Almost done at the specialist ward

Today I arrived at uni at 9am, as I planned. I elected to sleep in instead of going to the medical academic meeting. I spoke to one of the consultants en route to my ward, and then got crapped out by the reg for not being there at 8am. I tried to explain to him that I was only expected to be at the ward at 9am, but he wouldn’t hear reason.

The day was long and draining. We admitted 6 new patients for magnetic resonance imaging under general anaesthetic, replacement of gastrostomy or gastroscopy and sclerotherapy. I worked long and hard. My reg taught me a bit and then I got given a random tutorial which was really awesome. I then sat in my car for a while, then in traffic for another while.

2 days to go.

Today I didn’t arrive that late at the hospital. We saw our patients and then had tea. I left after we finished the discharges and the wardwork. I went to my podiatrist. I really appreciate how fucked up my feet are every time I see him. He just finds so many problems. My orthotics have been sent back to the workshop to get modified.

Last day at my ward at red cross tomorrow thank the good lord.

1 day to go.

Nearly Done with E2

I am not 3 days away from finishing my stint at the specialist ward at Red Cross children’s hospital. I have learned a lot in the ward. I felt quite frustrated at times. I found one of the consultants to be abrupt, cold and unpleasant to work with. I got shat on yesterday by quite a few different people for not following the appropriate hierarchy. In summery:
Never speak to a consultant unless they are speaking to you ever.
Never ask somebody who isn’t directly responsible for you for help unless it is for a resus
Never forget how low in the pecking order you are.

There are some very depressing patients in the ward. There have been two babies with spinal muscular atrophy type I. They pretty much stay in the ward on oral analgesia and antibiotics while we wait for them to die from chest infections. They can move their head a bit, and that’s it.

There’s a baby with opsoclonus myclonus. He just cannot stop moving at all. His mom dumped him and his elderly grandmother is worn out beyond words

There are others, kids with neuro-developmental problems that will never amount to anything and there parents.

It’s my formal this Saturday night. I will go, get drunk and enjoy myself with the few people that I like. Then we might go through to one of our houses in Simon’s Town where we will drink until we’re dead.

I’m struggling to fill the hours of the days.

The unbearable lightness of being

I’m at the end of the second week of my last block ever. I Feel very happy and excited to finally be getting this degree over with. I’m left, overall, with a bad taste in my mouth after spending 6 years with my class.

I’m at Red Cross Children’s hospital for the next 2 weeks. I’ve been placed for the month in E2 – the medical super-specialist ward. I complained thoroughly about the placement because I am not seeing anything common or useful. I also never take blood and am getting no practical experience in performing procedures. My complaints were heart, acknowledged and then nothing was done. On of the ward consultants is also on the course convening committee. She told me that I get more teaching and see more clinical signs than in the other wards, plus I am needed.

The work is generally quite laid-back, though it is subtly harrowing. One of the patient I worked with was a really sweet 7 year old boy. His mother got married to this preacher and dumped him with his grandmother who has her own children, one of which is younger than him. His a condition called prune-belly syndrome. They have abdominal wall muscle defects, undescended testicles and dialated tortuous ureters. Neither his grandmother nor mother are committed to him enough to ensure that he is able to spend the amount of time at the hospital required to get him stable in peritoneal dialysis and then get him transplanted and followed up. In summery, he’s going to die because nobody loves him enough.

There are other harrowing patients, but overall the ward contains a lot of hope. We have some bloody sick kids: Some child with jaundice, bilateral cystic kidneys, liver cysts, hypertrophic obstructive cardiac myopathy and neurological deficits. Nobody knows what’s wrong. We have a kid with familial hypertriglyceridaemia and pancreatitis on total parental nutrition. We have a kid with a urea cycle defect. We have a kid who thrombosed her renal arteries after a reimplementation procedure for renal artery stenosis. She has pneumonia, peritonitis and 2 necrotic, non-functioning kidneys. There are other kids with renal failure awaiting transplants that are better. One of the worst things with kidney transplants is that they only last for a maximum of 10 years.

I am no longer selling ADSL. The guy I was working with was the most unreliable and unpleasant person to work with. He “bought me out.” In truth I could have gotten a lot more money out of the arrangement, but I would rather just never have to deal with him again ever.

