound patient is being wheeled out of resus to the trauma theatre...
He doesn't make the few metres to the operating table, and goes into cardiorespiratory arrest in transit.
All efforts to resuscitate him fail.
I wonder why he got shot? Was he the bad guy or the good guy? I suppose it doesn't really matter..
I stabilise Heart Attack Guy ( we speak about our patients in terms of their diseases, rarely bothering to learn their names) and hand him over to the medical team.
What a start to the shift! As I walk out of resus and back into the front room I am confronted with a warzone.
The front room looks like it has been the site of a recent explosion, people shouting, people wandering around aimlessly, people crying, people everywhere.
In five years time I am gong to have post-traumatic stress disorder and then I'm going to have Vietnam-war-like flashbacks to this moment.
I am immediately cornered by the staff from the ambulance vehicles who have brought us five patients involved in an MVA. Where in God's name are we going to put these people? As I wearily start accepting the patients I hear the door creak open to reveal the paramedics wheeling some more people in on stretchers.
Doesn't it ever end?
Despite the ambulances dropping off new patients, there are still about twenty unseen patients names in the book from the previous shift. Some of them have been here for more than six hours waiting to be seen. They are scattered all over the front room. standing, sitting, lying on the floor. There are no more stretchers available and the super-intendant is taking forever to close the hospital despite being at full capacity. I secretly want to curse the previous team for leaving us with so many to see, but I know that they were just as busy as we are and that I can't really blame them.
A little while later I hear a commotion in the corner, and look up as the police escort two violent psychiatric patients into our unit for assessment. While trying to wrestle them to the ground, the policemen are sending impatient looks our way as they wait for one of the three of us on for the night to sedate the patients so they can carry on with their jobs. I ignore them.
Almost immediately some traffic officers join the party and escort in three drunken drivers for blood alcohol testing. I most definitely ignore them.
Christ almighty I'm seriously hungry. Not sure when I'll get a chance to eat.
While contemplating how many patients could have been seen in the time it takes for me to eat supper, I notice an old demented granny using the dustbin to poo in.
After I shouting at her not to do so she stops, mid-poo and trundles back to her bed...dripping the rest of the interrupted evacuation in neat little puddles on the floor behind her.
I have suddenly lost my appetite.
Straight ahead lies an epileptic patient who is confused after having a seizure. He promptly whips out his penis to pee on the floor next to the bed. Some of it splashes on the escort of the patient lying next to him and a fight ensues between the escort and the confused epileptic.
Inhale. Exhale. Inhale. Exhale.
I try to comfort myself with the fact that I'm gaining invaluable experience tonight that I probably wouldn't have learned anywhere else.
What I'm actually learning from these patients is how to make the most of one's Friday night:
Get drunk, drive a car, crash and fracture your pelvis. Get drunk, walk through the ganglands alone at night, get stabbed multiple times. Get drunk, get high on tik, walk in the middle of the road and get hit by a car, fracturing you tibia in three places. The fact that you are too high and drunk to realise that your leg is moving in the most sickening paradoxical motion unintended by nature's design is a testament to the analegesic effects of beer. I can feel the pieces of your shattered tibia grinding against each other while applying the plaster of paris. I think I'm going to vomit.
And what about you lady? What lesson will I learn from you? I see that you are lying face down on the stretcher and you have decorated yourself with long curly braids, earrings, and a large knife handle protruding from your back. I assume that the blade is stuck somewhere in your chest cavity. Tell me, what style of knife handle is in fashion now? MUST get myself one of those for the summer.
Luckily for you, the knife gods divined that the blade should only penetrate superficially under your skin so I can proceed to cut the thing out of your back.
Cool! At last something fun to do!
And...oh...here we go right on time at 04h00 hours. It's the nightly on-call entertainment, performed by the resident nutjobs.
Settle in y'all ! Grab the popcorn! Tonight it's a gut-wrenching caterwauling ballad from psych patient number 6 of the evening. The verse is an ecclectic mix of beautiful arabic verse sporadically punctuated by "Julle vokken holnaaiers". (you fucking bumfuckers). The chorus consists of her screaming obscenities as we wrestled her to the ground to sedate her.
Furthemore her insane soliloquy is manifested by an interpretive movement piece performed by psych patient number 5.
He has been pacing around the big doctor's desk in the middle of the front room incessantly for the last half an hour.
Round and round and round on a mission to nowhere, wearing nothing but a hospital gown and a cool leather hat on his head.
