What is in a name?

Today has been quite an eventful day. I struggled to wake up this morning and arrived late to lecture on lower GIT bleeding, which was interesting. Then we had a long gap in my timetable. I filled out a questionnaire to be part of a study where they do an MRI on you and give you opiates and pay you, which should be interesting, though I am worried about taking opiates.

My clinical partner told me that he wants to work with somebody else next year, which I thought he would. It’s still a little sad, but whatever.

The beautiful Christian chick from my course came back from her holiday today and is still looking beautiful. Another girl from our course is getting married – which I find quite hectic.

We watched 3 videos in the E23 library. One on gastroscopy, one on colonoscopy and one on endoscopic retrograde cholangiopacreotography. The gastroscopy one was a combination of rough and funny. I cannot believe how much pipe they can stick up somebody ass. I ate sandwiches during the colonoscopy one.

I got home at about 12 and had to finish this thai green curry that I made on Sunday and accidently dyed luminous green. About 20 minutes ago a found out something very funny that happens to your feces if you eat too much green food colouring.

I sorted out a lot of stuff with regarding our ADSL resale company. We registered easydoesit.co.za which is going to be our company named. We commissioned a website and finalised our ISP.

The search for the name of our company has take 4 days of constant thinking and whois queries. We started off on Friday by getting really exciting about registering lank.co.za . It then came to our attention that it was quite an immature name for a company. We tried out lots of other names but none of them had… I don’t quite know the word for it… It’s like this positive, vibey good feeling… a feeling of rightness.

Anyway, I eventually came up with easydoesit.co.za, which was free and we grabbed it and are happy

Lectures tomorrow, aftercare, need to see a patient, all’s good

Psychotic sister

It’s been quite a while since I’ve blogged. I was away in Durban being a medic on Habonim’s winter camp. I had a really fantastic time, met lots of cool people and relaxed. I’m in the process of setting up an ADSL resale company with one of the people I met. I spent most of today getting quotes from wholesalers.

I got this phone call from my mother this evening right before supper which was really irritating, typical, worrying, disempowering and enraging. She started off by telling me that my sister is really not doing well at all. She described how her obsessive compulsive disorder was getting worse and that she practically cannot do anything without having to go through a million rituals and that she has started to get paranoid.

At this point I started thinking about a list of worrying diagnoses. Then my mother started trying to talk about how she was trying to talk to my dad and I had to put my foot down.

For years I used to be the person that my mother dumped the stuff she was carrying about my father. This destroyed my relationship with my father and fed into my anxiety and depression to the extent that it nearly destroyed me. I will never play that role again, no matter the stake.

I put my foot down about it which caused my mother to end the conversation quite early and abruptly.

In my head I have a picture of myself rocking up at that filthy hole they call a house with the police and saying in a loud, calm and clear voice. “Alright, this is over.” Finally, once and for all, over. No more of this chaos. My psychotic sister is taken by the police and institutionalised She receives appropriate antipsychotic therapy and cognitive behavioural therapy and eventually is able to live a normal healthy life. My mom, freed from the burden of having to care for my ill sister and now without anybody to feed her mutual separation anxiety and illness rediscovers painting, which she used to do years ago. She suddenly gets re-invigorated and comes out of her 20 year long depression and clears her life out. Over time. A few years my family heals back to functionality and normality.

Out of my head that does not happen. It is not my place to step into my mother and sister’s home and fix their chaos. I do not know how to help my sister and my mother. My opinion on the courses of action that they are currently undertaking is clouded by my negative opinions of them and what I hear from my fathers. My gut instinct see’s me going into my sister’s psychiatrist’s practice one day and having a very serious discussion with him about inappropriate management of his patient, then reporting him to the health professional’s counsel of South Africa. My mom is unsavable and my sister… who knows?

The rest of graveyard week at Jooste - days 7 - 9

There were themes for each of the evenings that followed during my shift.

The Tuesday evening / Wednesday shift’s theme was psychotic patients. There was a man who, when I had just arrived, needed to be pinned down onto the floor and given diazepam to sedate him because he was going through delirium tremens. After 55mg he was still not adequately sedated. One of the doctors that I am not working with, who  I have grown to respect quite a lot, stayed quite a few hours after the end of his shift because this patient was not being managed properly. By the time he’d left the patient had had 70mg of diazepam, 10mg haloperidol and 25mg of phenergan. We had tied both his arms and legs to the bed.

There was this psychotic woman in red who drove me insane the entire night. She paced around and asked annoying questions. She took things and did things that were disruptive and cost money to the hospital.