I am in need of love and attention. I’m finding it a very difficult thing to find. I try put myself out there as much as possible, but people are too tied up in their own lives. It’s difficult. I don’t really know what to do. It seems like there is little hope of things ever getting much better. I’ve just got to get through this next bit of uni, but things are highly unlikely to get much better once I’m done. I’ll have less time and less in common than my friends. Things will get rougher without reprieve or hope of escape.

Things I did do today and things yo didn’t do

Last night I realised that I do not sleep well at all if I do not shower before I go to bed. I woke up numerous times during the night and had a horrible dream at some point, though I do not remember what the dream was about. I woke up at 8, showered, ate and went back to bed and slept for 2 hours, which was awesome.

I had mad missions today. I went to one of my computer suppliers where I collected a 500GB hitachi 2.5” hard drive. I got home also went to the local shopping centre where I got a birthday present for my step mothers 50th birthday tomorrow and 2 pieces of A1 black card which I am going to make into posters for my room.

When I got home I was very upset to find that the hitachi 2.5” drives are thicker than standard 2.5” drives and therefore do not fit into the nice iSonic 2.5” external hard drive enclosures. I went back to the suppliers that sold me the enclosure. They couldn’t help me so I went to the suppliers that sold me the hard drive. I exchanged the drive for a Western Digital drive which fitted snugly into the enclosure.

I went to the university to pick up my internship application form and then went to a client who was having incredibly vague problems with her computer. I am going to sell her a new one. She was trying to get me to give her computer lessons, but I do not have the patients. At all. AT ALL.

I visited a friend of mine. It was very shit because another friend of mine was at her house having a meeting with her about an office he needed her to design for 45minutes of the hour that I had with her.

I went to my friends for shabbos dinner. There were numerous employees of my friend’s dad there. We had a discussion about fokofpolisiekar before the blessings. We also discussed anal sex at one point. During the benching my friend’s aunt’s baby was trying to sing along, but wasn’t singing. She was just making a noise. It was very cute and funny.

I went to the bayit for nag. Half the people that were meant to come didn’t. I had an average time.

I found a poem I really love. It’s called “Things you didn’t do” by Leo Buscaglia. It’s just so sad and beautiful. It resonates with a part of me that feels unappreciated and unloved. It also resonates with a deep feeling of loss with which I sit

Winter Camp

My last week of surgery was a little chaotic. I had no desire to study, no desire to

prepare my portfolio and no desire to be anywhere away from my bed. I had a osce on Monday, a project presentation on Tuesday, and urology oral on Wednesday and a practical and portfolio oral on Friday. After a long and hard battle I failed to convince the mazkir to sort out a flight for me to Durban on Friday. I was quite angry and frustrated with him, and told him so. It actually didn’t make much difference and in retrospect was probably for the best.

I packed my bags on Friday evening and caught the 7am flight to Durban. I was collected from the airport by a good and dear friend. We stayed at the Durban bayit until Monday.

I initially felt quite overwhelmed. There were many people there, most of which I did not know. On Saturday afternoon we went to the botanical gardens. Apparently people went absolutely mad when the mazkir suggested this. It was quite an average outing.

My friend and I planned a peula for Sunday afternoon. It was along the lines of the “worst peula ever” peula that was initially run by an Australian and I on Shnat 2003. It ran something like this:

Boring speech at the beginning about how I have not run a peula before and am feeling nervous. We then get them to write the name of their best and worst madrich ever on a piece of paper. We collected the pieces of paper with the names of the bad madrichim on them and placed them in the braai where we tried burn them but spilt water on them. We later read them and laughed.

The madrichim were then split up using huggie bears – huggie bears 12, huggie bears 11 (forcing them to ostracise on of the group members), huggie bears eye colour, huggie bears number of living grand parents. This created 5 groups. There were only 4 stations, so we left the floating group smoke nag. The 4 stations were discussions about what makes a madrich cool (persona, sex-appeal, rule-bending and favouritism). The discussions were poorly timed and facilitated by senior madrichim we put on the spot.

