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.

Change of plans

I’m sitting in my room in a warmish autumn evening in Cape Town. I have just showered and have that warm feeling when you’re hot, but you know it is actually cold and that you’re giving off heat. I’m drinking my usual night time cup of milk chai tea with aspartame.

After a lot of planning, many many emails, a few attempted phone calls, but relatively little frustration, my elective to Israel has been permanently cancelled.

As it turns out I am disallowed access to any patient files in Israel because of something written in the Helsinki accords. I looked at the accords and could not find anything that even remotely said anything like that, but that’s what some people in Israel that I trust said. Because of this whole Helsinki accords issue Ben Gurion University flat out refused to have me. I then emailed everybody and told them that it was cancelled.

One of my contacts said that I should ask another contact at Rambam hospital in Haifa if he could make a plan for me.  Thing were looking hopeful for about two days, and I actually tried to phone them to finalise things, but then it all fell through.

I’m not too bummed about it. I was quite excited to see the Shnatis and my old shaliach’s family that I miss quite a lot, but unfortunately that is how it is.

I am not going to do my elective at GF Jooste Emergency room – the place where they had 12 gun shot hearts in 1 day and 10 survived. It should be quite a steep learning curve, which is what I enjoy.

Last night I went to Shaco’s masiphumalele clinic. The former head of GSH medical emergency room came with as the doctor. He’s a man that I really look up to. He’s got a dry sense of humour, is a superb teacher and is well organised and the best diagnostician I have ever met .I spent the drive up chatting to him about his life and about things I am interested in. He re-inspired me about doing internal medicine as a specialty and it was really great to see him.

I have a slight headache and feel lonely and tired. Tomorrow I have an orthopaedics lecture in the morning, followed by a trauma lecture and then orthopaedics clinic. Then I am going to fix a friend’s laptop’s wireless and then home.

What to do with shattered dreams.

I have two quotes that I feel are pertinent. The first is from a poem called desirata: “Despite all its sham, drudgery and shattered dreams, it is still a beautiful world.” The second is an approximation of a biblical quote, the approximation is from one of the Dresden Files by Jim Butcher “When every star in the heavens grows cold, and when silence lies once more on the face of the deep, three things will endure: faith, hope, and love.”

I’m sitting on cross-legged on my chair in my room. It just went midnight. The seasons are changing here in Cape Town. I have started wearing my thermal vests which get me through Cape Town’s mild winters. The raspberry tree outside my front door’s leaves are going brown and starting to fall off.

Last week Wednesday I saw Spidey at a friend’s 23rd birthday party. She gave me a lift to my car. She was friendly, talkative and looked good. She dropped me at my car and left. I sent her my usual sms thanking her for not being a bitch to me.

Fuck it man. It’s just so unreasonable. My issues with her happened like years ago, literally; and feelings just came right back after seeing her. I even had nice dreams about her.

I remember, years back, driving with my old housemate over the neck to Camps Bay. He was telling me how it wouldn’t be so bad for her if she wound up with a guy like me – we’d have a nice relationship. I don’t know why, but his words planted an idea in my mind which stands now like a great and ancient tree, unbending despite so much evidence against its existence. There are so many things about her that range from being slightly problematic to totally fucked. I know that there is no way of things working out between us. There will be no relationship; no magickal movie-like reunion; “come up to meet you, tell you I’m sorry, you don’t know how lovely you are.”

None of that – just pain and anguish and misery and hurt and betrayal. She probably still feels freaked out by me. She’s almost definitely not interested in me, and there’s a 99% chance that she’ll be like vanilla and give no effort or care, even if I did manage to actually make plans to see her. Hard fact on the ground is that I need to just give up and move on, but I don’t know what to do with the shattered dream.

I spoke to Buddy tonight about this feeling; desire; compulsion to call her and ask her if she wants to hang out. I know that I shouldn’t. I know that I should never see her again; never sms her again; never think about her or fantasise about her. But the feelings are still there. The main feeling is hope, this unquenchable belief that she’ll care and things will work out.