I saw two psychotic patients and a few others. The one women told me she was the present of south Africa.

By the end of the shift I was furiously irritated by the fact that these desperately ill psychotic patients were dumped at Jooste hospital where they were abused by staff, assaulted and abused other people, caused disruption and don’t receive the care that they needed. I spoke to one of the consultant physicians about it.

The next shift’s fun theme was TB. I saw a patient with mono-drug resistant TB abdomen and another serious TB patient with his whole left lung completely fucked by active TB. I really laughed at the emergency medicine registrar who works with us. She said “this man has TB like it’s nobody’s business.”

A patient that I had taken arterial blood gas from died in the toilet a few hours after I had seen her.

I did a lot of ECG and did stuff from the Jimmy

There was a patient with a head injury who was absolutely fucked. He walked around shouting in Xhosa. He stole things from other patients and wondered in and out of the resus cubicle I eventually got a security guard to watch him and make sure he stayed in the surgical holding area where he belonged. There was another psychotic gentleman with a broken leg who went around the entire casualty department including resus trying to by loose cigarettes from 20c each.

On Thursday night the theme was seriously ill patient. We had numerous diabetic ketoacidosis patients come in. One of them was this 16 year old girl who had been discharged directly from high care the same day she came back. She ha had a Ph of 6.9 and a base deficit of 29.8. she also had no veins. I helped a doctor put a line up in her neck. Later on, during the post-intake ward-round I watched them putting more lines in her and held her hands.

Another few DKA patients came in. We had quite a few myocardial infacts.
I did a lumbar puncture, put on a pop for a fracture patella and  did a therapeutic and diagnosistic peural tap on a patient with a fuckload of MDR-TB. I saw a man with atrial flutter ?mycardial infarction.

There was this hypersexual psych patient who was doing her to “look sexy” at 6am and who later pinched my inner thigh while smiling sin at me. It was very freaky. There was also a psych patient masturbating during the ward-round.

I was asked to do an ECG on the granny. When I went to her bedside her tongue was sticking out and when she tried to breath there was snorting increase of pressure before she would breath out with her tongue out making that funny farting noise. I was laughing quite a bit, then I asked the doctor if he knew that patient wasn’t protecting her airway, he said no and came to look. She was hypoglycaemic because her line had come out and we had to resite the line and give her iv 50% dextrose. She perked up and got much better.

The Graveyard - day 6 at Jooste hospital

Ok, for this week I am working the graveyard shift, which runs from 11pm till about 10am.

I arrived at Jooste just before 11 and we had a quick wardround. I sent of a woman’s sputum for cytology and tb cultures then I saw a 74 year old female with no past medical history now presenting with a left middle cerebral artery cerebro-vascular accident. She had decreased tone, decreased power and brisk reflexes on her right and a left facial palsy.

I saw a gentleman who was a MVA pedestrian. He had numerous abrasions, some of which required stitching, but was ok.

I also saw a gentleman who was stabbed in the pinky with a machete because he was sleeping with somebody else’s girlfriend. His finger was partially amputated but was still neuro-vascularly intact, so we sent him to the Groote Schuur hand clinic in the morning.

I then saw an incredibly confused gentleman who might have been assaulted. He was very wasted and had bruise on his right upper eyelid. He told me that he was at Somerset hospital and that it was Friday in march. He also said that he was in hospital because he liked getting drips and that he planned to stay here for a few years. On examination there was no pathology found. I think he went for a CT head today

The next patient I saw was also confused. He was disorientated to person, place and time. He was referred from the day hospital with a 2 week history of confusion and forgetfulness. On examination he was clubbed and wasted. He had epitrochlea and submental lymphadenopathy. His lower lip was discoloured.  His cardiovascular, respiratory and abdominal exams were normal. He had cerebellar signs and a glabellar reflex. I gave him a thiamine drip, pulled some bloods sent him for a chest x-ray and said he needed an LP.

I did quite a few other procedures. It was good, productive night.

The ward round went on forever the next morning and then I needed to see the partially amputated finger guy again, but he was outside and I eventually had to go find him so that I could write more notes in his folder before we sent him off. I learned a lot during the evening.

The Betrayals

A large part of the tremendous change that I have undertook of myself in the past 8 years has been about developing an appropriate sense of self-confidence and interpersonal behaviour.