It's impossible to stop him circling.
I dodge bumping into him for the nth time that evening, as I bend down to take blood from another patient (who is lying on the floor). As I do so,the flesh above the back of my jeans is unintentionally revealed. This sets the psych patient into a maniacal hypersalivatory state, resulting in him screaming at me to:
"sit jou hol weg. Maak toe jou hol! Dis MY hol, net ek kan jou holle sien!!!Die ander mans kan gaan kak!" (Put away your bum! Close up your bum! That's MY bum, only I can see your bum! The other men can go to hell!)
And that's when we rugby-tackled him, stapled a note that said "please abort" to his forehead and injected enough valium to send him straight back to his days as a fetus in the womb. Hopefully his mom would read the note and take our advice.
My sense of humour is nonexistent at this point and EVERYTHING is irritating me.
Even this poor 17 year girl who was depressed enough to try and take her own life by ingesting shampoo, hair gel, and toothpaste.
Even this 20 year old girl with multiple bruises after being beaten up by her boyfriend, and claiming that it was her fault she got hit.
Even the very frustrating fact that the nurses are only taking the temperatures of every second patient and not testing anybody's urine.
Speaking of urine - I should have gone to pee three hours ago.
But I'm NOT using the front room toilet. I don't care that I'll probably develop a urinary tract infection or an atonic bladder from keeping it in, but the last time I went in there, there was a delirious patient pissing all over the walls. And there was runny poo in the bowl.
The night is almost over anyway, I'll just keep it in until I get home and then burn a hole into the porcelain when I do eventually relieve myself.
Soon the new team arrives. I barely make it through the handover ward round, mumbling through my presentations of the numerous patients I don't remember that I've seen...I'm sure the consultant thinks I'm a retard.
Bleary-eyed and hypomanic from sleep deprivation, I stumble through my front door.
How did I get home? Did I drive? I can't remember.
While undressing I discover a huge blood stain on my sock. With no sign of injury to my foot I can only assume that the blood belonged to one of the trauma victims I saw last night.
What the FUUUUUUUCK!?!?!
What other bodily fluids have been deposited on my person that I don't know about?!?!
YUK!
I scrub myself raw with nuclear waste just to make sure I killed whatever was lurking on my skin.
I then collapse into bed like a boneless toneless fleshy lump. The most I can manage is to open my mouth while my husband feeds me breakfast...
I'm barely alive, but I survived the Friday night nastiness...
Only ten hours till I'm back for the Saturday night slaughter...
Which is pretty much a description of the evening itself:
My arrival at work is unfortunately not signalled by the large marching band, fireworks and a rip-roaring guitar solo played by a topless Greek God that I think I deserve.
Oh no...instead I am greeted with that age-old traditional greeting, peculiar to the lesser-incisor'ed native of the Cape Flats:
"Jou ma se poes!" (your mother's cunt!).
Seems that one of the psych patients has escaped from the front room, and is currently freaking out in the parking lot outside the unit, screaming obscenities at everyone. He is wearing a hospital blanket and shoes. As I walk past him into the unit, the security guards rush past me to try and capture him...but this one is a wily little bastard who immediately dropped the blanket, exposing his naked buttocks to the world and took off running like a man escaped from prison into the darkness...They might catch him, they might not.
Judging by the pendulous belly on the security guard, my money is on the patient.
I walk into the unit giggling...but this false sense of fun is soon arrested when I realise that there are no other doctors to be seen. Alarm bells start ringing when no-one is in the front room, it's a sign that they are somewhere else. And that somewhere else is usually in the resuscitation room, where there is probably some major shit going down.
I sheepishly shrink off to the tea-room to deposit my things, before braving the carnage I'm certain is waiting for me.
I'm not disappointed.
Dr MB and Dr Mommy are busy doing CPR on a morbidly obese lady in one corner.This happens in the resus room all the time. HOwever, what is peculiar about this is that they are performing this potentially lifesaving manoeuvre on the floor! Hospital is at capacity so no more stretchers available. Silly me to expect stretchers, in a fucking hospital.
What's that Department of Health? Oh, you don't give a shit? Tell me something I don't know.
Oposite them, Dr K and the surgeon are frantically trying to gain intravenous access on a patient. This man has been shot through his chest, possibly through his heart/aorta/lungs/trachea/oesophagus....blood pressure is dropping very quickly and things are looking pretty grave over there...