I do not know how to reconcile myself to that. I don’t know how to make my emotional mind realise that there is no hope and I should stop believing, caring, feeling, yearning and hoping. I’m mean seriously, it has been years, she’s not changed and she will never be what I need, but it persists.

Dear Spider-women,

Since I met you one day in a classroom at your school my feelings for you have grown and grown. I know that things between us didn’t work out previously. I mean hell, they turned into a really unpleasant situation that I would never want to repeat in a million years, but I still care for you.

I hope and believe that one day you will understand from where I am coming. I mean you no harm, no malice, no spite, just love and care. I enjoy your company and your humour and I hope that one day you’ll sms me, or call me, or email me, or meet me and tell me you care too. I hope that you’ll tell me that you want to see me and that you want to be a part of my life, because I want to see you and be a part of your life. I know that you are far from perfect, so am I, but that doesn’t change how I feel about you.

To be perfectly honest, I do not think that anything will ever change how I feel about you. We’ve both done some pretty unpleasant things to one-another and my feelings persist.

Life is short and contains a great amount of pain, suffering and misery, but, somewhere, amongst all of the mundane rabble, the day-to-day boredom and the chaos and hurt I hope to find you as a partner, friend and lover; someone to take the chill off life.

Until then, I suppose I’ll wait and try and find a replacement

Yours until I find away to free myself

‘Dinger
If I sent it to her she would not be happy, she would be freaked out and she would run and run until she couldn’t run any more. I cannot help how I feel. I cannot change or move my reality. I have tried to run from you and I have tried to accept things, but they stay perennial as the trees and solid as a mountain.

All I can do is wait and hope that time will fade my memory and my feelings, my hope and my love for her.

I am lonely and it hurts

Start of my orthopaedics, trauma and anaesthetics block

On Monday I woke up feeling early and perky. I got up, got ready, got my stuff together for kriyah that night and then went to uni.

The opening lecture for our orthopaedics block was in a lecture theatre located at the Woodstock end of the out patients department on the J floor. It was on the hand and we got grilled on hand anatomy. Afterwards we went through to the hand clinic, which was a little arbitrary.

We then went through to trauma where the senior consultant gave us an informal introductory talk. He was great, funny, inappropriate and American. Don’t get me wrong, he has nothing on Dr Aboo, but he was great. At the end of the walk around he asked who wanted to be on call that night. After a pause I volunteered, then I regretted it. I also volunteered to be the group rep. We sat in a room and decided on our call roster for the block.

After that I chilled a bit and then went through to an OPD clinic which was very arb. When I got bored I went through to pic n pay where I bought a pie, a sandwich, a chocolate and a litre of water, then through to my x’s brother at the bayit. We chilled and smoked nag. The nag made me feel tired and shit. He fed be some 3 minute noodles.

I then went back to Trauma and started trying to make myself useful. There was a ward-round, where the senior consultant was very funny. The patient’s folder read “had tonic-clonic seizure then spontaneously aborted.” He said “was the guy pregnant? It must have been difficult doing a PV. Oh. This is great. Ambulance reports that they arrived on scene and everybody was ++drunk.”

I sent a lot of patients for x-rays. There were two resusses that I saw. One was a kid that was hit by a car. He went into v-tach, but spontaneously went back into sinus rhythm. We transferred him to RXH, but he died there. The other was a gun shot wound to the abdomen. I learned how to suture and took some bloods and ABG. I showed the new intern around the hospital and helped her put up drips. The MO on call was a doctor that I knew from Mowbray maternity home last year, in fact I hit on her a little there and continued to do so. I stayed until 5h30 and went home in order to sort out a whole lot of emails about my elective.

I spent the whole of Tuesday in bed – seriously.

On Wednesday I was pretty pomped. My feet were still very sore from Monday night. I arrived a little late and saw a friend who was late for an exam and asked for a lift up the hill. I arrived 15 minutes late for the lecture, accompanied by a friend. We found a sign on the door of the lecture theatre saying that the lecture was not to be interrupted under ANY circumstances, so we sat outside. The lecture after that was an introduction to orthopaedics and was crap.

