Another day another dollar

Last night I did not sleep well. I fell asleep well enough, but I woke up in the middle of the night and struggled to fall back asleep.

I drove through to the CHC where we waited around for our site facilitator who ran late. Once she arrived we spoke for a while then elected to go home and “work on our project.”

I stopped off at one of my IT clients in town. They needed some installations to be done and their router wasn’t working. Eventually I came to the conclusion that there was a hardware problem. I went home and placed an order for a new router from one of my suppliers, then picked it up and shot off back to their offices where I installed it.

I got home quite tired and made myself a lunch of toasted a tuna mayo sandwich, corn and an apple. Then I lifted my family’s domestic worker to the taxi ranks. I got home feeling quite exhausted. I ate lunch and read some of my book.

I am feeling quite down at the moment.

Oh the places you’ll go

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For my birthday this year my mother gave me the book “Oh the places you’ll go.” by Dr Seuss. This present resonates with a lot of sadness within me.

Sadness for my mother who spends her days at home smoking, watching tv and reading. Sadness because of her depression and her failures. A sadness I will never truly understand.

Sadness for my sister who is stuck with my mom at their house watching tv and smoking. She has done nothing with her life and gone nowhere.

Sadness for my father who has been burdened by so much and is sometimes so sad.

Sadness for myself. The world opens before me and I just want to lie down and sleep. I see and feel so much loneliness, emptiness, betrayal and failure.

“Oh the places you’ll go…”

This weekend was horrible. I worked like a dog on university stuff. I spent most of the day yesterday searching for articles to review for my family medicine and palliative care portfolios. Today I did more work on that, plus some project work and read-ups for my simulated office oral examination on Thursday.

I visit Max briefly, but it felt hollow and empty too.

An empty day

Today flew by. It was empty and hollow.

I was delayed in traffic on the way to a child care centre in the Philipie area by a roadblock on vanguard drive. I arrived late and completely zoned out during a long and verbose talk by a religious christian doctor. I did not hear a word he said. He spoke for a long time. We then went on a tour of the christian child care facility. Then we had tea. Then some other people spoke to us and I did not hear a word they said.

We left and met a medical school about our project. I didn’t pay much attention either.

I got home and called a girl I love in Israel. It was her birthday. I was happy to hear her voice and to speak to her but I didn’t have too much to add.

I tried to have a nap, then I finished my book and started another one.

I went out for supper.

I feel empty and lonely and hollow. There has been too much death this week

Palliative care home visits and Lolita’s shame

On Wednesday I went into university where a doctor who works for medical aids spoke to us for the whole morning on a range of interesting topics like health care in south Africa, south African medical aids and a few other things.

I made plans to see my favourite joburger in the afternoon at 17h30 so I decided to skip the simulated simulated office oral role play activity in the afternoon. I went to the library because I want to look up how to do the “dying” conversation. I looked through a few palliative care books but was unable to find the text I was looking for. I bumped into a surprising number of people I knew from 5th year and 1st year and we had a really awesome chat. I went to the SHAWCO office to order my scrubs.

I then went to St. Luke’s Hospice in Kenilworth because I thought there might be somebody there who could help me find the article for which I was I was looking. I sat on the floor in the library and browsed through a lot of hectic books but I couldn’t find what I was looking for, nor could I find anybody to help me.

I went to aftercare at Kenilworth Clinic. At this point in the day I was feeling pretty down and wretched. Aftercare was interesting. I did not feel much better afterwards.

I missioned through to UCT, parked and visited my friend. We chilled in their room in res for a while then went outside and had a nag. After a while I got freezing and we went back inside and chilled. Then I took them to a parking area and started the process of teaching them to drive. It was a slow start, but I was happy to be their for them.

When then went through to sir. We chilled there a little, then went to a little cheap and tasty Chinese place in sea point where we got take-aways. I ate a hearty meal with them and then went to Cafe Ivrit to say goodbye to peppers who is going to Israel. It was really awesome to see buddy, the shaliach, his wife and some other friends. The house has some of the worst art I have ever seen on the walls. These sad pictures of unhappy people with miserable back-grounds.

I went home and was quite surprised to find that my university bad was not in my car. I decided that I had either left it at the SHAWCO office, the library of the hospice library.

Today was rough. I drove through to Retreat Community Health Centre where I met up with a lovely sister from the hospice.

First we drove through to St Lukes where I failed to find my bag. After a while we left again.