After this section we played bang and another name game as an ice breaker

They then had one of those walk around museums which had really crap quotes and lead down a narrow passage into a toilet.

We ran a meditation during which my friend and I changed into a mad costume – me in a latex mask of adolf hitler and he into a silly bathing costume. We then started making strange noises as the sikkum.

On the first night, while we were planning this peula I had my first laugh in ages. We made a quote which read “become the change you seek” after which I started writing mahatma ghandi, but then crossed it out half-way and wrote hitler. My friend then did a dance around his bead room in his underwear with a knife.

A friend of mine was hooking up with a girl 5 years his junior. I decided to express my feeling that he was being a bad example but going into his room, using a giant jerry can as a drum and telling him that he was sinning. This happened twice.

We discussed the idea of possible putting this one baby back into his mother for a time. We also considered attaching valcro onto her labia to keep the oven closed.

On Monday we went to the the camp site. It was the same camp site we used last year. I was in a chalet with the camp steering committee. In my room were two of my good friends. We set the nag up in the room. The 4m long pipe I used was perfect so that each bed had a nag. It was in this room that I had some of the most fun I have had the entire year.

For the first few nights we were just raucously out of control. People, mostly senior madrichim, came and we entertained them. We were mocking this one madrich, when his x-girlfriend said something very hysterical about him. We realised that one of our room mates looks almost identical to a mop, so we dressed a mop up like him and stuck it in his bed with the nag. We had a little party commemorating the 4 year anniversary of the onset of symptoms from my friend’s brain tumour.

I met some really cool people. One of the Bogrim 1s was just the nicest girl I have ever met. She just loved me! She understood that I was just a puppy dog and gave me love and attention and her boyfriend was ok with that and a really amazing guy. One of my old chanichim was very enjoyable. He used to impersonate his dad being a neurologist “walk for me!” which I just loved. I would impersonate this song one of the madrichim sang. We impersonated some prominent members of the WPZC.

I spent most of my time in bed. There were few kids and very few medical problems. I completed reading the Harry Potter series which I thoroughly enjoyed.

I also had quite a few meaningful experiences.

I finally spoke to that girl that I like. I had emailed her a few weeks previously and was really struggling. I told her how I felt and why. She listened and things seemed ok. After spending 9 days in close living quarters with her I was not coping at all. She was often around and friendly enough, but she wasn’t giving me enough attention which made me feel progressively more anxious. I would keep trying to get her attention by making physical contact with her which she understandably was not feeling comfortable with. She was express her discomfort which would make me more anxious. The last two days were hell.

I met a girl that really understands me and I understand her. I suppose that I knew that she would understand, but it took a while for me to speak to her. Eventually, on the last night, I had a really amazing chat with her about life. We just understood each other. I am not struggling not to be in hectic contact with her. I will not contact her until Sunday.

There was another girl who was just the biggest bitch in the entire world. I eventually head her story which is incredibly rough and then I found the good side of her; well a better side anyway.

I am now back at home. My laundry is done and I’m unpacked and settling down.

Money’s a bit toight. My car’s starter’s not working and I’m struggling to keep busy and sane.

Finally some understanding

I have done as was suggested to me. I took my closest friends aside and spoke to them about all that has been trouble me. I have asked them for help and told them what I need.

I have gained a tremendous amount from this experience. For the first time I finally understand what is going on. I understand exactly how I am stuck and why. The last piece of work required is to find another way.

Firstly, because of complicated factors I sit with unmet fundamental human needs. I need support, care, concern, love and human contact.

I have learned to give greatly of my self. I am able to receive and take, but I do not know how to communicate my needs to women effectively. The only method that I know how to employ is to give and show concern, which has the opposite effect to what is desired. It freaks the women out and drives them away at worst, or make them see me as a close friend at best.

The major problem, however, arises when I start to develop feelings for a girl; realising that she might be able to fulfil my needs. As the feelings grow and develop they resonate more and more powerfully with my unmet needs, which becomes painful and uncomfortable; like dangling a carrot in front of a starved horse, or like an itch that you cannot scratch. The feelings of extreme anxiety, loss and sadness grow worse and worse until I cannot contain them any more.

