Honestly, I have no words for this referral, which I am not shitting you, is exactly how it was sent to us, punctuation and all.
Read it and weep.
I did.
Dear Doctor,
Thank you for seeing above mentioned patient with Parkinson's Issues "best friend passed away" disease, otherwise stable, social.
Please assist with further investigations and management.
Thank you,
Dr Retarded.
Sunday, January 10, 2010
Wednesday, January 6, 2010
Incontinence: The emotional kind
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?
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?
Tuesday, January 5, 2010
Retarded Referrals (3) V-Fib
Write! ( Yes, I'm doing that.)
I mean,
Right! ( In that authoratitive, I'm the doctor in charge, let's get this shit on the road voice)
This, my dear readers is another lesson in retardedness.
The moronic, blockheaded, boneheaded cretin-ness of this, the dimwitted,nincompoopy, pinheaded sheer stupidity of this referral, defies reason, defies logic, is as a matter of fact simply incredulous, spectacular in its stupidity, so utterly mind-blowing that my brain actually exploded all over the front room when I read it.
Please sit down before you read this:
Dear Doctor,
I have diagnosed ventricular fibrillation via Ultrasound in my consulting rooms.
Please do ECG and manage further.
Kindly,
Dr Retarded.
Ok just breathe.
Calm down, take a deep deep breath,
Here...have some of this sweet milky tea while I collect your grey matter off the floor and shove it back into your cranium through your nostrils using a spatula.
Yes,my darling, I know... VENTRICULAR FIBRILLATION! *insert blood curdling scream here*
V-fib ( which is what us cool kids call it) is a medical EMERGENCY.It is a sudden, lethal arrythmia characterised by twitching, fibrilliating, unco-ordinated heart muscle contractions that will kill you in seconds as there is no output of blood from the heart's ventricles to the rest of the body's vital organs.
Like the brain.
Which is why the patients I've seen with V-fib are unconscious.
Always unconscious.
This patient,totally raped of his hard-earned cash, had this v-fib medical lethal emergency "diagnosed" by Dr Retarded, and was then given a letter to bring to us, and as such, walked, fully conscious, into the front room with it.
(Makes the v-fib diganosis highly unlikely hey!)
Secondly a diagnosis of V-fib warrants immediate CPR and defibrillation (Electrical shocks delivered to the chest).
Which Dr Retarded, after making "this brilliant diagnosis" via ultrasound, did not think it necessary to do.
Wrong. Wrong. Wrong.
Fail.
Do not pass go.
Do not collect your R200.00
Go directly to jail.
I mean,
Right! ( In that authoratitive, I'm the doctor in charge, let's get this shit on the road voice)
This, my dear readers is another lesson in retardedness.
The moronic, blockheaded, boneheaded cretin-ness of this, the dimwitted,nincompoopy, pinheaded sheer stupidity of this referral, defies reason, defies logic, is as a matter of fact simply incredulous, spectacular in its stupidity, so utterly mind-blowing that my brain actually exploded all over the front room when I read it.
Please sit down before you read this:
Dear Doctor,
I have diagnosed ventricular fibrillation via Ultrasound in my consulting rooms.
Please do ECG and manage further.
Kindly,
Dr Retarded.
Ok just breathe.
Calm down, take a deep deep breath,
Here...have some of this sweet milky tea while I collect your grey matter off the floor and shove it back into your cranium through your nostrils using a spatula.
Yes,my darling, I know... VENTRICULAR FIBRILLATION! *insert blood curdling scream here*
V-fib ( which is what us cool kids call it) is a medical EMERGENCY.It is a sudden, lethal arrythmia characterised by twitching, fibrilliating, unco-ordinated heart muscle contractions that will kill you in seconds as there is no output of blood from the heart's ventricles to the rest of the body's vital organs.
Like the brain.
Which is why the patients I've seen with V-fib are unconscious.
Always unconscious.
This patient,totally raped of his hard-earned cash, had this v-fib medical lethal emergency "diagnosed" by Dr Retarded, and was then given a letter to bring to us, and as such, walked, fully conscious, into the front room with it.
