Update

I’m sitting my newly re-covered chair in my bedroom. My room is bright with indirect sunlight flowing in from my open blinds; the air is freshish from the open window. Chris Daughty’s “over you” is playing on my computer and a toasted chicken mayonnaise and 3 a bowl bean soup are waiting to be eaten to my left. My room and my environment around me is clean and I have become quite good at maintaining it.

I have been enjoying my paediatrics rotation through Red Cross War Memorial Children’s Hospital. I’ve been placed in ward B2, which is a general admissions ward with a high-care cubicle. The ward registrar is a Muslim-looking woman with a sternotomy scar. I cannot decide whether she is hot or not, but she is a very decent person and I enjoy working with her. The medical officer is a lovely Muslim woman who I help with taking bloods. She’s friendly and interesting. I’m unsure exactly who the interns are that are in the ward. The two guys who seem to be there always are both very decent. The one with whom I am most friendly is a white guy from Pretoria University. He has a dark dense of humour and numerous piercing. The other guy is a warm, fantastic guy with a strong dose of cynicism.

I enjoy working in the ward because I feel like a part of the team. This is because I nagged them about whether I could help continuously since I arrived. I help them take bloods and hold down screaming children.

I also help out in the emergency room, which I really enjoy. I feel that I have learned a tremendous amount so far and there is a lot more to learn. Paediatrics is fast paced, interesting and broad. I like the discipline.

I have re-started attending Monday night kriya. It’s very relaxing and important. I really do want to keep doing it. The main reasons why I stopped going and feel a little put off by the organisation is that it encourages deepening involvement in itself, and I am unused to not responding to such encouragement, but I do not want to become anything more than a person who does the Kriya on a Monday night and sometimes during the week.

I have firmly re-establish contact with Alia and chat to her regularly on MSN. I think its ok. I feel firmly connect to her and it is difficult because she a complex, distant and strange person who is not interested in me to the same degree as I am interested in her. She is involved in a long term relationship with a well known conceptual artist who is 10 years older than her. She is very sexual with which I struggle because it attracts me to her, which is not her desire or intent.

Lolita is not communicating well with me at all, which makes me anxious.

I went to my long lost medical school love’s 23rd birthday party at Alba Lounge 2 Thursday nights ago. I was there for 2 hours, and said about 4 sentences to me. She’s so ridiculously beautiful; it’s a pity about her extreme immaturity.

I attend the Shawco Masiphumalele clinic every Tuesday night. Last week there was an extreme shortage of patient but there was a hot 1st year OT religious Christian chick in the cubicle with me.

My clinical partner is excellent. I really enjoy having him around, though I do not work with him. There’s this hot reborn Christian fundamentalist in my rotation that I am enjoying a little too much. She likes wearing sandles and has pretty feet. She’s got an angelic face and I want to do terrible things to her.

In ward B2 is the first hot nurse I have ever seen. It’s a pity that she’s a bitch.

Sometimes to cure. Often to relieve. Always to Comfort… or not

This article has been written as a reflection of my time spent in your hospital with specific reference to the hospital slogan “Sometimes to cure, often to relieve, always to comfort.”  It is not an attack on the hospital staff, doctors or management. I understand the difficult circumstances in which Your hospital operates. I believe that your hospital is doing an important job and succeeding well in containing and managing acutely psychotic patient in Cape Town and the Western Cape. I am writing specifically about whether or not the manner of the patient management is in keeping with the hospital slogan.

At my first day at your hospital I noticed the hospital slogan on written on the wall of the education centre. It seemed like such a noble and important thing that psychiatrist strived for “Sometimes to cure, often to relieve, always to comfort.”  By the end of my 2 month in Your hospital it seemed clear to me that that slogan was not on the minds of the people working there.

It does need to be said up-front that psychiatry is a difficult field. I have no seen such suffering in any other medicine field. The degree of desperation and pain experienced by the patients and their care-givers is extreme.

Obviously being a health care professional there is a there are difficult lines between not caring, empathy and sympathy. It was difficult for me, initially to not become completely overwhelmed by the different extremes that I experienced during my rotations through different disciplines. Many of my colleagues, on the other hand, seemed completely cut off; dehumanising their patients into a collection of signs and symptoms without any inherent feelings or emotions. The doctors working in the wards were an extreme version of my colleagues – disinterested and disillusioned.

When I started my rotation at one of your hospital’s wards I hoped to find compassionate and caring practitioners who would be living examples of the above slogan. What I found in the ward rounds in terms of the patients and their diseases was something truly horrific: I found depravity and desperation. I found out that mental illness was truly worse than anything medical that I had seen. And, much to my dismay I found a similar callous disregard for the patient’s humanity that I continue to see in my medical training.