Afterwards there was a good trauma lecture on emergency management.

I then went to the Trauma unit where the doctor from Monday night and another doctor that remembered me from 3rd year were there. We saw a guy with a monoparaesis due to trauma on the skull with a hammer.

I then went to the knee OPD clinic where I learned how to assess the knee joint.

I went home exhausted and slept. I woke up, had supper, read some text book and went back to sleep.

I woke up really tired this morning. I arrived on time to my lecture, which was quite a good lecture on bone infections and orthopaedic emergencies. After that there was another lecture on Trauma stuff, which was very boring because the lecturer had no detectable personality.

The orthopaedic clinic was quite good. It was a mixed clinic and I saw lots of stuff and learned about external fixators.

I went home, napped, did some crap with my computer, ate, and will now study and sleep.

Garlic Hummus?!

Garlic Hummus,

After sleeping later yesterday I did some reading and ran all my diagnostic software on my computer because I have some strange obsession with keeping my computer working at tip top performance.

On Friday evening, just before I left Zulu’s house I washed my hands with Vanilla soap. I should never go near anything Vanilla because it reminds me of Vanilla, the girl who I was with who is very immature and not talking to me. So I left the bathroom and this smell poured over me and into me, reviving old feelings of anxiety, love, hope, betrayal, anguish, fear, resentment and scorn. The main problem with getting a scent that you do not like on your hands is that you hands are permanently attached to your body and the only way to get the scent off is to overpower it or destroy it.

After a terrible car ride home with my mind and body racing and fighting the memories from which I had worked so hard to move away, I managed to get home and pour bleach on my hands. Drastic yes, necessary – most definitely. Another thing that happened in the car is that I wrote Vanilla a message which read “I accidently washed ma hands with vanilla soap, now my souls burning with memories of hope, fear, etc (as above).I cannot believe how bitchy you are to me.

At 16h30 I took a slow drive through to my former housemates flat. On the way he smsed me, as he always does, because he forgot to do something and wanted me to do it. Then I got an sms from Vanilla. Now it can be very difficult to understand how rare it is for Vanilla to reply to an sms. I could sms her about anything from the most mundane to something profoundly important and she absolutely will not ever reply on an infinite time line ever. She said “I am sorry you feel that way. I never meant to hurt you. I try my best not to be bitchy.” It really annoys me when people apologise for how I am feeling. Surely my feelings are my responsibility? Anyway, so I replied back after composing the message in my head while driving “Then how come you never sms, phone, email, make arrangements, reply to my message or be honest with me. All I did was care for you. It is hurtful and unfair how this turned out.” She has not and will never reply to that message.

I arrive at my former housemates place and he was busy making hummus. The hummus making was an incredibly protracted process where he added too much garlic and then had to add 4 more cans of chick peas and it was still too garlicky. We chilled on the balcony and smoked nag with his housemate and I had a good time with him. I was concerned because there had been bad vibes between him and other people that I was friendly with and I just didn’t want to deal with it or mediate, but the topic didn’t pop up and I most definitely wasn’t going to bring it up.

I got home to an empty house at 8ish and wound up having a chat to Wawa on MSN. She had got an impression from me that I was interested in her, which was partially true and we spoke about it for a while, then she started freaking herself out and I had to call her, then I agreed to go out with her a few times, but after reflecting on it for a while I decided that I didn’t want to. I care about her and I have a good understanding of her, who she is, and what she wants in life, but I do not think that a relationship between us would be a good thing at this point in time, so I smsed her and told her. I don’t feel any less friendly towards her, but she is worried that I will feel awkward.

Today I spent quite a while working out how to sync my cellphone with Google Calender. Basically I downloaded the Lightening addon for Thunderbird, because I’d rather had my calendar integrated into my email program then separate. I then downloaded the google calendar integration addon from Mozilla.org, then I downloaded My Phone Explorer which is an awesomely powerful tool for Sony-Ericssons. I run windows XP x64 which is not compatible with the Sony-Ericsson software, so for the last 2 years I’ve been using Bluetooth to send picture across and my dad’s lappy to back up my contact details. But now I can use My Phone Explorer, with the thunderbird plugin, plus the google calender thunderbird plugin and sync my phone with google calendar. The trick is that you need to use the google calendar account as your only calendar account, you cannot merge between a local and network calendar.