(Makes the v-fib diganosis highly unlikely hey!)
Secondly a diagnosis of V-fib warrants immediate CPR and defibrillation (Electrical shocks delivered to the chest).
Which Dr Retarded, after making "this brilliant diagnosis" via ultrasound, did not think it necessary to do.
Wrong. Wrong. Wrong.
Fail.
Do not pass go.
Do not collect your R200.00
Go directly to jail.
Sunday, January 3, 2010
Christmas Carnage
I worked every single day of the Christmas weekend.
It was tough. Doctors, paramedics, police throughout the country celebrated Christmas by working themselves to the bone.
Oh but there's one dude responsible for this:
I blame Santa Claus...you drunken red-suited buffoon!
Well done buddy.
Good Job.
Good Job.
Maybe you did you not read the freaking tourist manual to the Cape Flats that I sent you?!! Huh??!
Rule ONE: Do not drink the tik-laced milk and dagga cookies left out for you. IT’S A TRAP!
Oh it seemed tasty did it?
Oh you just couldn't help yourself, right?
What's that? It would have been rude not to partake of what was offered to you then hey?
Is that why you screwed up and rewarded the good little gangsters, and drug-induced psychotics, and alcohol sodden short-tempered aggressive folk with knives, and guns, and bullets, and other such cheerful weaponry? Huh? Because you were HIGH?
Panga's: The gift that keeps on killing.
Tra la laaaa! ( That's me warming up my voice for the Cape Flats Casualty Christmas Carol)
Ready? Here we go:
On the weekend of Christmas, those shifts they offered me:
One dead child
Two thoracotomies
Three gunshot abdomens
Four beaten wives
Five drunk drivers
Six stabbed chests
Seven drug-induced psychotics...
Can you tell that I was not impressed by the Christmas weekend's holy shitstorm and emphatically not overcome with the spirit of Christmas joy and love?
So here's a tip for next year, Santa Claus: Rudolph and that gang, me thinks it best to leave them at home. That red nose of his is like a shiny conspicuous beacon, and that jolly red suit of yours - BURN IT!
To achieve successful delivery of the goods, without getting stabbed or forced to feed on narcotics, you need to blend in man!
First, remove your two front teeth. ( This will have the added benefit of making you sympathetic to the plight of those cute freckle-faced munchkins who desire just that waiting for them under the christmas tree.)
Next, get a tattoo of something obscene on your forehead. Something like, "I kill for fun and rape for joy". That's just a little something I read on the face of one of my patients a while ago - maybe you could use that one.
Learn some choice phrases in Afrikaans to throw them off the scent that you're actually a do-gooder come to bring light and joy to the dark corners of the Cape Flats.......you know the filthy vulgar ones I'm talking about.
No?
Go back a few posts and have a little read - you'll be sure pick some up from those.
This way - you can wander around the freaky scary place our patients call home and offer those in need some assistance. Your goodie bag may need to be slightly different from the one you're traditionally used to. If you can fit in one first-class education system, a health system run by competent people and some regular nutritious FOOD for the poor...perhaps I'll reconsider your current low-ranking on my list of favourite people of all time...
At the moment you are down there with the Easter Bunny ( who dropped mandrax laced eggs over the Easter Weekend) and the Tooth Fairy - who went rogue and is making a killing off the lessor-incisored natives of this crazy town, used her takings to start smuggling drugs and is now known on the Flats as...the Tik Fairy...*drum roll *
It was tough. Doctors, paramedics, police throughout the country celebrated Christmas by working themselves to the bone.
Oh but there's one dude responsible for this:
I blame Santa Claus...you drunken red-suited buffoon!
Well done buddy.
Good Job.
Good Job.
Maybe you did you not read the freaking tourist manual to the Cape Flats that I sent you?!! Huh??!
Rule ONE: Do not drink the tik-laced milk and dagga cookies left out for you. IT’S A TRAP!
Oh it seemed tasty did it?
Oh you just couldn't help yourself, right?
What's that? It would have been rude not to partake of what was offered to you then hey?