We first went to the house of a man with multiple myeloma with metastases to his legs. He lived in a small house with his daughter, her husband and his grand daughter. He was a pleasant man, though severely wasted. We spent a bit of time there speaking to him and his family. His pain was worrying him so we upped his morphine dose. The family has neither a phone nor a car nor money for a car. They had missed their last appointment at the Groote Schuur Hospital cancer wards – L-bock.

We drove around quite a bit. The nurse I was with showed me around her area teaching a lot about the people living their. We went to Retreat, Grassy Park, Vrygrond, Capricorn and other areas. She showed me library. We saw amazing things people did with the meagre houses or shacks they were lucky enough to have. We saw patients who were well and mobiles and patients on deaths door. I was shown the St. Luke’s hospice office and shop which was run entirely by the community.

The last person who I visited was the most difficult part of my day. We visited a new patient who the sister had not seen before. We arrived at her beautiful home and were welcomed in by her sister. The women was old, weak and sad. Her hair was grey and thinning and her body extremely thin and wasted. The picture which became clear during the 45 minutes we spent their was difficult. This lady could feel that her time was coming. Her husband and their private doctor were pumping her full of chemotherapeutic agents in the hopes of curing her, but it seemed blatantly obvious to me that there was absolutely no hope of curing her advanced ovarian cancer.

The chemotherapy was detracting terribly from her quality of life. It made her nauseous and gave her terrible diarrhoea. She was hating the chemotherapy but doing it for the sake of her husband. She knew within herself that she was dying but her family wouldn’t let her talk about it or deal with it. She was in pain and not keeping her medication down, but she was trying to be strong for her family.

Her family were very supportive and caring. They clearly loved this women who was their sister and mother and they did not want to loose her. She wanted to die and asked us to help bring the end a few times.

It also became clear that her son in the UK had not even been told that her mother was sick because she did not want him to worry and come down. It was clear that if they did not tell him soon he would only find out when she died.

I left there feeling exhausted and overwhelmed. The sister dropped me off back at the CHC and I drove home. I stopped off at UCT where I found my bag in the shawco office, then went into one of the buildings where I found some first years I know and gathered support from them.

On my way home I stopped off at my parents work and bought a calling card to call my friends in Israel and England tomorrow for their birthdays.

I got home and had a really tastey toasted tuna mayo samwhich on my home-made bread. I also had some corn. I dropped our domestic worker at the taxi rank and then I went to bed and failed to have a nap.

After “waking up” I switch my computer on where I had a brief parlay with Lolita. She had put on a play on Wednesday evening. I had found out about it at aftercare and decided to send her a text message wishing her luck. I would have gone to see it, but I found out too late and I was also very concerned about violating her space. She thanked me for the message and told me the play went well. She said I should have come. She did not respond at all to anything I said but it was pleasant.

The last time I interacted with her was around the time of my birthday. Her birthday is 3 days before my birthday. I chose to buy her a nice birthday present and made her feel really special on her birthday. She forgot my birthday and I smsed her twice about it. I sent her a message at about 1am and then I sent her the same message again in the morning when she had not replied.

She ignored both messages and then she crapped me out from a dizzy height after I spent a week trying to initiate some form of communication with her to find out exactly why she was upset with me. She told me that I made her sick. She said that something had happened which had nothing to do with me save that my initial two smses coincided with this other event and that whenever I message her she felt sick again. This made me feel really humiliated, ashamed and embarrassed. I’m sure I was blushing furiously. I have had no ill intent towards her and felt so bad that I had made her feel sick. She said that she felt better after speaking to me.

Then I smsed her that night to say good night and that I was happy she felt better. She sent me another hectic sms about how I said I would stop and I didn’t stop and that she doesn’t want to hear from me any more. This made no sense to me because I had specifically asked her and she said she felt much better. It made me feel even more ashamed and humiliated and embarrassed. I removed her number from my phone and removed her from my facebook and my msn just so she could have some space from me. She messaged me after that saying that she was sorry and was in a bad space it I should leave her alone. I said I agreed and I would.

An ordinary day

Today was quite a pleasant and laid-back day.

I slept well last night. I went to bed early because I was feeling traumatised.

I adjusted my alarm clock so that I didn’t arrive at the community health centre ridiculously early any more. I don’t know why it took my me so long to do that.

I saw a 20 year old male with no past medical history now present with a 2 month history of an itchy rash worst on his legs, then his arms then his trunk. His face was unaffected. The rash was a normally pigmented papular rash with white excoriations. After speaking to the tutor we decided to treat him for scabbies and also gave him antihistamines.