My little holiday and some exams

It’s been quite an interesting busy week and I have been enjoying myself, though there obviously have been many ups and downs!

Last Wednesday I went to aftercare at Kenilworth Clinic. After aftercare I spoke the main counsellor there about my re-established contact with Alia of the Knife. After spending quite a while having increasingly hectic conversations with her over MSN I wound up going to see her play the night before. At the play a few things happened. I felt ignored and let down. I had gone extremely out of my way to see her and she was very busy and doing her play stuff, which is fair. I do not blame her for that, it’s my fault for having build up expectations. Lolita practically ignored me and I felt very bad. John – Alia’s now long term boy friend was there. I knew he would be there, but I chose to not think about it.

Alia’s play was haunting and beautiful and so fucking complex that less than 10% of the people who watched it understood it. The actors were good and there was good music and dialogue. The sets were intricate and good. After the play I went home. On the way home I sent Lolita a message saying “You no longer need to try work out what I feel, you actions have made your feelings clear enough. Look after yourself.” It was too cryptic, but I get very into my head when I am driving and compose eloquent complicated messages in my head and by the time I get home and send them they’re always too hectic.

So I chatted to Alia on MSN. Lolita came on to check if I was ok, but I was in the toilet and missed. I spoke to Alia about how I felt about Lolita’s behaviour earlier on that night. We spoke about her play and about John a bit, then I logged off.

After speaking to the guy at Kenilworth Clinic my opinion re-resolved. No Alia, I do not want to just be friends because you are fucking intense and the more time I spend being friends with you the more I let you pull me into your world. You have made your choice and you chose John, now I have made mine. Then I blocked her and Lolita and a few other choice people on Facebook and MSN, determined, once again, to rid myself of my desires, hopes, shattered dreams and pain, by moving away from the source thereof.

During the entirety of “last of last week” – the week of the 20th to 26th April I worked very hard to cover the required work for my pharmacology exam on Friday 25th April. I arrived just on time for the exam, having been delayed by traffic and my student card not letting my out of the parking lot. In one of the previous weeks we had been promised that the pharmacology was going to be an hour and a half long with fifteen mark questions. One we were all sitting in the exam we were told the paper was 45 minutes long. I gave Daria a high five and was very happy!

The exam was relatively straight forward. They hadn’t asked anything about malaria, so all the work I had spent trying to remember how to spell and say Artermether and Artesunate was in vain. There was a challenging 10 mark question asking about the initiation of ARVs and TB treatment in a patient just diagnosed with TB and HIV with a CD4 count of <40. I said phone a pharmacologist.

On the weekend I tried to make plans with a friend from Kenilworth Clinic. To be completely honest she’s really beautiful and has a strange outlook on life that blows my hair back a little. Anyway, after trying twice I got the response “I’m sorry, I cannot make it on Sunday because I have to help a friend of mine find a matric dance dress.” I replied to her “Oh. Ok. You seem like a really busy person. If you ever want to make plans with me you can get in touch with me. Take care,” which translates into “fuck you, you little lying bitch! How fucking stupid do you think I am? That’s the most made up and lame excuse I’ve ever heard. I really expected more of you, so fuck off.”

On Tuesday, after spending a large portion of the weekend procrastinating and another large portion of the weekend reading Paediatric and child health by Coovardia et al., I had my paediatrics examination. I arrived at the Falmouth road parking area at the same time as a few medical student friends, I then moved my ass really quickly up to and then through the hospital to G25 where my exam was. I chilled their a while and didn’t do anything too stressful, eventually the ward consultant came to call us.