Before I started this long process of change and “healing” I did not really interact with other people. I had been hurt and betrayed by my parents and peers a like during an excruciating and traumatic childhood and I had generally had enough of trying to make friends and socialise. I know my parents meant me nothing but good, but shit happens and I have forgiven them. If there were people I was attracted to fear and anxiety controlled me and prevented me from doing anything short of looking like a idiot.

After my time in Kenilworth clinic I started a rapid process of reintegration into society. At the time I had long hair and gothi. I walked around in black clothes and trenchcoat, but I was out and exploring. Every personal interaction I had brought meaning to my life. I was a wild, crazy, extroverted enigma; always carrying my nargilla with me and cracking jokes.

Deep down, underneath I remained sensitive and was able to subtly use that to play crowds quite well. Under the right condition I could be the centre of attention of a large gathering. I suppose I still can, though I rarely venture down that road anymore. I crack jokes, tell great story and am full of witty chirps.

I had successfully changed school and integrated myself into life at Abbott’s college I was happy and matriculated well. I was accepted into medicine in order to help people. People were my higher power, the race of humanity. Those who fed me emotions and made me feel alive. Those who fuelled my recovery.

I went away with my oldest and dearest friends on my gap year, Shnat Habonim; Shnat hachsarah v’hagvurah. I declined my application to medicine and went. I was anxious and had discussed it with the people at Kenilworth clinic. I trusted most of the people I was going with. I had no idea what to expect and I found myself in Israel among the Australians.

I loved the Australians and they loved me. There are people from that cohort that I miss and wish I could live with – still, 5 year later. Then one day it rained chaos, hell and balefire. The program coordinator gave us the option to leave the Ausies and go our own way. I knew how the Ausies would react, but I allowed myself to be spoken down and we decided to leave them.

The rage and hurt leaving them caused tore my psyche into shreds. People that I loved more than other turned on me, shouted at me, verbally abused me and it was my fault. I had the power to have changed things, but didn’t for the good of the group. Humanity – my higher power had betrayed me. They treated me unfairly and unjustly. They were insensitive and they hurt me deeply, raking open new wounds.

For the week the followed leaving the Ausies I was a complete wreck. I slept a lot and felt anxious. Our small group of 9 grew together. He had our good times and our fights, but the damage was done and it was not worth it. For the first time as I write this I realise that I regret this decision. That’s two. I regret what happened with Spidey and I regret leaving the Ausies. It was within my power and it was not worth it leaving them.

After I got back from Shnat; hair cut short, gothi gone; the camp I had to go on was a little piece of hell. The girl that I loved for years was working with me. She hooked up with our Israeli in my tent, every night. I missed the Ausies and I didn’t know where I was going to live after camp. I had told my father in no uncertain terms that I did not want to move back home with my mother. At the time he was living in a bachelor flat. I had stayed with my neighbours the 2 days we had between Shnat and camp. I couldn’t go back there. My best friend betrayed me by not having time for me. I needed him, but he had other responsibilities.

Medicine was difficult. After Shnat I had a lot of social confidence and hoped and believed that I would meet more amazing people. I met a girl and fell in love with her instead. The people who study medicine, with some exceptions, fall into 2 categories: Religious nutcases and very competitive bastards/bitches. I don’t like either of those cohorts of people. So for the first year and a half of medicine I hung around the girl I love and her friends. I eventually wound up feeling like a puppy-dog chasing after its owner; pathetic.

I was working too hard studying and wound up going back into individual therapy at the beginning of 2005 and by mid 2005 I was back on hardcore medication. Kenilworth clinic – those who destroyed my previous personality and rebuilt my current one erroneously lead me to believe that I could do it without medication – and I cannot; the anxiety is too much much – its like a burning all of liquid fire and freezing ice burning out of sight into the sky and washing over me, taking away my breath, my thoughts and my hopes and with it comes it friend.

My depression is bimodal. I have an anxious depression which is subtle. I am well versed at dealing with myself and my feelings and it sometimes can take weeks for me to admit to myself that I a depressed and in need of help. The main sign is sleeping I sleep more and feel body pain more than normal, the classic signs like loss of social interest, anhedonia, etc are still there, but they are within me and the change is subtle. It’s something that is bearable and unnoticeable if it lasts for days or weeks, but prolonged it is not compatible with life.

The other less common form of my depression is an emptiness that knows no bounds. It’s a stillness of mind, body and sole that stretches off as a grey cloud concealing every colour into dull tones and blanketing out the sounds of the world. It feels like that look in the actresses eyes when she is stabbed fatally moments before completing her life’s work, the pleading desperation in her eyes unexpressed by her quivering lips, her limbs flailing uselessly as she falls down dead and empty.

