The paediatrics block

Paediatrics block

The kneidelach mixture is setting in the fridge for the next hour, giving me some time to sit down and write about what’s been going on in my life over the past while…

At the moment I am about to enter my last actually week of my paediatrics block. The block has been quite a good one. It has been stimulating, interesting, new, challenging and fast moving. It has also been quite a sad and harrowing experience.

During the first month of this 2 month block I was placed in ward B2 at Red Cross War Memorial Children’s Hospital. The ward had a really awesome team of people working in it and I quickly integrated myself into the functional team. The registrar (person studying to specialise in paediatrics) was very friendly and helpful, the medical officer and 2 of the interns were also very cool. One of them was this gay (I’m assuming) piercing freak who had a very dark sense of humour that I thoroughly enjoyed. My days in the hospital were made up of tutorial, ward rounds and holding down screaming children while doctors poked them with needles.

On Mondays we had lectures, during which I mostly read my books. I spent time in the emergency room on Wednesdays instead of going to out patient’s because the doctor in out patients was extremely old and spoke very slowly and it irritated me.

Lots of kids died. I actually watched this 3 year old girl die, which was really sad and harrowing, especially when the doctors broke the news to her parents. Lots of kids have gastro. They also get this awesome thing called shock gastro, which is when they go into circulatory collapse because of the gastro; other kids of TB and HIV; some kids have down syndrome.

I am now at New Summerset hospital, in the old section. I’m not sure if that means I’m just at summerset hospital. The hospital is quite nice. Not nice like Red Cross, which has money coming out of its ass, but nice in a “this is the oldest hospital in South Africa” way. It has high ceilings and old-school paintings on the walls.

There are a lot of sad patients at Summerset hospital. The one has this syndrome called holoproencephaly, which is, as far as I know, a gross brain abnormality not compatible with prolonged extra-uterine existence, coupled with a cleft lip, no nose and a single nostril in front of the mouth. I am not sure whether I would consider it to be human because it is not capable of living outside of the womb and has no brain. I feel that it should have been euthanized. There was another child with cerebral palsy. It was blind, deaf and its arms and lefts were hypertonic and fixed. It craved physical contact with another human being because that was the only way it could experience the world, but unfortunately it barely got any. I would euthinase this child as well. It made me unbearably sad.

Next week is my last proper week of paediatrics and then I have this amazing week. It consists of public holidays on Monday, Thursday and Friday and exams on Tuesday and Wednesday! Then I have the (long) weekend off and then I start my new blocks.

My next block is divided into two one month parts. The first month covers trauma, anaesthetics and orthopaedics. I am quite looking forward to it. The second part is my elective block where I can do anything anywhere for a month. I’m hoping to go to Israel for that month and then the 3 week holiday that follows it.

My life in Cape Town has been quite uneventful. The one thing that did happen was that a former channie and friend of mine died of leukaemia. I was not specifically sad about it, but the knock-on effect it had on my close friends was heart wrenching. The funeral had about 600 people at it. All of the pall bearers were x-chanichim and friends of mine. After the body was placed into the cold cold earth I pushed through to comfort them. They cried on my shoulder and cried and cried. It was terrible. My pain is better now, but theres continues.

I smoke a lot of nag. I do this with different groups of friends. It happens probably a few times a week. I enjoy it, except for sometimes when it makes me completely exhausted.

Last night I hung out with a trio of medical student friends of mine that I like. We are a group of misfits. There’s a zulu guy, a coloured girl, a white girl and me. We all don’t fit into our stereotypes and it’s funny. We tease each other. I smoked way too much nag with them and now my throat is sore.

Nothing specifically exciting’s been going on otherwise

Tonight’s pesach, which I enjoy.

The Cerebral Palsy baby

In the all-too-large bed lay a little baby; a 3 week old boy. His hands have already developed contractures and his hips cannot be abducted. His legs are already scissoring. He is unable to see. He is unable to swallow. He is unable to hear.

He was born at vanguard drive MOU. He had birth asphyxia. He had hypoxic ischaemic encephalopathy. He now has cerebral palsy. He has spastic quadrapresis. He is cortically blind and neurologically deaf. He will never be able to talk, to walk, to see, to hear, to do or to bed, yet he lives and he will continue to do so.

When we saw him he was miserable and crying a lot, but the simple gentle stroking of his head by our tutor made him calm. He has been alive for 3 weeks and completely unstimulated. Unlike other babies his parents do not hold him, they do not breast feed him, they do not wake up in the night to see how he is. He lies cold, alone and unloved in a ward at Summerset Hospital. He craves human touch because that is his only way of experiencing the world. He continues to crave it.

The Funeral

I’m sitting in my room now. It’s early evening. My usual Friday night friends were invited out for shabbas dinner and I was not invited with, so for the third week in a row I’ve not seen them. I’m ok with that.