I notice the medical intern at the back of the room struggling to intubate one of his patients in severe respiratory distress...Looks like that's where I'm needed most, so I make my way over to help.
However, my efforts are thwarted by the head nurse who thrusts a fat folder into my hands and tells me that there is an old man having a heart attack in the waiting room. ARGH!
Sorry little intern...you're on your own.
As expected, the old man is of the Kentucky Fried Chicken-loving kind, and I can see the nicotine-stains on his teeth. According to his clinical symptoms and ECG he most definitely is having a heart attack.
By this time the resuscitation on the lady on the floor has been called off.
We couldn't save her and she couldn't save herself. Call the family. Break the bad news and move her out of there. My heart attack guy needs a bed in resus so that we can initiate treatment and try to save what's left of his myocardium, so that he can get to work on destroying that too .
As I wheel the old man into resus the gunshot wound patient is being wheeled out of resus to the trauma theatre...
He doesn't make the few metres to the operating table, and goes into cardiorespiratory arrest in transit.
All efforts to resuscitate him fail.
I wonder why he got shot? Was he the bad guy or the good guy? I suppose it doesn't really matter..
I stabilise Heart Attack Guy ( we speak about our patients in terms of their diseases, rarely bothering to learn their names) and hand him over to the medical team.
What a start to the shift! As I walk out of resus and back into the front room I am confronted with a warzone.
The front room looks like it has been the site of a recent explosion, people shouting, people wandering around aimlessly, people crying, people everywhere.
In five years time I am gong to have post-traumatic stress disorder and then I'm going to have Vietnam-war-like flashbacks to this moment.
I am immediately cornered by the staff from the ambulance vehicles who have brought us five patients involved in an MVA. Where in God's name are we going to put these people? As I wearily start accepting the patients I hear the door creak open to reveal the paramedics wheeling some more people in on stretchers.
Doesn't it ever end?
Despite the ambulances dropping off new patients, there are still about twenty unseen patients names in the book from the previous shift. Some of them have been here for more than six hours waiting to be seen. They are scattered all over the front room. standing, sitting, lying on the floor. There are no more stretchers available and the super-intendant is taking forever to close the hospital despite being at full capacity. I secretly want to curse the previous team for leaving us with so many to see, but I know that they were just as busy as we are and that I can't really blame them.
A little while later I hear a commotion in the corner, and look up as the police escort two violent psychiatric patients into our unit for assessment. While trying to wrestle them to the ground, the policemen are sending impatient looks our way as they wait for one of the three of us on for the night to sedate the patients so they can carry on with their jobs. I ignore them.
Almost immediately some traffic officers join the party and escort in three drunken drivers for blood alcohol testing. I most definitely ignore them.
Christ almighty I'm seriously hungry. Not sure when I'll get a chance to eat.
While contemplating how many patients could have been seen in the time it takes for me to eat supper, I notice an old demented granny using the dustbin to poo in.
After I shouting at her not to do so she stops, mid-poo and trundles back to her bed...dripping the rest of the interrupted evacuation in neat little puddles on the floor behind her.
I have suddenly lost my appetite.
Straight ahead lies an epileptic patient who is confused after having a seizure. He promptly whips out his penis to pee on the floor next to the bed. Some of it splashes on the escort of the patient lying next to him and a fight ensues between the escort and the confused epileptic.
Inhale. Exhale. Inhale. Exhale.
I try to comfort myself with the fact that I'm gaining invaluable experience tonight that I probably wouldn't have learned anywhere else.
What I'm actually learning from these patients is how to make the most of one's Friday night:
Get drunk, drive a car, crash and fracture your pelvis. Get drunk, walk through the ganglands alone at night, get stabbed multiple times. Get drunk, get high on tik, walk in the middle of the road and get hit by a car, fracturing you tibia in three places. The fact that you are too high and drunk to realise that your leg is moving in the most sickening paradoxical motion unintended by nature's design is a testament to the analegesic effects of beer. I can feel the pieces of your shattered tibia grinding against each other while applying the plaster of paris. I think I'm going to vomit.
And what about you lady? What lesson will I learn from you? I see that you are lying face down on the stretcher and you have decorated yourself with long curly braids, earrings, and a large knife handle protruding from your back. I assume that the blade is stuck somewhere in your chest cavity. Tell me, what style of knife handle is in fashion now? MUST get myself one of those for the summer.