But why? Why did my depression and anxiety return with such avengeance? It did so for the simple reason that it did. Yes, there were numerous extraneous and internal factors at the time like miserable home life, loving a beautiful girl who had the maturity of 10 year old and didn’t share my feelings and made her and all of her friends stop talking to me from one day to the next, loneliness, lack of motivation to study, etc. Betrayed by my own body.

Bottom line is that I am ill. My biogenetic make-up has imbued me with the superpower of major depressive disorder. I will be on medication for the rest of my life. I will have major depressive episodes. I will have anxiety. I will deal with it because there is no escape.

As I said earlier, but I feel I need to mention it again, I told the girl that I love how I felt. I spoke about her for session after agonising session with my psychologist. I knew that she didn’t feel the same. I was no longer in denial about it, but I thought, mistakenly, that she was a sweet human being who would deal with me gently. I was so painfully wrong. I was shaking with anxiety while I drove her to her Rosh Hashanah venue. I told her after I parked for her to get out and she said “Don’t say things like that.” Betrayed again

University got worse. The people who I had called my friends, from 1 day to the next, stopped talking to me. I had been betrayed by my friends. The shit thing was that for the next 12 months I was stuck in a group with them and a bunch of other people that I generally did not get on with.

It was during that time that I was forced by the awkward painful space I was trapped in at university to redevelop myself. I started carrying a book around with me at all times. I read the wheel of time and other fantasy books. At the soonest possible moment after a compulsory activity ended I would run away from the little flaming hell I had created for myself and found a corner to read. I learned to be independent of other human beings and their feelings, irrationalities and betrayals, though that lonely empty part of me that characterised my previous borderline personality ached more I become more independent.

At the end of 2005 the last and final betrayal came and it nearly killed me. During 2005 I had invested a lot of time and effort into Spidey and we were very close. This was all telephonic and over the net because she was now on Shnat. I asked her what we were going to do about it and I scared the living crap out of her and she never spoke to me the same way again. She returned at the end of the year, still feeling awkward as well and still as mature as a new born caterpillar and she ignored me.

My youth movement had empowered me to run the kitchen at camp; a job that I would never have been able to prepare for. Each day at camp I would be verbally abused from dawn till dusk, then after the quite calm of night settle in over machaneh neve shalom I would run to my tent, unable to go relax with my friends because Spidey would sit there and break my heart to burning piece of death. My youth movement betrayed me because they needed somebody to do an impossible job and I was willing.

For 6 months after machaneh I was a wreck. I didn’t see people. I didn’t talk to people. I didn’t do anything. One day I got home from university to find a big fuck-off mountain fire burning so close to the house I was living in at the time as a care taker that I could feel the fire’s heat easily from the front door. Once a helicopter’s waterbomb landed on our lawn. Fucking close. Anyway, so I got home and Spidey was there. I went and did work on my computer, then I walked out to see the fire and saw The Enemy kissing her, the girl I loved, in MY HOUSE! I cried and I went to bed and wrote a note for my door saying “Do not disturb me unless the house is on fire.” Then, yes, you guessed it, somebody disturbed me. Friends from university came to visit and then I locked my keys in my door. The next day I was forced to go to university to watch a movie called “whit.” It’s this really awesome movie where you get to watch Emma Thomson die of cancer – in graphic, soul destroying detail. I sobbed like a little girl, went to a friend for supper and then got home to find spidey and her new toy boy waiting for me.

We had a fight; you know, one with fighting and saying mean things to one-another. There were 2 points that made it different. Point one was that I didn’t say anything mean to her and she said the single most hurtful thing any human being has ever said to me “I used to think you were amazing when you were with !%#$- the perfect guy, but now you’re just fucked up.” Secondly half the stuff she was saying was untrue; lies to try and make me go away.

It took me a year-and-a-half to finally sit down with her and speak about our feelings honesty. I jumped around screaming for an hour afterwards. It took me another year and her being a complete bitch to me to apologise and start treating me decently.

Things have been comparatively better since then. At the end of 2006 I moved in to a house with my father and stepmother in edgemead. It was good to move out of the youth bayit. I was finally able to put huge distance between Spidey and myself. In 2007 I was able to submit a written request to not be placed in the same university group as the girl I love.

There were more betrayals, but they have gotten easier to bear. The other day I even managed to get rejected by a girl I like without even feeling bad.

Since my time in Kenilworth Clinic in the winter of 2003 where my entire world, soul and personality were unmade by shear force of will it has not been an easy ride.