Is that why you screwed up and rewarded the good little gangsters, and drug-induced psychotics, and alcohol sodden short-tempered aggressive folk with knives, and guns, and bullets, and other such cheerful weaponry? Huh? Because you were HIGH?
Panga's: The gift that keeps on killing.
Tra la laaaa! ( That's me warming up my voice for the Cape Flats Casualty Christmas Carol)
Ready? Here we go:
On the weekend of Christmas, those shifts they offered me:
One dead child
Two thoracotomies
Three gunshot abdomens
Four beaten wives
Five drunk drivers
Six stabbed chests
Seven drug-induced psychotics...
Can you tell that I was not impressed by the Christmas weekend's holy shitstorm and emphatically not overcome with the spirit of Christmas joy and love?
So here's a tip for next year, Santa Claus: Rudolph and that gang, me thinks it best to leave them at home. That red nose of his is like a shiny conspicuous beacon, and that jolly red suit of yours - BURN IT!
To achieve successful delivery of the goods, without getting stabbed or forced to feed on narcotics, you need to blend in man!
First, remove your two front teeth. ( This will have the added benefit of making you sympathetic to the plight of those cute freckle-faced munchkins who desire just that waiting for them under the christmas tree.)
Next, get a tattoo of something obscene on your forehead. Something like, "I kill for fun and rape for joy". That's just a little something I read on the face of one of my patients a while ago - maybe you could use that one.
Learn some choice phrases in Afrikaans to throw them off the scent that you're actually a do-gooder come to bring light and joy to the dark corners of the Cape Flats.......you know the filthy vulgar ones I'm talking about.
No?
Go back a few posts and have a little read - you'll be sure pick some up from those.
This way - you can wander around the freaky scary place our patients call home and offer those in need some assistance. Your goodie bag may need to be slightly different from the one you're traditionally used to. If you can fit in one first-class education system, a health system run by competent people and some regular nutritious FOOD for the poor...perhaps I'll reconsider your current low-ranking on my list of favourite people of all time...
At the moment you are down there with the Easter Bunny ( who dropped mandrax laced eggs over the Easter Weekend) and the Tooth Fairy - who went rogue and is making a killing off the lessor-incisored natives of this crazy town, used her takings to start smuggling drugs and is now known on the Flats as...the Tik Fairy...*drum roll *
Tuesday, December 22, 2009
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...
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...
Saturday, December 12, 2009
Back pain and Triple A
At the entrance to the front room there is an old steel trolley that rules my life. On it lies the patient log book: The book of life and death. Every patient that requires our team's attention is recorded in this cruel master of the shift...
She is a terrible slave-driver, relentless in her ass-whipping...doling out her punishments with cruelty and wicked irony - throwing out the sucker punches of end-stage cancer/HIV/TB at one moment, and then blasting you with the shotgun shells of stabbed hearts, cracked skulls and eviscerated bowel post knifing. And then, right at the end of your twelve hours overnight, she cackles, and slaps you in the face with a flat, blue, not breathing baby that has just been delivered at home on the floor of the mother's kitchen.
Sometimes her torture is just slow and painful...like when she sends you the patient logged as "back pain".
Argh - the worst, the worst of the worst. What a vague awful random non-emergency type of complaint. Yes, there are life-threatening conditions that can present with back pain:ruptured abdominal aortic aneurysm, peptic ulcer disease, pancreas issues.
But mostly, it's the complaint of the the overweight or old and arthritic - and not exactly something I'm ever in the mood to deal with at three in the morning inbetween the heart attacks and incomplete abortions.
So what happens is that the back pain patient gets skipped over...and after sorting out one patient and approaching the book of life and death for my next beating, I purposefuly bypass the back pain for something I think is more worthy of my early morning attention. I know my colleagues are doing the same, and we are each secretly hoping that someone else will be the better doctor and go and sort that patient out, but are not willing to take the plunge ourselves.