Luckily for you, the knife gods divined that the blade should only penetrate superficially under your skin so I can proceed to cut the thing out of your back.
Cool! At last something fun to do!
And...oh...here we go right on time at 04h00 hours. It's the nightly on-call entertainment, performed by the resident nutjobs.
Settle in y'all ! Grab the popcorn! Tonight it's a gut-wrenching caterwauling ballad from psych patient number 6 of the evening. The verse is an ecclectic mix of beautiful arabic verse sporadically punctuated by "Julle vokken holnaaiers". (you fucking bumfuckers). The chorus consists of her screaming obscenities as we wrestled her to the ground to sedate her.
Furthemore her insane soliloquy is manifested by an interpretive movement piece performed by psych patient number 5.
He has been pacing around the big doctor's desk in the middle of the front room incessantly for the last half an hour.
Round and round and round on a mission to nowhere, wearing nothing but a hospital gown and a cool leather hat on his head.
It's impossible to stop him circling.
I dodge bumping into him for the nth time that evening, as I bend down to take blood from another patient (who is lying on the floor). As I do so,the flesh above the back of my jeans is unintentionally revealed. This sets the psych patient into a maniacal hypersalivatory state, resulting in him screaming at me to:
"sit jou hol weg. Maak toe jou hol! Dis MY hol, net ek kan jou holle sien!!!Die ander mans kan gaan kak!" (Put away your bum! Close up your bum! That's MY bum, only I can see your bum! The other men can go to hell!)
And that's when we rugby-tackled him, stapled a note that said "please abort" to his forehead and injected enough valium to send him straight back to his days as a fetus in the womb. Hopefully his mom would read the note and take our advice.
My sense of humour is nonexistent at this point and EVERYTHING is irritating me.
Even this poor 17 year girl who was depressed enough to try and take her own life by ingesting shampoo, hair gel, and toothpaste.
Even this 20 year old girl with multiple bruises after being beaten up by her boyfriend, and claiming that it was her fault she got hit.
Even the very frustrating fact that the nurses are only taking the temperatures of every second patient and not testing anybody's urine.
Speaking of urine - I should have gone to pee three hours ago.
But I'm NOT using the front room toilet. I don't care that I'll probably develop a urinary tract infection or an atonic bladder from keeping it in, but the last time I went in there, there was a delirious patient pissing all over the walls. And there was runny poo in the bowl.
The night is almost over anyway, I'll just keep it in until I get home and then burn a hole into the porcelain when I do eventually relieve myself.
Soon the new team arrives. I barely make it through the handover ward round, mumbling through my presentations of the numerous patients I don't remember that I've seen...I'm sure the consultant thinks I'm a retard.
Bleary-eyed and hypomanic from sleep deprivation, I stumble through my front door.
How did I get home? Did I drive? I can't remember.
While undressing I discover a huge blood stain on my sock. With no sign of injury to my foot I can only assume that the blood belonged to one of the trauma victims I saw last night.
What the FUUUUUUUCK!?!?!
What other bodily fluids have been deposited on my person that I don't know about?!?!
YUK!
I scrub myself raw with nuclear waste just to make sure I killed whatever was lurking on my skin.
I then collapse into bed like a boneless toneless fleshy lump. The most I can manage is to open my mouth while my husband feeds me breakfast...
I'm barely alive, but I survived the Friday night nastiness...
Only ten hours till I'm back for the Saturday night slaughter...
Friday, September 18, 2009
Going once! A hug! Starting the bidding at....
At 2am, in the middle of my night shift, I am not the most sympathetic of doctors.
I have to keep my emotions lean.
There is no inexhaustable supply of feeling at this time of the morning and I must preserve the little bit that's left for those times that patients and their families need extra special care.
I have to keep my mind keen.
I cannot waste brain power on repeating three times and in three different languages that your pathetic mosquito bites will not be treated at the emergency centre tonight. Go away. Stop sapping my brain power like a dementor out of Harry Potter.
I have to be mean.
I need my mean face to make sure the drunken assholes don't get out of control, and my triage skills have to be objective and ruthless enough to turf the patients whose issues can wait until the next morning.
However, all my patients will get one solid chance to prove to me that they deserve emergency treatment at this time of the evening.
Those that fail this test, do so because they are wasting my precious goddamn time.
You are WASTING my time and you are WASTING time that could be better spent on someone with real issues.
And those that make it past this initial test, well they get my everything.