Yesterday was a really horrendous and draining day, but I survived along with everybody else.

In the morning I had a tutorial at 8am. I was asked to prepare a respiratory case for presentation. I struggled to find a case and wound up with this super complicated patient. She was a 9 year old female with MDR/XDR-Tb and HIV who had a seizure either due to drug reaction or TB meningitis. I didn’t examine her because I thought I only needed to prepare a history because it wasn’t a bed-side tutorial. I was wrong and I made the history up on the spot.

At about 12h00 I left the hospital and went through to Charlie’s bakery where I bought 2 pig’s ears for R5 each. I ate them on the way to Pinelands.

I arrived at pinelands at 12h30ish and the parking was almost full already. The hall of death (whatever its called) was nearly full and funeral only started at 13h00. They managed to get us to walk forward twice to fit more people into the room. I stood with Buddy, his girlfriend and one of his best friends. I sweated, which means buddy and his girlfriend sweated a lot

At 13h00 they rolled the coffin out of that side room and feminine cries and moans erupted from all over the room. I stood there sweating. Sir and Perfect Penis were among the first wave of pall bearers. Most of them were my former channies, if not all. There were 3 groups of 8 to 10 of them. I stood next to Buddy and sweated more. The Rabbi spoke his usual crap which irritated and upset me. I stared around. Vanilla stood a few steps in front of me but I ignored her. I looked up and saw P.P’s face contorted in pain, which was very difficult to bear.

We took the long route, out the side door on the right, then round the back and to the right. The reason for this is that there is construction work under way. The amount of people there was truly staggering. I walked with people, but I kept trying to get forward to P.P.

By the time I arrived at the grave they had already stuck the wooden box containing 1 dead friend into the cold soft ground. The Penis(not PP) and I went through to where the pall bearers and family were standing.

It was a little vision into the bowels of hell. Everybody was broken crying and sobbing. I went to PP and had him cry on my shoulders, then sir, then so many many more of them; all completely destroyed. My boys from camp – ALL OF THEM & Death his girlfriend. The Big Fat guy wasn’t very huggable and I stayed clear of the girls. They cried and cried! X looked so utterly broken. Some of the were stronger. Some weaker.

I hung around trying to offer my support and strength to the Shnaties. I told them the truth – that it would hurt, and be sore and they’d feel him missing for a long time, but it would be come bearable and ok again. I promised that I would be there for them and they could call any time.

I stood by the not-quite-full beach sand hole in the ground that now contained my friend for a time. I got down on my haunches for a little and the made my way out of Pinelands.

I went through to Best Friend’s house where many people congregated. We smoked nag. I lightened the mood as I have a habit of doing. At 17h30 we all left. Most went to prayers, I went home, broken and went to bed at 18h00.

The Lurking Beauty

You know her! Don’t lie to me. You’ve seen her in the streets, in your schools sometimes at your work.

She looks at you with those dark eyes; sparkling bright, liquid colour filled with warmth, intelligence and emotion. You’ve felt shrunken and utterly defeated by her before, I know.

She’s spoken to you with her words like healing, health and happiness; each tone and each syllable filling you with wasted hope and dreams that are to be shattered totally and completely.

You’ve smelt her, you remember – don’t you? The fragrance maybe soft, maybe warm, exotic and inviting.

You might have even touched her, maybe in passing, maybe in a soft gentle caress. You’ve felt her skin like living velvet infused with a magic that quickens you heart and steals your breath.

If you have tasted her then you do not know her. For to taste her is for her to give to you more than the slight insignificant unimportant trivial pass-by characteristic and pathagnomonic of whom I speak.

She’s Gatsby’s Daisy across the bay. She’s Edgar Allen Po’s Annabelle Lee. She’s that being that holds for you all of your hope and creates all of your despair. She’s enchanted your mind, stolen your sole and then she’s walked away and forgotten about you.

No, she never actually knew you. She never cared! Your feelings, concerns, thoughts, hopes and efforts are foreign to her and she cares not.

Gracefully, elegantly she walks past you and off into sweet, silent oblivion leaving you behind; ever hoping

Ever longing

Ever hurting.

Threes

They sad that bad things happen in 3s. I do not know who this “they” is, or what right or power they have over when bad things happen, but I’m hoping that “they are right.”

On Friday I did not go into university. I spent the day reading and relaxing. I managed to get out of Friday night supper. I stayed at home and tried to relax.

On Saturday I slept late and well. I had gone to bed early and had had about 13 hours of sleep. I awoke sleepily but feeling more well. I went around an uninteresting and unstimulating routine for most of the day. I did my toiletries, read, played with my computer generally tried to relax and calm down.