We had exactly such a patient one day - and because she presented near the end of the shift she unfortunately was not seen by the time the handover round started. That morning, the consultant in charge of the handover was none other than the Godfather of medicine in the Western Cape, a legendary figure whose initials, Triple A,are both his nickname and the medical abbreviation for Abdominal Aortic Aneurysm...and he is just as deadly.
Triple A is renowned for his spot diagnosis and unparalleled clinical skill - having the uncanny and inspiring ability to diagnose a patient's condition from the end of the bed - sometimes by just looking at them, not even one question asked.
Not only is he an astute medical genius, but he is also a staunch atheist, a lover of incrediby rude jokes and also wholeheartedly committed to the poor patients accessing state health care.
The stories that circulate about him are the stuff of legend. One of them being that one morning on the hand-over ward round he developed chest pain, and went to lie down on the floor next to a plug on the wall.
When people asked him what was happening he replied that he was probably having a heart attack, and since the ECG machine was situated on the other side of the front room and that he knew there were no extension cords, he decided to lie next to a plug, thus could someone please go and fetch the damn thing and check him out. The poor intern did the honours, trembling all the while, not believing that he was bent over his grand master, and then exclaimed while reading the ECG that there were no classical ST elevatory changes to indicate a myocardial infarction.
Triple A, lying on the floor had a slug's-eye upside down view of the ECG and promptly exclaimed, "Fuck you, man, there's an R-wave in lead V1, I'm having an inferior infarction, get the streptokinase!". He then refused to be moved to another hospital, exclaiming that if he didn't have faith in his own place of work, then how could he expect his patients to do the same.
When we arrived at the bedside of the old, overweight lady with back pain, we presented her as an arthritis. But we might have been talking to the walls - Triple A wasn't listening. Ignoring us, he asked her to describe her pain, where it radiated to and what time she felt it during the day. That was all. And then he looked at us and proclaimed: "This woman has cancer of her pancreas". He hadn't laid a finger on her. We all balked. And there were mutterings that perhaps the senile dementia had finally got to him...But he insisted, she was sent for an ultrasound, and the report came back that there was a mass in her pancreas, most likely a malignancy.
We all felt like fools. Like shits. Like we knew nothing about anything worthwhile. Like we were mere amoebae in the presence of this medical guru.
Needless to say, I've changed my behaviour towards the back pain patient...and when the book of life and death throws that one at me, I'll accept the punishment gladly to try and atone for my previously wicked behaviour!
She is a terrible slave-driver, relentless in her ass-whipping...doling out her punishments with cruelty and wicked irony - throwing out the sucker punches of end-stage cancer/HIV/TB at one moment, and then blasting you with the shotgun shells of stabbed hearts, cracked skulls and eviscerated bowel post knifing. And then, right at the end of your twelve hours overnight, she cackles, and slaps you in the face with a flat, blue, not breathing baby that has just been delivered at home on the floor of the mother's kitchen.
Sometimes her torture is just slow and painful...like when she sends you the patient logged as "back pain".
Argh - the worst, the worst of the worst. What a vague awful random non-emergency type of complaint. Yes, there are life-threatening conditions that can present with back pain:ruptured abdominal aortic aneurysm, peptic ulcer disease, pancreas issues.
But mostly, it's the complaint of the the overweight or old and arthritic - and not exactly something I'm ever in the mood to deal with at three in the morning inbetween the heart attacks and incomplete abortions.
So what happens is that the back pain patient gets skipped over...and after sorting out one patient and approaching the book of life and death for my next beating, I purposefuly bypass the back pain for something I think is more worthy of my early morning attention. I know my colleagues are doing the same, and we are each secretly hoping that someone else will be the better doctor and go and sort that patient out, but are not willing to take the plunge ourselves.
We had exactly such a patient one day - and because she presented near the end of the shift she unfortunately was not seen by the time the handover round started. That morning, the consultant in charge of the handover was none other than the Godfather of medicine in the Western Cape, a legendary figure whose initials, Triple A,are both his nickname and the medical abbreviation for Abdominal Aortic Aneurysm...and he is just as deadly.