I care deeply about my friends and I always will, though most times I do not feel like seeing people. I spend a lot of time sleeping and reading and a lot more time feeling alive and directionless. There still exists a huge emptiness inside me. It is as much a part of me as my humour and my emotions. When I am busy I am happy, but I struggle to find internal motivation to create and strive. When I am idle I do not feel driven by the emptiness to fill it anymore.

That’s not entirely true; often, late at night, before I go to bed, I will hold my cellphone in my hand and think of a beautiful, intelligent and/or funny girl to sms and hope that she will give me some hope. Often I fight the feeling down and put my phone away. Generally the emptiness rebreads itself. It sits there like some monolithic tribute to my failure to find a mate, to the betrayals that stood testament to the naivety of my shattered dreams. It can cripple me and make me feel like lying down and dying.

I have many things that I must force my self to do. I manage to get myself up every morning, to dress and clean myself, to go to university and help others. I push myself to study, to go out, to see people, to do much, but, without a shadow of a doubt, the hardest thing that I have to force myself to do is to walk away from the hopes that those women who I loved and who betrayed me will sms me, call me or whatever and say “I am sorry. I miss you. I love you too. Everything’s going to be alright.”

There are, however, two fundemantal problems with the above hope.
1.    Everything is not going to be alright – bottom line we all suffer and die, its a slow subtle process that is best past unnoticed, focussing on the small victories among the great defeats
2.    They are not sorry. None of them and they do not miss me or give a flying fuck. Neither shnicks, nor spidey nor BYT, nor Lolita, nor Alia of the knife, nor Gebsta, nor my dear long lost schizophrenic love. AND THEY WILL NEVER!

So now sit here in my bedroom in my house in Edgemead. I am cold and contently full after supper. I have my desk and bedside lights on and my room light off. I am wearing grey fluffy slippers, white socks, black cargo pants, a quicksilver belt that I have been planning to scrape the logo off for ages, red briefs, red t-shirt, red polar fleece zip-up tracksuit top. My glasses are dirty and my ankles are sore from the pressure of sitting cross legged. My back hurts from my bad posture. My father is washing the dishes an my step-mother is pottering around the house somewhere. It is cold.

I look around my room and see all of the material possessions that I have collect around me. My computer, the big wooden desk my father gave me. My bookshelf with a row of university books a row of leisure books – mostly fantasy. My bottom shelf with a 70cm pile of old Mad Magazines from my adolescence. A shelf of computer game boxes from back when they made computer game boxes and another shelf with other crap. My clothes, my bed, my draws.

This stuff means so little to me and is all replaceable. I spent time cleaning everything and making it neat to fill my empty time. I cleaned my car. I polished it until it shone and I could see my reflection in it just to fill the time. I tutored a beautiful 17 year old girl that I am not interested in so I could earn more money to spend on more shit, or more likely petrol and food.

I can go out for dinner with friends; eat tasty food and feel that nagging emptiness asking me: “Is this IT?” When I was younger I used to feel so fulfilled and excited by just seeing my friends on the weekends, now I feel nothing but let-down. My emptiness laughs mockingly at me and I grin cynically

Who is this empty shadow of a man that I have become? I have born witness to horrors in my life beyond description. I have survived and endured despite the guarded outlook I was given at Kenilworth clinic. Some would argue that I have not survived but succeeded and achieved much.

My medication controls my anxiety to the extent that it is not there most of the time. I need to take medication to sleep. My body hurts me. My joints! My skin! I want to crawl out of my own skin and be free! My medication controls the pain. I reject the yuppie flu / fibromyalgia / chronic fatigue syndrome label.

I ask that I may find somebody to share my life with. Somebody who can understand me and stimulate me and care for me. Somebody who is stable, well adjusted and caring. Should this not be possible I ask that my desire and hope to find this person be removed from me so that I can get on with existing until I am granted my release.

I have found a form of strength in my old age. I am a caring and sensitive person without any spite. I have found my spirituality and sometimes some quiet peace. So help me god I swear it upon those who I love that should you betray me, with intent,  I will destroy you utterly and completely so that you live and exist in unspeakable agony for countless miserable years. If you mistakenly betray me I will walk away and never look back.

Grace, grant me the strength to walk away from those who I loved who betrayed me.
Grace, grant me the courage to forgive those who loved me and betrayed me
Grace, grant me serenity to wait in until I find somebody with whom to take comfort and hope.
Grace, when the time is right, grant me the freedom I have sought for so many years

Severe Illnesses day - Day 5 at Jooste

I really struggled to get up on Friday. I arrived at Jooste at 9h20 and still found the ward-round nowhere near finished.