A sick patient will come into the ward round and be made a spectacle of in order to facilitate teaching and diagnosis. Surely if the patient is floridly psychotic is not necessary to make them perform embarrassing tasks like singing and dancing, or intentionally triggering the patient to digress into complex delusional systems which seem horrendous just to show it to everybody else.

Furthermore, outside the ward rounds I do not see much comfort or relief taking place in the hospital. I was fortunate to have excellent, objective teachers on my ward who were able to highlight the acute problems within your hospital regarding the legal system and the lack of facilities for chronic inpatient. The ward I was in had a few chronically psychotic and highly problematic patient which clearly illustrated further difficulties faced by the hospital.

There was a heterogeneous cohort of patients in my ward, some of which would benefit from a different kind of care. Patients were known to rape and sexually interfere with other patients regularly, but there was nowhere else for them to be placed. Surely, if anything, this sort of patient-patient interaction serves to worsen any psychosocial problems rather than cure, relieve or provide comfort.

I have a great deal of empathy for the staff, particularly the nurses, who work in the difficult wards at your hospital. I imagine that I would struggle to work in a place with such a great concentration of human suffering and deprivation day after day for years. My empathy for them does override my assessment of their performance. I found the nurses to be completely uncaring and cold. The Tobacco Products Control Act of 1993 strictly prohibits the smoking of tobacco products in public places like within the wards of Your hospital hospital. I assume that the main reason for this law is to protect the health of innocent bystanders. Surely nurses smoking in the wards at Your hospital are a violation of this law and the patient’s rights? I complained to the hospital manager about this but it had effect for a very short time.

I am not sure who exactly is meant to be comforting the patients as per the slogan after which this letter is named. I understand that it is rather difficult to comfort an psychotic patient, but surely once their psychosis has calmed down they should be comforted, reassured and nurtured. I felt that an authoritarian, cold clinical approach was very often used when speaking to patients and their families.

Go to a patient, any patient who is not severely mentally handicapped and look at the index finger and thumb of their dominant hand. You will notice burns. This is because they roll cigarettes with newspaper and smoke the entire cigarette even though it is burning their hands and sometimes lips. Surely this should be stopped. De Leon et al showed that there was a positive correlation between schizophrenia and smoking. I’m not sure what purpose allowing patients to smoke cigarettes rolled in newspaper to the extent that they burn themselves is serving, but it does seem a little cruel.

Waiting for inevitable

This weekend has been about waiting for the inevitable. On Thursday I found out that a chanich and friend of mine who got leukaemia on Shnat last year had failed his experimental miracle treatment and was on deaths door.

To be fair his prognosis was never good. He had the “worst” kind of acute lymphoblastic leukaemia. He received a full course of curative chemotherapy, but the disease relapsed rapidly after treatment. He became very sick after that and received numerous leukocyte transfusions. After what seemed like an eternity he received a bone marrow transplant, which failed after a few months. Then they decided to start him on this new experimental drug mono-therapy.

I never really had much hope for his recovery after I heard about the severity of his disease. It was still a shock to me when Sir called me from Joburg to tell me that he was dying and that “it is a matter of hours or days.”

On Friday I went to this prayer meeting thing in support of him. The only reason I went was to be around people and offer support. I hate rabbis and prayer meetings. Anyway, I heard that he was on life support and his dad had just flown through to him. He was septic with multi organ dysfunction syndrome. The amount of denial in that prayer meeting was horrific, but understandable.

After having to go out with my family to celebrate my sister’s birthday I went to the bayit where I spent some time with friends of him.

On Saturday I waited. I killed time. I slept. Every time my phone made a noise I thought that it was The Phone Call or his cousin The SMS. I wound up seeing a moving with Buddy and Mega, then we went to Buddy’s house and smoked nag.

He’s being buried on Kibbutz Tzora.

Today I went to a consecration. I saw BYT, she asked me how I was and I said “fine thanks and you.”

I’ve not been sleeping well at all. I’ve had my phone on and I’ve just been uncomfortable and restless.

Today, after the consecration I had a fantastic shower, then read a bit of text book and had a really good nap. I’ve been feeling great since that shower. I hope I’ll be able to sleep tonight because I slept for a long time today. I feel sick thinking of my friend lying intubated in some hospital far away in a coma on deaths door. I feel accepting of it though. I think that I am more upset by the people around me then by the actual dying of my friend.

Death

Death is a very real entity with which most people form some kind of obsession with during their lives. Most commonly people obsess about avoiding death, the build their entire lives around living longer, decreasing their statistical chance of dying. I suppose it makes sense to build you life around its avoiding its opposite. Other people, myself included, try to find death to escape life.

Surely in order to avoid death its location must be known. I believe that death exists a few millimetres away from the body in all directions, never closer, never farther, just outside reach.