My first patient was a 3 month old male child with croup and oral candidiasis. I took that being confident in your exam thing too hectically and got kakked on from a dizzy height by my examiner about being arrogant. I have subsequently reflected on it and emailed him an apology. My second patient was 4 year old with severe cerebral palsy, microcephay, cortical blindness and bad teeth. I passed both stations and therefore pass from this work into holidays.

I had made plans with one of my misfit medical student friends for that evening, but she forgot, so I wound up going to best friend’s house for nag. After some nag and robot chicken I went home and read a ridiculous amount of Dreseden Files Book Seven – Dead Beat.

On Wednesday I slept late then went back to aftercare. It was quite a decent group, but I am feeling old there. It is difficult to imagine myself having any kind of meaningful and equal relationship with the patients there, but I am still happy going. Afterwards I went through to my Wednesday after aftercare nag appointment. We smoked. This guy came and we started having a discussion about how Telkom, south africa’s evil and corrupt telephone provider has started charging for calls that do not connect. So this guy who just arrived said that it wasn’t true, then he said he had a friend at Telkom that he can phone to prove himself right. Then we kicked him out for having a friend at Telkom.

I then spent some time with my friends older brother and his other house mate looking at this awesome facebook group called “Funny inspirational pictures that are in poor taste.”

I then missioned through to Sir’s new flat in Sea Point. The main problem that occurred at this point was that I arrived at 20h00 and sir only arrived at 21h30. It was cool though, I hung out the Sir’s younger brother and his family. When Sir finally arrived we played some Jas and ate and had a fantastic time.

It then went through to a friend’s birthday at a club in Long Street. I had to fight to get in and then said happy birthday and left with Spidey who gave me lift to my car. She was looking beautiful and being nice to me and I had a return of a lot of strong feelings that I wished did not exist. I drove home trying not to think about her and sent her my usual message thanking her for not treating me like shit.

I slept late again and then spent the entire day trying to find and download software for unblocking my Sony Ericsson K750i. After hours and hours and hours, and frying a good many brain cells I managed to download a cool program called XS++ (http://forums.se-nse.net/index.php?showtopic=16338) which had a lot useful features, actually worked, and actually downloaded. I haven’t actually used it yet because I ran out of steam.

I then went to my main mate’s house. It was his birthday. We hung out there for a while, then went to Primi at Canal Walk. After 45 minutes at the restaurant his house mate SMS him to say that he had been taking a leak since we left and only just finished. He was very drunk. Then every got more pissed and we had a long protracted conversation about starting a show called “Big Brother Midgets.” Then we came up with another one called “Bigger Brother” where we get a whole lot of people from Sex and Love Addicts anonymous and stick them in a house, then after 15 minutes somebody will say “I cannot handle this any more, I need sex” and everybody will just have sex until the show ends.

We then went back to his house and everybody except me got high on cocaine, which was quite intense. I played Xbox360 with somebody for a while and we smoked nag which was cool

After another late night and a late morning I spent most of the day sorting out shit on my computer and reading. In the evening I went back to main mates house to get my jacket that I had left there, then to the bank to put money in my account from my dad’s account, then to Zulu’s house. The misfits met there and we smoked an absolute shitload of nag, ordered pizza and hung out. I played with wawa’s feet a bit and hugged her a bit. It felt alright. Lots of other randoms came and left. I enjoy hanging out with the misfits.

Today I have a plan with stutter.

I’m feeling well rested and happy. I’m ready to start my new block

Every night when I go to sleep I lie on my back with one hand on my chest and one hand on my abdomen. I then focus on my right foot and take two deep breaths, visualising roots of light growing from my toes up my leg. I eventually go through every part of my body. By the end I am meditating and calm. I then pray a bit. It feels good. It doesn’t always work, but it helps me sleep 50% of the time. I have started doing the kriyah again.

I am hoping and praying that my Elective to Israel comes around. I will be leaving in under a month if it happens. The woman at BGU is struggling to find a doctor to supervise my research. Every day I hope to hear from her, and I just don’t. I know she’s trying but I hope she succeeds. I would really enjoy a trip to Israel, I think.