EVERYTHING.
Some of them even get my neatly packed food and drink if they're hungry.
I can't tell you the number of times my patients have asked me for food because they haven't eaten in two days.
For fucking FOOD.
How can I blame you for defaulting on your TB meds and arriving at casualty with respiratory distress because you didn't have food to take your tablets with?
I don't feel particularly good when I go out of my way for patients in this manner.
One would expect to feel like a saint, or a good samaritan.
But I don't.
In fact I just feel livid.
It makes me want to stand in the middle of the front room and scream at whoever is responsible for this sick situation of poverty.
Yet sometimes, offering a non-medical type of comfort to a needy patient is actually the best kind of treatment I can offer at that moment.
For example, my 45 year old delirious patient from two nights ago.
I fell in love with him.
He was very well behaved, very trusting of the staff, but simultaneously slightly confused with alternating periods of lucidity.
This is a very rare occurrence in our casualty, confused patients who are well-behaved.
After being told to fuck off in numerous languages, how can one not love that?
Part of my work-up for his delirium included sending him for a chest x-ray.
I wheeled him to the X-ray department while listening to him talk gibberish and then deposited his confused self in front of the radiographer's desk.
As I turned to leave, he suddenly grabbed my hand, pulled me towards him and hugged my torso fiercely.
"Don't leave me alone here, Doctor!" He pleaded, "There's nobody else here. I must have people around me at all times or bad things happen!"
I thought of all the other patients waiting to be seen.
Then I looked at his eyes, wide open in terror like a child frightened of the bogeyman under the bed, and promptly forgot about the rest.
I sat quietly, with him hugging me for fifteen minutes as we waited for the radiographer. All the while casualty filled up behind me.
After a some time, suddenly unsure as to my commitment to his request, he pulled me closer to him and whispered frantically in my ear, "If you stay with me I will give you eight thousand rand. You are a good doctor. You can have my eight thousand rand if you stay with me."
Clearly this guy was not delirious, he was a freaking genius!
Eight thousand bucks for one of my hugs?
Now that's what I'm talking about!
The department of health barely gives me eight thousand bucks for my back-breaking overtime for the whole month!
This confused man, who probably had to scrape together the ten bucks to make it to hospital, highlighted his appreciation for the one thing we all crave so desperately, and which the poor get denied constantly; affirmation that one is worthy of love.
That said, I do give AMAZINGLY SUPER-AWESOME hugs.
It's no suprise that he was willing to pay thousands for some more of them.
My hugs are so awesome they will rock your world!
My hugs are so awesome they are like chicken soup.
My hugs are so awesome they motivate world peace, eradicate suffering and cure cancer...
Oh how I wish...
I have to keep my emotions lean.
There is no inexhaustable supply of feeling at this time of the morning and I must preserve the little bit that's left for those times that patients and their families need extra special care.
I have to keep my mind keen.
I cannot waste brain power on repeating three times and in three different languages that your pathetic mosquito bites will not be treated at the emergency centre tonight. Go away. Stop sapping my brain power like a dementor out of Harry Potter.
I have to be mean.
I need my mean face to make sure the drunken assholes don't get out of control, and my triage skills have to be objective and ruthless enough to turf the patients whose issues can wait until the next morning.
However, all my patients will get one solid chance to prove to me that they deserve emergency treatment at this time of the evening.
Those that fail this test, do so because they are wasting my precious goddamn time.
You are WASTING my time and you are WASTING time that could be better spent on someone with real issues.
And those that make it past this initial test, well they get my everything.
EVERYTHING.
Some of them even get my neatly packed food and drink if they're hungry.
I can't tell you the number of times my patients have asked me for food because they haven't eaten in two days.
For fucking FOOD.
How can I blame you for defaulting on your TB meds and arriving at casualty with respiratory distress because you didn't have food to take your tablets with?
I don't feel particularly good when I go out of my way for patients in this manner.
One would expect to feel like a saint, or a good samaritan.
But I don't.
In fact I just feel livid.
It makes me want to stand in the middle of the front room and scream at whoever is responsible for this sick situation of poverty.
Yet sometimes, offering a non-medical type of comfort to a needy patient is actually the best kind of treatment I can offer at that moment.
For example, my 45 year old delirious patient from two nights ago.
I fell in love with him.
He was very well behaved, very trusting of the staff, but simultaneously slightly confused with alternating periods of lucidity.