After the ward-round finished I spent some time doing ward-work. I took an ABG and VBG from some patients and took some bloods. I put up drips.

I saw a 33 year old severely wasted HIV+ TB+ patient who was suffering an acute deterioration of function. He complained of leg weakness. He had a cough and was leaking urine unintentionally onto the bed. He also defecated on himself a bit. After quite a struggle I managed to get a nurse to do a dipstix and found out that he had HIV associated nephropathy. His blood gas showed that he did not have a lactic acidosis. It’s also possible that he had developed MDR-TB

I took a very breathless woman to the side-room to do femoral venepuncture on her. I initially did try take venous blood from her but she had shit veins. She was very short of breath, possibly gasping, and very confused once I got her to the room. I hooked up her oxygen and eventually managed to get the blood and get her back to the asthma corner where she was sitting. I told the doctor that she was very confused and I thought she was retaining CO2.

A few hours later they found her lying dead in the bathroom.

It got very busy later on. There were patient lying on stretcher on the floor. There were no psych patients that required sedating. A gun-shot abdomen came in and was placed on the floor of the resus room for a period of time.

I asked the doctor running the rotation if I could join his rotation for the rest of the block. I will be working the graveyard shift for next week

Psych patient day - day 4 at Jooste Hospital

Today I woke up tired. I decided to sleep in for an extra bit of time. I made it in by 9 and the ward-round hadn’t even made it through the all the patients in beds – not even nearly. This made me feel really frustrated. The ward rounds go on and on and the patients just lie around sick. The doctors who do the ward rounds do not talk loud enough.

Anyway, so somebody asked me to put up a normal saline to flush the blood out of a transfusion line, which made me feel much happier. When I arrived at the hospital I noticed the place was smelling decidedly worse than previously. Now, Jooste is a fucking hectic hospital where there are normally patients soaked in urine or faeces, if not vomiting and unwashed. It normally smells bad enough to make a beginner take a step back, but it was smelling noticeably worse, which is something. The smell was something gently disgusting, sinister and pervading and I found it when I went to fetch the normal saline. The very thin guy who was not for resus yesterday had passed away and his corpse / body was smelling something terrible. It took an unacceptable amount of time for somebody to come collect the body – god knows what the patients were thinking.

I helped with ward work. I put up drips and took bloods. I did another plural tap.

I saw a 57 year old gentleman who had had previous spinal fusion (L5/S1).  His presenting complaint was that he stepped on a rock and then lost all power and sensation in his lower limb. He also complains of lower back pain, having about 2 blackouts a day – where his sight goes black and he has to sit down and having fresh blood pr when he wiped his ass. I did a thorough exam on him and found nothing. I mistook his liver and spleen for being enlarged, but it was secondary to hyperinflation caused by smoking. I mistook his JVP for being up but it was actually his prominent carotid. The PR was disgusting but unremarkable. I could feel all these little pieces of faeces in his rectum but struggled to get a piece out for the faecal blood sample. The doctor to whom I presented him must later in the day thought that his blackouts were secondary to impingements of his vertebral arteries by an osteoporotic canal.

I saw a man of similar age who presented with sudden onset dizziness. He had dysarthia, expressive aphasia, progressing weakness in his right upper limb, absent knee jerk reflexes in his left lower limb and right lower motor neuron facial palsy. I examined him with a very nice doctor and we did tests on him.

There was a psych patient who screamed “Why did you give me the wrong pill” “Im just very hungry” “Give me water to vomit” “I don’t understand what you are doing” at the top of his lungs for 6 hours, then we gave him a valium injection and he went to sleep. I dripped him and sedated him myself.

Another psych patient came in that I helped sedate.

The liver woman from yesterday, that I actually wound up calling last night to check if her kids, was encephalopathic today. She told me that she came in from some dorp this morning and was restless and psychotic the whole day.

There was a man in resus who had a medial pneumothorax and some very hectic surgical emphysema.

I was busy all day and had a good and interesting time I left at 16h00 before the ward-round

Getting tired - day 2 and 3 at Jooste

Yesterday was a long and hectic day. I arrived early and helped out a bit around the ward before the ward round. The round was exceedingly irritating. The doctors spoke exceedingly softly and  I couldn’t hear anything unless I was right next to the consultant. During the round I was given random bits of ward work to do, which was cool. I sited some drips and mixed a thiamine drip for a patient.