Triple A is renowned for his spot diagnosis and unparalleled clinical skill - having the uncanny and inspiring ability to diagnose a patient's condition from the end of the bed - sometimes by just looking at them, not even one question asked.
Not only is he an astute medical genius, but he is also a staunch atheist, a lover of incrediby rude jokes and also wholeheartedly committed to the poor patients accessing state health care.
The stories that circulate about him are the stuff of legend. One of them being that one morning on the hand-over ward round he developed chest pain, and went to lie down on the floor next to a plug on the wall.
When people asked him what was happening he replied that he was probably having a heart attack, and since the ECG machine was situated on the other side of the front room and that he knew there were no extension cords, he decided to lie next to a plug, thus could someone please go and fetch the damn thing and check him out. The poor intern did the honours, trembling all the while, not believing that he was bent over his grand master, and then exclaimed while reading the ECG that there were no classical ST elevatory changes to indicate a myocardial infarction.
Triple A, lying on the floor had a slug's-eye upside down view of the ECG and promptly exclaimed, "Fuck you, man, there's an R-wave in lead V1, I'm having an inferior infarction, get the streptokinase!". He then refused to be moved to another hospital, exclaiming that if he didn't have faith in his own place of work, then how could he expect his patients to do the same.
When we arrived at the bedside of the old, overweight lady with back pain, we presented her as an arthritis. But we might have been talking to the walls - Triple A wasn't listening. Ignoring us, he asked her to describe her pain, where it radiated to and what time she felt it during the day. That was all. And then he looked at us and proclaimed: "This woman has cancer of her pancreas". He hadn't laid a finger on her. We all balked. And there were mutterings that perhaps the senile dementia had finally got to him...But he insisted, she was sent for an ultrasound, and the report came back that there was a mass in her pancreas, most likely a malignancy.
We all felt like fools. Like shits. Like we knew nothing about anything worthwhile. Like we were mere amoebae in the presence of this medical guru.
Needless to say, I've changed my behaviour towards the back pain patient...and when the book of life and death throws that one at me, I'll accept the punishment gladly to try and atone for my previously wicked behaviour!
Wednesday, November 25, 2009
Retarded referrals (2): Surfer Doc
Matthew McConaughey is working as a doctor at one of the primary care centres that refer patients to our front room.
This pic is for the ladies...a quick little perv. opportunity before I carry on with the narrative.
Satisfied?
Ok, let's continue...
Seriously.
I'm convinced it's him.
And I'm convinced it's a specific type of him, the one from that totally self-indulgent movie, "Surfer, Dude!"
It's either the real him or a very good imposter.
He calls every few weeks with a telephonic referral reminiscent of a stoned surfer's philosophical conversation with his board than an actual medical referral.
Quote, unquote:
Telephone: "tring tring!"
Dr S: "________Casualty Unit, Good-evening, doctor speaking."
Surfer Doc:" Howsit, hey...Look here man...I've like, got this dude here...and like his hand, man, it's like totally fucked, dude!"
Dr S: "Um...What?"
Surfer Doc: "Ja it's like been stabbed, his hand, it's totally fucked hey! Can I send him through to you guys?"
Dr S: (trying to suppress the giggles and sound professional)" Well, I guess if his hand is that fucked then he most certainly needs to come through to us, dude!"
I had no freaking idea what was wrong with that patient, and accepted him purely on the basis that that the poor patient at least warranted an assessment by somebody who was not, like, totally fucked on marijuana!
P.S. Matt McConaughey: If it is you - Pop round to our casualty unit, preferrably topless. Give up this doctor gig you're trying out...it's not really your thing, thinking and all that. When you get here, don't bother talking, just pose. Flick your hair a little, and flex your muscles while flashing me a heart-stopping knee-quivering smile.Be a thing of beauty in this hell hole of a unit and give me a reason to rush to work every day!
This pic is for the ladies...a quick little perv. opportunity before I carry on with the narrative.
Satisfied?
Ok, let's continue...
Seriously.
I'm convinced it's him.
And I'm convinced it's a specific type of him, the one from that totally self-indulgent movie, "Surfer, Dude!"
