The weeping ward

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It is our privilege as medical professionals to be a part of our patient’s lives during difficult times and near the end of life…

It must be my extreme privilege to have been placed in ward F5 at Groote Schuur. F5 is the ward from which the Soeters firm operates. Dr Soeters is the head of the firm. I have not seen her yet and I have been their 3 weeks. The Soeters firm is that very privileged firm which deals with women suffering and dying from gynaecological malignancies.

I met a lovely elderly white lady from Port Elisabeth. She has a mass arising from her pelvis. The mass was up to the level of the umbilicus. She is a pleasant lady; helpful, easy to talk to and kind. Her upper lip always looked strangely pale to me. She has ovarian cancer which is inoperable. She was told so in a pleasant enough way and then sent back to Port Elisabeth… to die.

A 35 year old female, also from Port Elisabeth was referred in because the benign-looking tumour they removed from the anterior lip of her cervix was turned out to be a malignant adenocarcinoma of the cervix. I had not seen her for a week because I was thankfully in the less privileged hospital of Jooste where all the patient I saw survived. When I returned my patient was looking happy. She was less depressed now that they had started her on prozac. Her hair was long and beautiful, her figure thin and youthful

During her operation last Tuesday they found that she had metastases to her pelvic lymph nodes. Her lymph nodes were debulked and her uterus and cervix, tumor and all were left in situ. I asked why?

If you cannot get clear surgical margins there is not benefit of removing the tumour. She will get radical chemo-radiation. She has a very poor prognosis. Her five year survival probability is less than 1%. She’s 35 and still beautiful.

Voices of a madman

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The voice of a madman

The police van comes to a halt.

“look at what a failure he turned out to bed. I told you he’d get caught.”

“Ja. I knew he’d get caught too”

“He’s so pathetic”

“And weak”

The policeman opens the back.

‘Don’t touch me!’

‘Then get out and come with us. If you do as we say there’ll be no need to use force’

“What now as Mr Goodie goodie follows the little police man’s orders”

“He’s not even a man”

“He’s so stupid. Following like sheep”

I stumble out of the van into the blinding light. The voice laughs at me stumbling. “The doctors will get him they we will have our turn to hurt him some more”

“I love hurting him. I love watching him scream and beg”

The policemen lead me in through the door of the hospital. There’s a rectangular room with 10 or so dirty broken chairs against 3 of the walls. There’s a security door, followed by a metal detector followed by a security door. We pass through the doors.

“Oh great. They’ve taken him to Jooste.”

“This is the place they take pathetic weak people like him to die”

“I knew he would come here. What a weakling.”

“What a joke”

We walk down a short corridor. On my right is waiting area filled with people. Fat ones, thin ones, black ones, coloured ones, sick ones, well ones. They’re all here to see me. To laugh at me and my failure.

“He so pathetic. He shouldn’t be here.”

“He should have just laid down at home and died”

“The police got to him. Nobody is stupid enough to get caught by the police”

“Nobody but him”

I walk passed some closed doors and then through a large door; metal with a glass window. On the other side is the very bowels of hell. The room stinks like human filth; Shit, piss, vomit and unwashed bodies. There are people lying around and dying. The ghosts of the dead are hear and they are laughing at me. There are nurses and doctors looking down at me with hate in their eyes and promise of suffering to come. The room spins… The laughter…. the hatred.

“Now he’s cracking.’

“We show him the truth and he can’t handle it”

“Look; His mother has come to spit on his grave”

“she shouldn’t waste the spit”

It’s true. The voices have never lied to me. They speak the truth. I am pathetic. My mother has come with the police to chain me into this burning hell of suffering and pain. I cannot. I must get out of here before it’s too late.

“Oh. He’s going to try and fight.”

“What him loose”

“His mother will even laugh at him then”

“Maybe she’ll be the one who’ll pin him down”

‘NOOOOO’

I try and take a swing at the policeman. He grabs me. I fight back. Push him. Try to get out of there grips. I must escape. They are trying to tackle me. They mustn’t I must get out of here before the doctors come with their pain.

I cannot… I have failed. I policeman is sitting on my chest. 2 security guards are holding my arms, 2 are holding my legs. The policeman is holding my head. Every muscle in my body hurts but I cannot move at all. I am sweating and straining but I cannot move.

“Here comes the doctor”

“Time for hell on earth to come”

“He’s so weak and pathetic. He really deserves this”

“I hope they make him suffer for all of time”

“Look. His mother is laughing”

“Everybody is laughing”

“The dead and living”

It’s true. The voices are always right. Everybody is laughing. The world is spinning and burning NO! A doctor is coming. He has needle. I must escape. I MUST! I cannot move. They are holding me too tight. The doctor is saying something evil about me in English. The white man has brought his poison to me.

I feel a burning as a needle goes into my arm. I won’t give up. I will escape. I wi…

Darkness

Child-birthing nightmares

Sudden flashes of terror

23 year old female gravida 2 now para 2 referred from the private active birth uni with a post partum haemorrhage. The cord has snapped during the delivery of the placenta and the placenta was retained. An attempt was made to remove the placenta manually in the labour ward, but this failed so she was brought to theatre.

She was given a general anaesthetic and placed in lithotomy posission. The placenta was removed manually and came out intact yet the uterus remained complately atonic. Two boluses of IV oxytocin plus 5mg of ergometrine were administered. 600Mcg of pv misoprostil were given, yet the uterus remained atonic. A hand was placed in the uterus and an attempt was made to compress the fundus of the uterus between the hand in the uterus and a hand on the abdomen. Blood continued to gush out of the vagina.

Her blood pressure dropped to 60/30mmHg and her haemoglobin was 4.2g%. She was given 2 units of emergency blood plus 3 units of ASAP grouped blood and 2 units of fresh frozen plasma. The Prof was called in and a total abdominal hysterectomy was performed saving her life. She was transferred to Groote Schuur hospital on a ventilator and made a good recovery

Days pass

26 year old female gravida 2 para 1 presents with decreased fetal movement. An ultrasound scan confirms interuterine fetal demise. She was started on augmentation and transferred to second stage to deliver the stillborn child. A few hours later, as the ward round arrived to the last cubicle she had just miscarried her 24 week infant. It lay facing us; its never seeing eyes closed. The mother lay in bed looking down in horror at the baby she had failed to carry. The midwife wrapped the baby in a towel and allowed the mother to hold it only this time

Days pass

27 year old female gravida 3 para 2 presents. She has had two previous caesarean sections but was dilated to 7cm. She was HIV positive with a CD4 count of 147. She had active chickenpox, varicella zoster pneumonia and pcp pneumonia. A ctg was applied which showed a reactive tracing. She was transferred to second stage where she delivered a completely flat baby. The CTG tracing remained active after delivery showing that it was actually recording the maternal tachycardia not the fetal heart.

The baby was taken through to the resuscitation room by the paediatrician. We tried to revive the baby for 45 minutes but it never moved, it never cried and it never lived. It’s mother was transferred to Groote Schuur where she might not live as well