Then one of two things happen: I diffuse it by having an uncomfortable conversation with girl who is then left with the unpleasant and unfortunately choice of having to tell me she shares the feelings or not. She inevitably says she doesn’t share the feelings and then she feels awkward and does everything in her considerable power to get rid of me.

OR I leave her and move on, which normally doesn’t work the first option supersedes.

I wind up creating things that are so sad, terrible and beautiful; like the Elves. I fall for girls who don’t love me, love them until it drives them away and then cannot move on. The reason that I cannot move on is the hope created during the process; the hope that this women might be able to meet my needs, is all I have. To let go of that shadow of something that might have been is too much to bear because without it there is nothing.

I believe in truth; in life, too much is left unsaid.

I speak my truth calmly and openly because it is the only thing left to do when the hope is gone and the hollowness hurts horribly.

My truth is the searing hot spark that turns my reality into a blazing hell of pain

After time the blaze burns down and the scars remain, and the shadow of the hope sad, beautiful and terrible.

A pearl of wisdom

I have had an incredibly difficult day.

I woke a few times during the night and early in the morning. When I eventually got up I thought of the fucking amazing day at had yesterday and got straight back into bed. Yesterday I went to Jooste where I chose to go help out at the surgical out patients clinic. The doctor who runs the clinic had an American girl with him. She was not even a medical student. Just a completely random girl. He was being very flirty and talkative with her, but I didn’t mind. I just did my bit, helping him out, seeing patients, etc. I eventually saw a lady who need a benign, though large, tumour cut out of her inner thigh. Because I believe in thoroughly examining the patients I see I noticed that she was profoundly anaemic with a tachycardia and tachypnoea. I asked the sister if we could do a ward haemoglobin on her, but we couldn’t because the machine was broken. I proceeded to take blood from her to send for a formal haemoglobin. I’ve been taking blood from patients for years and I had very good reasoning to do this investigation. When I told the doctor he decided to shit me out for not getting his permission. I think he thought it made him look good for the american chick. What an asshole.

Anyway, so today I woke up feeling like shit. My university/work was terrible. My friends are all busy writing exams, my family are in a state about my dad having heart surgery soon, my time is free but I have nothing to do. I’m so lonely and bored.

I went to Kaya where I had an excellent chat with one of the counsellors. He suggested that I speak to my friends and people and tell them what I need. He also suggested that I speak to people to get feed back about my interactions with women. I then attended there aftercare. I had an issue with one of the patient who was being aggressive and trying to intimidate me, which wasn’t fun.

I went to the bayit where I had a nag. I then went out with a good friend for sushi. Then I visited one of my good friends who is down from Joburg. I had a long serious talk about how I am feeling. It was good to speak about it. In talking to him I realised why I haven’t ever been able to feel real closure with those many women who has caused me so much pain.

When I liked each of them they gave me hope of human comfort and understanding. It is the most that I have ever had. I cannot let go of the hope because the hope is all I have. I will only be able to let go of the hope when I have somebody or something to fill that small space of the vast emptiness within that is occupied by the hope.

The Creeping Doom

I have found it difficult to reflect lately because my life feels very empty and uneventful. It feels like the constant stream of medication I take to maintain myself. I have two blister-strips and one bottle. In the morning I take 60mg duloxetine. They are arranged in 2 rows of 5 tables and 1 row where the middle table is missing making 14 in the blister-strip. Each month the pharmacy gives me 2 blister strips and 2 tablets cut from another blister strip making 30 tablets. I can take whichever one I want from the blister-strip. Some months I take them in order, some months I make a pattern, this month I am taking them out at random.

In the evening I take quetiepine 100mg and phenergan 25mg. The quetiepine comes in blister strips of 10 arranged in two rows of 5 tablets. I get 3 blister-strips. I normal take them in rows of 2. The pherergan comes in a plastic bottle. I feel bad because I have a draw of plastic bottles that I cannot recycle. I sometimes take 50mg of phenergan if I really want to sleep well. If I need to wake up very early and not sleep much I don’t take the phenergan.