During the day 2 psych patients had to be pinned to the floor and sedated for being aggressive. One of them was a guy I was dealing with. A work colleague had a fishy story about him needing to go to green point to sign something, but he was insane. It ended with a security guard sitting on his face while we gave him 20mg diazepam. Another patient claimed he was Thabo Mbeki, which was strange. He was transferred across from the psych ward to the Casualty for a medical workup and got really agitated. It was exceedingly funny. He was saying things in Xhosa that made the nurses make very unhappy noises and block their ears.

I was looking for a patient that I had signed up to clerk. I asked a woman in a wheel-chair if she was the said patient, to which she replied yes. I went to go fetch a patient information sheet and came back to find her lying prostrated on the floor sleeping. She had wiped out off her wheel chair. I called one of the doctors who told me that that wasn’t the patient I thought it was and that he was seeing the patient for which I had signed up. He asked the women what he name was and she turned her head and said “Jesus.” I was crying with laughter.

I saw a patient with a hepatitis and a confused person who was later discharged.

I did 2 lumbar punctures later in the day, and then I did a pleural tap on a man from Zimbabwe. The man spoke no English and was very confused. He had a very intense way of looking at me, which made me feel quite uncomfortable. I managed to get 3L of TB effusion out of his right hemi-thorax.

I left at about 5h45

Today I was feeling quite tired when I woke up.

I got to Jooste a little late for the round. I still couldn’t quite hear what the consultant was saying, but the round was good because one of the doctors gave me a growing list of procedures to do while the round went one.

Throughout the morning I helped patient expectorate sputum, I took an arterial blood gas, put up a drip and did a lumbar puncture on one of the most ill-looking human beings I have ever dealt with. The man was literally skin and bones, his abdomen was sunken in extremely. I did not need to feel for his vertebra because I could see them as well as the gaps between them clearly. His skin was dry and he was dehydrated.

I think they decided not to resuscitate him because he was just too ill. Obviously this was a financial issue because the amount of time and money spent on him would have been great and his prognosis was not good.

I saw a very confused gentleman who couldn’t string together a coherent sentence, was fatuous and had echolalia. We gave him the jet-fuel infusion and some diazepam and hopefully he recovered later on. When I examined him he was very difficult. He would shout “haai haai haai…” whenever I did anything and didn’t like me looking into his eyes. He would actively oppose anything I tried to do. I got one of the cool doctors, to whom I presented him. She was much better at examining him. I handed him over to her and left early because I had been waiting around to present that patient for hours and was tired and frustrated.

First day back at Jooste

After my elective to Israel fell through I wound up organising a 1 month elective to GF Jooste’s accident and emergency department. While my Israeli Elective was still being finalised the idea of spending a month in the intense, chaotic, busy and hectic casualty department at Jooste was very tempting. There is a tremendous amount of practical experience and knowledge that I can gain during my time there.

Jooste Hospital is a 2nd level hospital located in Manenburg, the heart of the Cape Flats. It serves a true demographic transition population. A large amount of the patients that come through Jooste have HIV, TB and at least one other major medical problem. Additionally there are a constant stream of strokes, MIs and diabetic complications.

I woke up at 6am after a bad night’s sleep and missioned through to Jooste. I received at least 2 separate yet very similar tours of the casualty department. The one was by a very decent guy and the other by the doctor that is supervising me. She was nothing how I imagined her. She was kind, interested in both my time and the patient’s well being.

During the ward-round we found 8 patients that had been waiting in medical holding area – a 6m square room with 4 beds and lots of chairs – who had been waiting there for 3 days. A man with a STEMI came in from a private hospital without being given streptokinase and my supervisor got really pissed off and said that she had already started taking action against the hospital with the HPCSA.

I saw a 30yo male with known seizures following brain surgery who had been non-compliant on his medication now presenting with a rib fracture after having a seizure. The rib fracture had given him atelectasis which had caused him to develop a right lower lobe pneumonia.

I helped deal with a 20 year old male who overdosed on tricyclics and paracetamol. I also saw a woman with appendicitis. I took quite a bit of blood, put up a few drips and had a generally good day. I was on my feet from 8 till 3 without realising it, which was awesome.

I left at 17h30 after putting up two drips and taking bloods from the patients.

Groote Schuur Hospital Trauma unit and a bit of cowboy medicine

The accident / trauma unit at Groote Schuur hospital is a very hectic place. From the massive ambulance-only parking area, through the security doors the entrance is on the right, with the emergency unit on the left. Through another set of locked security doors is the actual unit. Immediately on the right is a CT-scanner then, next on the right is the bed area where new patients who are not able to sit are kept. There is room for 5 or 6 beds in the room, with a push and it has a few basic monitors.