The Dragon phoned me and I went through to the bayit at around 5. We smoked a nag on the second floor’s balcony thereby avoiding the irritation. We went to Harley’s liquor store in order for The Dragon to buy something for his nights plans. We tried to go to Fontana’s in Town for supper, but it has closed down. We wound up going to another restaurant.

The Dragon has just said to me that our friend who was dying of Leukaemia was actually much more stable than everybody when his girlfriend phoned to tell us that he had just died at around 6pm on Saturday April 5th 2008CE.

We hurried through our food and went through to The Dragon’s girlfriend. We were there a long time. I wound up having to type up a statement from Habonim that The Dragon dictated to me. He was not in a good mood, but I was tolerant and polite.

We then missioned through to the bayit where I was dropped. I had to find the some Shnati’s phone number and then changed somebody else’s flight. I lurked around.

A group of us then went to the best shnati’s house. I hung out their for a while and smoked nag. I managed to stick my foot into it horribly. I was joking with two male friends of mine and said that whatever I was talking about was on my list right after curing cancer. Then everybody laughed and I felt terrible, but it was ok.

Today I spent many hours in bed truly relaxing and it was great.

The 3 year old

Life is an incredibly fragile thing. It is some fluke occurrence that does not persist indefinitely. Life ends at a completely random point. There is very rarely a clearly recognisable reason for a life to come to its end when and where it does. At the ending of life a great deal of energy is discharged. The energy causes waves and ripples of chaos across those who knew the life. Then it is gone; “lost in oblivion, dark and sacred and complete.”

She run around and plays in the waiting room at Red Cross War Memorial Children’s Hospital. She’s a 3 year old girl; an immigrant from the Congo. She’s been well, but had a bad headache today.

The past week has been quite a difficult one, though nothing unbearable. I read a good book called “Slaughter House 5” by Kurt Vonnegut Jr. It’s about a damaged man’s life revolving around the firebombing of Dresden at the end of World War II. It’s well written, interesting, strange and not in any chronological order. I really enjoyed reading it.

Suddenly she gasps in breath. Her body stiffens and she lets out a loud slow cry as she falls to the floor. Her body tenses – stiff as a board and then relaxes, then tenses again. The cycle repeats for a while. She loose continence of urine and faeces.

On Monday in the day I missioned through to the Deck on Cape Town station in order to by a new hands free kit for my cell phone so that I could listen to radio in the car. It was a little frightening piece of hell on earth. In the evening I went to the Art Of Living’s follow up session for the second week in a row. I had a really great Kriya. I felt so relaxed afterwards. I lay on the floor and my body occupied a single point. I was disorientated in space and without thought. It was beautiful. I smsed Lolita afterwards and told her because one of her favourite things is that sensation of movement when you’re lying still and quiet in bed. She replied and we’ve been in touch a little this week.

She was taken through to the emergency room. They arrested her seizures with phenobarbitone and sedated her with midazolam. They had to intubate her because she wasn’t protecting her airways. They gave her rocuronium for that. The medical officer kept saying “She was fine. She was running around. I don’t understand.”

On Saturday I went out for a late lunch with the DJ. We had shwarmas and then frogurt. It was really good to catch up with him. He’s a great guy. I wanted to go see the penis’ new flat, but it was mini-machananeh. This is the first time in a long time that a mini-machaneh has happened and I didn’t know about it. It was a strange feeling. On Sunday I spent a substantial amount of time at the badger’s palace.

She was struggling to maintain her perfusion so we needed to give her a dobutamine infusion. We set up a pulse oximeter and then carted her off to CT scanning. Her brain was so grossly oedematous that her ventricles were completely obliterated.

I went to aftercare on Wednesday. Last night I went to my friends 1 year share at narcotics anonymous. I was very lost on my way their and I felt a bit out because I was the only non-addict non-smoker there, but I was pleased I went.

We wheeled her back to the emergency room, then back up to ICU. They took a piece of gauze and tested her corneal reflex which was absent. Her respiratory reflexes, gag reflex & doll’s eyes reflexes were also absent. She had coned, which is when your brain herniated through your foramen magnum causing brain death. The switched her respirator off and I watched her die.

Yesterday I rode into a beautiful black dog on the highway. I braked as hard as I could. I didn’t swerve because I would have had a serious accident if I had. The dog was knocked by my bumper. It did not get run over. It continued running across the highway towards the N1 after I hit it. It did not seem broken. I wanted to vomit.

We broke the news to the girl’s parents. They were hysterical.

It has not been an easy week. Yiye tov… it will be good

It turned out the girl had undiagnosed sickle-cell anaemia. She had auto-infarcted her spleen which lead to her being very susceptible to streptococcus pneumoniae. She had had streptococcal meningitis and sepsis.  She was 3 years old and so she shall remain forever

Oolai yiye beseder… maybe it’ll be ok?