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...
Tuesday, December 22, 2009
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.
Saturday, November 7, 2009
Pregnant? The patient's guide to parenting.
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.)
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.)
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.
Subscribe to:
Posts (Atom)
LinkWithin