On your left, parallel to the bed area you may turn down a short passage. On your left is a bench where patients sit and wait for their medication after being discharged. This bench is opposite the nurse’s station. Behind the bench is a closed room that contains about 30 bags of clothing that patients had left there after being admitted, there are also a few washing stands on trolleys.

The passage ends in a T-junction. On the right of the T-junction is the area where the walking-wounded sit and wait to be seen. If you turn right into this room you are facing a desk, next to which is are about 15 chairs. Opposite the chairs are two beds for doing stitching and other such procedures.

If you were to turn right at the t-junction you would pass a few chairs on your left where walking wounded patients would sit awaiting diagnosis or test results. As you pass the desks the corridor opens on your right into an area where maybe 5 beds could be placed. This is for stable patients awaiting either a bed, surgery or other definitive management.

If you continue walking straight passed this area you come into a corridor where patients sit awaiting x-rays, the x-ray room is directly opposite the exit to the corridor.

If you continue walking straight after entering the main doors, passed the new patient’s bed area and the corridor leading to the walking wounded area, you’d pass the corridor where the x-rays are, then some more doors, a room for putting plaster of Paris on and another disused room.

Even further down the corridor, just passed the reception for x-rays, which is different to where the patients sit – it’s where you take the folders and where the radiographer sits, there is the resuscitation room. This room is very impressive – it’s divided into two parts

On the right is the high-care / ICU area. This area has place for four beds with patients on ventilators. It has lots of monitors and functions like a short term ICU where patients lie when they’re awaiting surgery, a bed, or the inevitable. This room also has an x-ray machine and a blood gas analyser

On the left is the actual resuscitation room. It has 2 beds, ventilators, monitors and a LODOX machine. This room is where the hero cowboy stuff happens when it does.

I was on call in the trauma unit on Saturday from 8am to 6pm. Time literally flew – patients poured in, some died, some got better and some weren’t that badly off to begin with.
A homeless person came in who smelt so absolutely terrible that the other patients had to cover their noses. One man had to leave the room. He was confused, couldn’t tell us when he hurt his leg – it was either last month, or last week or two weeks ago. Anyway, I tried to deal with him, but I just couldn’t. He was shedding lice everywhere and he smelt like something had died on his person. It was really rough. One of the doctors in the ward saw him and then he wouldn’t leave. The sisters asked me to help and I eventually had to hold his hand and lead him out which was disgusting and heart-wrenching.

A man came in from Jooste with multiple stab wounds. His saturation was 17% on arrival. After 10 minutes we managed to get it up to 55%, it went a bit higher – to around 70% for a little, but then dropped back down – his brain was mush… so it goes. Another man was there when I arrived who had fractured the base of his skull from his mandible anteriorly to his contralateral mastoid, right through the centre. He had stroked out his right hemisphere and some of his left hemisphere, plus he had coned – he was also a vegetable… so it goes. He arrested while I was there, but the other patient was probably switched off at 11pm last night… so it goes.

A man came in from Pollsmoor prison at 3pm. He had been stabbed in the chest. The wound entered at the mid auxiliary line, or slightly medial to it in the 4th intercostals space and tracked down inferiorly. He was conscious and clinically had peritonism. He had a ridiculously low blood pressure like 20/10, but I think the cuff was broken. He had distended neck vein and muffled heart sounds – so he was in tamponad. We put up lines and phoned theatre, but they were busy… so we waited. At 5pm the senior consultant arrived and kakked the doctors out. He said they should have done an x-ray and ECG. We did that, then he told us that we should tube him before he crashes.

Once tubed he said that we had to decide whether we were taking him up theatre now or cut him open right here right now. He wasn’t stable so they sent me running to the blood bank to get 4 units of blood. I ran there, had a fight with them, and ran back. They had done a thoracotomy on him and were busy dealing with his heart. When the cutting reg took his fingers off the holes he literally hosed blood out of his chest cavity. I stuck 2 units of blood into the warmers. Once they were ready I had a job. I had successfully put up a 16G line earlier with high flow tubing. My job was squeezing the blood as quickly as I could though the tubing. I was very proud of my 16G drip and that it worked.

At the end of the day the cutting reg assisting the senior consultant had managed to patch two wholes in his left ventricle in the resus room. It was very impressive and hectic.