Sometimes I forget to take the duloxetine in the morning. I always put it out on my bedside light’s stand the night before. Sometimes, when I wake up, I see it but I roll over or get distracted and then forget to take it. By early afternoon I can feel that I have forgotten to take it. When I move quickly, especially if I move my head quickly, I get a shooting sensation through one of my arms. It is painful or pleasant. This gets worse if I miss the medication for two days in a row. I rarely miss my medication though, I think that I am more than 95% compliant.

I never forget to take my quetiepine. I cannot sleep at all without, not matter how sad, tired, depressed, despondent, exhausted, or sick I feel I cannot sleep for one “millisecond of a motorcycle wheel” without it. It has been like this for over 3 years.

In the morning I wake up. Half the time I feel sore. This is when my joints feel achy. It’s not an arthritis problem, but a psychosomatic manifestation of my illness. It normally goes away within 20 minutes, sometimes it doesn’t. Other times I wake up feeling tired. I often wake up feeling lonely. There is nothing that I look forward to when I wake up.

University is very unstimulating at the moment. I am doing surgery. I spent a month at groote schuur of which 3 weeks was spent in the breasts, thyroid and sarcomas firm. This involved busy interesting days on Monday and Tuesday and quite chilled Wednesday, Thursday and Friday. In fact, I haven’t gone in on Friday for over a month. I am not going on on Thursday at the moment because it is just tutorials and lectures and I don’t give a horses ass. I feel bad. I feel that I am missing out on something.

I have been studying medicine for more than 5 years and I know that I am not missing out on anything. I am missing out on those lectures that I was forced to attend last year. The lectures that I was bored in and resented last year. I am not attending them.

Tomorrow I will go in at 10am because there is a lecture from 8h30 to 9h30 by the vascular firm. Vascular surgery is one of my least favourite topics of discussion. At 10am I will present my scrawny Jewish ass to the orthopaedics outpatients clinic at G.F. Jooste Hospital where the consultant will, as he did last week, scream at me to shut up whenever I try to answer a question. I will not care about his verbal abuse and continue to try to learn orthopaedics. I will then go home.

When I am at home there are a few activities which I use to help fill up my days so that I don’t go any more crazy. I am devouring Harry Potter at the moment. I spend a substantial amount of time every day reading Harry Potter. Reading Harry Potter has no long term benefits. It just serves to fill the vast, nearly overwhelming emptiness. I watch TV series and I play computer games. I am currently playing Warcraft 3’s Frozen Throne expansion on hard. I am on the first level of undead. The online tutorial I had to use describes this map, along with most of the other maps in this campaign as either almost impossible or impossible. I find that far form motivating, but it does fill time.

I also spend quite a bit more time than I am used to cleaning. I clean my room, sort things, wash, dry and pack away dishes, just because it fills time. It also provides a false sense of maintenance. I am maintaining my… erm… room therefore I must be maintaining myself and my happiness. This is quite the contrary.

I spend a significant, though small, period of time every day trying to communicate. I send text messages to my friends. I send a message to a girl I really like every day wishing her well for her studies and exams. My relationship with her at the moment fills me with pathos and sadness. I know that she does not have feelings for me. I also know that there are complicated reason why we will never be together.

There are other girls with whom I communicate less frequently. The content and feeling are the same. I barely even expect a reply.

I try, whenever possible, to socialise. I attend aftercare at Kaya on Wednesday afternoon where I contribute greatly to the group therapy. I smoke nag with some of my friends and go out for dinner with others. I speak to them, try to laugh and tell jokes. I try to relate my experiences with them in a positive way.

The mantra I find myself saying to myself more often then not is “There is nothing.”

My problem is that I have hope. My hope is unreasonable and irrational. While, in this period when most of my friends have exams, I feel isolated, lonely and forgotten, I maintain hope for unreasonable things happening. I still clutch with the remants of my will onto the hope that girls whom I have chased for years will like me. I hope that girls who have rejected me, insulted me, scorned me, ashamed me, humiliated me, betrayed me and then forgotten that I exist will like me, will communicate with me, will contain me and care.

Why do I hope for that which is impossible and would damage me beyond repair, when I cannot believe or understand that tomorrow might not be another hole in the threadbare cloak of my soul.