Death cannot be found, but it will find you. When your time comes death will come, find you, and take you, and there is absolutely nothing you can do in order to change that simple fact.

Life exists as moving, living, being, islands in a giant sea of death.

Death can be a beautiful thing. It is still, quiet and without pain or suffering. It is very often the end point of a long, unpleasant process of dying during which a person suffers a great deal of emotional, physical and spiritual pain; once death happens that pain is gone.

Equally death can be a terrible thing. It often strikes blindly and without meaning destroying people’s families and lives; taking children away from parents, parting lovers, rendering people destitute, depressed and in agony. The pain of suddenly loosing somebody dear is something which you get used to, but which never goes away.

In order to master life it is necessary to accept and embrace death. Death is the final common pathways, the rich and the poor, the powerful and the weak are all born equal and all die equal. We start off as a single cell and at the end we feed more cells and give our shell back to the circle of life.

No matter how well or healthily we live, we all die. No matter our will, belief, fears and hopes we have no control over death. It will come whenever it chooses and the only power we have is to accept it and not live our life fearing it.

“I must not fear. Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past I will turn the inner eye to see its path. Where the fear has gone there will be nothing. Only I will remain.” The Litany Against Fear from Dune by Frank Herbert

Some hard work

I’m sitting straight backed on my chair infront of my computer. There’s a dull glow in my room from my energy saving light bulb which is reflecting off my wooden bedside desk. My nose is a little blocked because of allergies. My head feels a little too full and numb.

On Friday I went through for my autopsy. After sitting in traffic with the funny, intelligent and generally brilliant garath cliff playing in the background it was quite a let down to have to go cut up the dead. When we arrived we were told to immediately go through because our tutor was waiting for us. We almost went into the dissecting area but I noticed her in our lecture venue. We spoke for a while about gun shot wounds, and then went through to Hell.

We went into the change rooms where we got dressed only to find out that there were no masks. I asked somebody and they were brought through. My clinical partner smeared so much vicks into his mask and onto his face that he cried through part of the dissection and I comforted him.

Inside dissection room one was worse that it has been so far. There was a dead baby and a white guy who had hung himself and had a giant bright purple bulging tongue. We had two cases. The first was an asthamatic who died before arrival at a CHC. She had her asthma pump clenched in her one hand a peter styvasant cigarette in her bra. We did a LODOX scan on her and I got to fix the LODOX machine.

Our second case was a 33 year old white male from milnerton who hung himself with his tie from a pipe on his gyser in his bathroom. He had suffered some back trauma which required surgery and resulted in him having some mild paraplegia which caused him to need to use crutches.

At some point during the autopsy we needed a alcohol specimen kit, so our Doctor decided to give us the grand tour. The smell of the one fridge was above and beyond the scope of normal human experience. The smell was completely overwhelming, to the point where it had a tangible presence. I made it 3 steps inside the fridge before I decided to take 20 steps away from it and take deep calming breaths. The fridge was one of those industrial kitchen fridge with racks and racks of human bodies at various stages of decomposition.

The second fridge smelt much better. This was probably because it had a machine next to it that produced ozone. The freezer had hectic bodies in it but wasn’t smelly.

Our patient wasn’t too interesting. He had a plate and two screws in his back which we discovered with the LODOX machine. His organs were congested and he had signs of congestion everywhere. His brain was surprisingly unremarkable. We did a bloodless neck dissection which showed one small haemotoma.

Afterwards I got a phone call from the prof who’s examining me in obstetrics and gynaecology saying that I need to come and collect my portfolio task and redo it, as it was unacceptable. This made me feel sad, ashamed, pathetic, irritated and angry. But I have leanred that presentation and spelling do count in medicine and worked tirelessly this weekend on readying all my portfolio tasks for Monday.

I then went to the local pharmacy where I found the price of my medication went up R50 not covered by medical aid, which was a bit horrendous. I also bought some face scrub.

I went home and was surprised to find that our ADSL had been enabled in under a week. I spent the remainder of the day on the phone to technical support, but got it up and running, then we used up our cap.

I went to my aunt’s boyfriend’s flat for a very nice supper with the family. I read a few pages of A Brief History of Nearly Everything, which was fascinating, superbly written and just fantastic! The meal and company were good. My cousins were there and their partners. It was a good evening.

I went home and fought with the cap a while, then went to bed.

Saturday was spent working on portfolios and fighting with internet problems. I saw my buddy in the evening where we smoked nag, ate supper and had ice-cream. I always whine when I’m with him and must make an effort not to do so.

Today I grafted all day on portfolio work, but I am not happy with my portfolios and need to graft for the rest of the week on obstetrics and gynaecology notes.

I’m feeling bombed and tired and sore, but ok