This is a very rare occurrence in our casualty, confused patients who are well-behaved.
After being told to fuck off in numerous languages, how can one not love that?
Part of my work-up for his delirium included sending him for a chest x-ray.
I wheeled him to the X-ray department while listening to him talk gibberish and then deposited his confused self in front of the radiographer's desk.
As I turned to leave, he suddenly grabbed my hand, pulled me towards him and hugged my torso fiercely.
"Don't leave me alone here, Doctor!" He pleaded, "There's nobody else here. I must have people around me at all times or bad things happen!"
I thought of all the other patients waiting to be seen.
Then I looked at his eyes, wide open in terror like a child frightened of the bogeyman under the bed, and promptly forgot about the rest.
I sat quietly, with him hugging me for fifteen minutes as we waited for the radiographer. All the while casualty filled up behind me.
After a some time, suddenly unsure as to my commitment to his request, he pulled me closer to him and whispered frantically in my ear, "If you stay with me I will give you eight thousand rand. You are a good doctor. You can have my eight thousand rand if you stay with me."
Clearly this guy was not delirious, he was a freaking genius!
Eight thousand bucks for one of my hugs?
Now that's what I'm talking about!
The department of health barely gives me eight thousand bucks for my back-breaking overtime for the whole month!
This confused man, who probably had to scrape together the ten bucks to make it to hospital, highlighted his appreciation for the one thing we all crave so desperately, and which the poor get denied constantly; affirmation that one is worthy of love.
That said, I do give AMAZINGLY SUPER-AWESOME hugs.
It's no suprise that he was willing to pay thousands for some more of them.
My hugs are so awesome they will rock your world!
My hugs are so awesome they are like chicken soup.
My hugs are so awesome they motivate world peace, eradicate suffering and cure cancer...
Oh how I wish...
Wednesday, September 2, 2009
There are two kinds of people in this life...
Monday morning. 08h00 am.
Mondays come after weekends.
Weekends in the front room mean that we've had three days worth of collecting nutjob psycho's, sorry, I mean, "mental health care patients".
There are no mental health care physicians over the weekend so we can only refer them to the nutjob psycho's, sorry, I mean "psychiatrists", on Monday mornings.
This job usually falls into the hands of the most junior doctor.
Which would be me.
I like this job so much that I would rather remove my own pancreas with a combine harvester.
The handover Monday morning ward round progressed into the psychiatric holding area.
A young Indian lady patient proceeds to greet me in this manner:
"WHO ARE YOU?!!!"
I don't respond. I don't show any teeth. I make no sudden movements.
She goes on:
"ARE YOU A FUCKER? OR ARE YOU A LOCKER?"
I couldn't help but let my confusion show. Which one should I be?
Thankfully she made the decision for me.
"I KNOW! YOU'RE A FUCKER!"
I was not aware that those were the two types of people I could choose to personify.
I thanked her for making me a "fucker" and not, a "locker".
After all, as I could only interpret it, she was speaking metaphorically!
Thus, "Lockers" must ultimately get used by "Fuckers",
because "fuckers" get to put things INTO "lockers" !?!?!?!
WTF-"er"?!?!
Mondays come after weekends.
Weekends in the front room mean that we've had three days worth of collecting nutjob psycho's, sorry, I mean, "mental health care patients".
There are no mental health care physicians over the weekend so we can only refer them to the nutjob psycho's, sorry, I mean "psychiatrists", on Monday mornings.
This job usually falls into the hands of the most junior doctor.
Which would be me.
I like this job so much that I would rather remove my own pancreas with a combine harvester.
The handover Monday morning ward round progressed into the psychiatric holding area.
A young Indian lady patient proceeds to greet me in this manner:
"WHO ARE YOU?!!!"
I don't respond. I don't show any teeth. I make no sudden movements.
She goes on:
"ARE YOU A FUCKER? OR ARE YOU A LOCKER?"
I couldn't help but let my confusion show. Which one should I be?
Thankfully she made the decision for me.
"I KNOW! YOU'RE A FUCKER!"
I was not aware that those were the two types of people I could choose to personify.
I thanked her for making me a "fucker" and not, a "locker".
After all, as I could only interpret it, she was speaking metaphorically!
Thus, "Lockers" must ultimately get used by "Fuckers",
because "fuckers" get to put things INTO "lockers" !?!?!?!
WTF-"er"?!?!
The write way to kill your friend
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...
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...
Sunday, August 23, 2009
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