The Uni Gap

Yesterday was my first day back in the breast, thyroid and other tumours firm. I had a decent time in trauma but it was nice to be back. I arrived at 7h15 for the post-intake ward round after which we had patient allocations and then a tutorial by the head of the vasular firm who felt that it was completely justified to open two Fogerty catheters, the cheapest of which was valued at over R1000. He openned them just to show us and probably threw them away afterwards.

After the tutorial I went to the medical school library where I took a fantastic crap.

I then went back to the hopsital where I saw a 28 year old male with with treatment resistant immune thrombocytopaenic purpura. He had a strong smoking and ethanol use history and had facial features of fetal alcohol syndrome. He initially presented to a second level hospital with epistaxis echymosis and rectal bleeding. He has been at Groote Schuur for the past month and is currently on predinsone 2mg/kg/day and still has a bicytopaenia with platelettes between 5-10 and haemoglobin between 5-10. He has undergone numerous transfusions. When I examined him he had 2/6 ejection systolic murmer and tender hepatomegally extending 1cm bellow the costal margin. The total liver span was 6cm. He liver was smooth and non-pulsatile. He was pale.

The second patient I saw was a 48 year old female with a strong family history of breast cancer presenting for sentinel lymph node biopsy and radioisotope occult lesion localisation. The tumour was found on mammography. Histology and cytology point towards it being a grade C3 papillary carcinoma. She also had a single thyroid nodule which will be investigated after the surgery.

I went to the computer labs for a while. I printed some documents for my meeting with the dean on Friday and I work on something for a friend. We had a ward round after which I went to a friend to help him with a computer problem, then I dropped my phone charger at another friend.

I went to bed quite early because I had had a late night on Sunday.

Today I assisted in the S ROLL which was very smooth. The surgeon removed the tumour and we found the sentinel lymph node which was radioactive and blue, but did not have malignant histology. I took a break then I watched a massive spleen being removed. I went home just before the ITP guy’s procedure started. He had had plasmaphoresis and was transfused with platelets and blood.

I am not going to go in for the rest of the week because there are just lectures and tutorials and I don’t pay attention in them. I need to go to aftercare. I need to get a better handle on my surgical studying and I should write up my patients. It feels weird. I feel bad, in a way, or not going to uni. I also feel like it is completely justified because I cannot handle any more boring lectures or tutorials.

Things are difficult at the moment

I’m feeling pretty low at the moment. I feel miserable, cynical and petulant. I am bored with my studies. I feel boring. I feel like I am struggling to make conversation with people. I feel uninteresting. I continuously feel let down by the social interactions that I struggle to organise.

I feel useless and worthless. I know this is a completely absurd statement, but it’s how I feel. I am know that I will be a doctor soon. I feel skilful and able to be a important and helpful part of any hospital team, but, at the same time, that doesn’t seem to matter.

I am so incredibly frustrated by my relationship issue. I am tired of chasing shadows and I am tired off all my shattered dreams, yet I do not know how to move on. I don’t know whether to run away or run towards.

This are difficult at home. My dad has been quite down lately. My step mother has been going through her own stuff with her own family.

This past week I rotated through trauma at Groote Schuur hospital. I generally had freakishly quiet shifts. I met good, friendly and kind doctors who taught me and treated me well. I was able to help out and felt part of the team.

The best that I have felt all week was after I had been awake for about 27 hours and donated blood. I was over tired and found my long lost sense of humour, for a while. It is now gone again.

I help sort out a friend of mine with a new PC and got another friend of mine an external IDE laptop hard drive enclosure.

On Monday I saw one of my friends and his partner for supper. On Tuesday I took myself out for a movie and saw a friend who came over to collect some computer hardware I had collected for him. On Wednesday I gave a friend a lift to the airport. On Thursday I was meant to see one shadow but, predictably and very frustratingly, she cancelled. I saw another shadow afterwards then I worked for the whole night. I slept the whole day on Friday and then worked from midnight to 8.

I saw a few people die. I saw my first rape patient. I saw people in agony.

I am struggling so much. I feel so alone. I waste vast amounts energy keeping myself going and chasing after my friends and shadows.