It's either the real him or a very good imposter.
He calls every few weeks with a telephonic referral reminiscent of a stoned surfer's philosophical conversation with his board than an actual medical referral.
Quote, unquote:
Telephone: "tring tring!"
Dr S: "________Casualty Unit, Good-evening, doctor speaking."
Surfer Doc:" Howsit, hey...Look here man...I've like, got this dude here...and like his hand, man, it's like totally fucked, dude!"
Dr S: "Um...What?"
Surfer Doc: "Ja it's like been stabbed, his hand, it's totally fucked hey! Can I send him through to you guys?"
Dr S: (trying to suppress the giggles and sound professional)" Well, I guess if his hand is that fucked then he most certainly needs to come through to us, dude!"
I had no freaking idea what was wrong with that patient, and accepted him purely on the basis that that the poor patient at least warranted an assessment by somebody who was not, like, totally fucked on marijuana!
P.S. Matt McConaughey: If it is you - Pop round to our casualty unit, preferrably topless. Give up this doctor gig you're trying out...it's not really your thing, thinking and all that. When you get here, don't bother talking, just pose. Flick your hair a little, and flex your muscles while flashing me a heart-stopping knee-quivering smile.Be a thing of beauty in this hell hole of a unit and give me a reason to rush to work every day!
Saturday, November 21, 2009
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!
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!
Monday, November 9, 2009
Retarded Referrals (1)
The front room in this secondary level hospital sees patients referred from the surrounding local day hospitals, and private GP practices.
Nobody, unless presenting in an emergency is supposed to be seen in our unit without a referral letter from a doctor.
However, sometimes we get referrals from retards pretending to be doctors.
(Yes, I said it,you read it, RETARDS)
(The referral letter being a self-written testament to their idiocy.)
I'm not the sharpest tool in the shed.
I'm not even marginally clever.
But compared to these blunt brained buffoons, I'm like a freaking diamond cutting laser.
This is thus the start of what is sure to be a series of posts about retarded referrals:
If you please....
Dear Colleague,
Patient seems frought with worry! I can't seem to elucidate what's on his mind?
He complains much of genital issues/? crying?/He didn't want medicine and is asking for a chest X-ray. Please see if you can manage.
Thank you,
Dr Retarded.
First lesson in retarded doctor school:
Do not even ATTEMPT a diagnosis.
Worry?
Genitals?
X-ray?
WTF is going on?!?!?!
For god's sake man! How about taking a proper history instead of raping the man of 200 bucks and then palming him off to someone else to do a proper job. You cannot refer a patient just because they want an X-ray! Did you even examine the man's penis? Or listen to his chest? Or look him in the eye? CARE a little bit why don't you!
Lick your right elbow while trying to bite your left ear and repeat after me:
"I am a retard!"
Nobody, unless presenting in an emergency is supposed to be seen in our unit without a referral letter from a doctor.
However, sometimes we get referrals from retards pretending to be doctors.
(Yes, I said it,you read it, RETARDS)
(The referral letter being a self-written testament to their idiocy.)
I'm not the sharpest tool in the shed.
I'm not even marginally clever.
But compared to these blunt brained buffoons, I'm like a freaking diamond cutting laser.
This is thus the start of what is sure to be a series of posts about retarded referrals:
If you please....
Dear Colleague,
Patient seems frought with worry! I can't seem to elucidate what's on his mind?
He complains much of genital issues/? crying?/He didn't want medicine and is asking for a chest X-ray. Please see if you can manage.
Thank you,
Dr Retarded.
First lesson in retarded doctor school:
Do not even ATTEMPT a diagnosis.
Worry?
Genitals?
X-ray?
WTF is going on?!?!?!
For god's sake man! How about taking a proper history instead of raping the man of 200 bucks and then palming him off to someone else to do a proper job. You cannot refer a patient just because they want an X-ray! Did you even examine the man's penis? Or listen to his chest? Or look him in the eye? CARE a little bit why don't you!
Lick your right elbow while trying to bite your left ear and repeat after me:
"I am a retard!"
Saving lives???
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.
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