I left at 10 and went to my local shopping centre where I bought a new pair of Jean Pants, a gift voucher for my step-mother for easter and had a shwarma. I then missioned back to town where I saw my american friend who I looked after last week. We went for a walk on Sea Point beach front and then had a milk shake. She is going back to the states on Sunday.

I got home and had a nap, then I did my part of our family medicine project and typed up a patient I saw yesterday. Tomorrow I am going to see one of my favourite people. I also don’t think that I am seeing any patient tomorrow which is awesome

The worsts stories ever

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Today we went to learn about how children die. I heard some of the most utterly horrible stories I have ever heard in my life:

“Doctor! Doctor! Will I die?

Yes my child, so will I!”

A baby came in with intractable pain. They gave him the maximum dose of everything but it didn’t help. The mom said but you haven’t tried his cough mixture. The mother had not understood the cough mixture was only for an acute illness so she gave the baby cough mixture continuously for over a year. He was going through codeine withdrawl

How do you respond when a teenager asks you “Am I going to die?”

Habo Hadrachah – you ask questions back, assess what they no and don’t take away their hope.

How do you respond when a 4 year old asks you “Can I take my mommy with me when I die?”

Give them something positive back “You cannot take your mommy, but you can take your teddy-bear.” The doctor tutoring us said “You cannot imagine how many teddy-bears I have sent down to the mortuary.”

An intern at a rural mission hospital was called into to do a Caesarean section. He arrived to find that there were no other doctors, no anaesthetists and no nurses. He did the entire procedure himself with the aid of an nurses aide. The baby and mother both survived. He walked out the hospital and became a car salesman.

The doctor walked into the neonatal ICU. She heard the crying coming from behind the door. She looked and found the intern sitting on the floor crying. There was some emergency and she had been left alone in the ward with 2 patients who had just had liver transplants and 10 other ICU patients.

“When is my child going to die?”

Don’t give time estimates. Children need to be loved and cared for until they are dead. If they want food feed them. They need love. It’s not over until the fat lady sings. She might be humming, but she’s not singing.

A mother from Northern Africa looked after her baby. She changed his nappy and cuddled him. He was dead for 10 hours by the time they found somebody – a security guard to come in and tell her that her baby had died.

One of my colleagues saw them perform a laparotmoy on a lady with an 18 week ectopic pregnancy. When they removed the gestations sack the doctor cut it open and the fetus was moving and responsive. The nurse poked it a few times and it with drew from the stimulus. He watched the baby die over half an hour cold and alone. I am not against abortions, but this is still rough. End it quickly or humanely?

There were two young children with severe burns sharing a ward. The one had been there 3 month the other 2 months. One day the child that had been there longer had a cardiac arrest. They wound up calling many doctors; surgeons, physicians, anaesthetists and ICU specialists. In the end they were unable to resuscitate him. They put the lights off and left…

the other child alone in the dark for the whole night after watching his friend die. The next morning they found him lying under the bed with catatonic psychosis.

And there was morning and there was evening. One Day.

Some hummus, a party and a tear.

At Lotus river on Thursday we started off our day with a heated discussion about our project. The doctor supervising us keeps on having these tangential ideas which I find frustrating. Eventually my clinical partner from last year and I went around and met the various doctors working at the hospital. We took their feedback and have come up with a new plan for our project.

I went home and called the our course secretary to find out about whether or not we were going to be going to ThemaCare on Friday. After a few phone calls it turned out that we did not need to go anywhere on Friday so I stayed up quite late with my computer and slept in on Friday morning.

I woke up, did some varsity and computer work and then made a lot of hummus. Somewhere around 4L. The recipe I used and am now happy with is as follows:
2 cans of chick peas
about 3 table spoons of techina
2-3 cloves of garlic
salt
ground cumin.

Separate the chick peas from the brine in which they come, but do not throw the brine away. Put most of the chick peas and the garlic in a blender with some salt and a little cumin and then add as little of the brine as possible. The idea is that you want the blender to be able to blend the chick peas, which requires the brine, but you don’t want your hummus to be watery, so you need to add just the right amount. Blend the chick peas until smooth then add the techina and blend it in. Lemon and olive oil can also be added.

I found that the lemon was a bit strong and I like my hummus subtle. If you do add some lemon add about half a small lemon in at the beginning.

I also found that the olive oil was a bit over-powering. It should be added with the techina or else the hummus doesn’t blend as smoothly.

The hummus should be placed in a flat dish. It should be smoothed so that there is an island of hummus, then a circular indentation, then another raised ring. In the indentation olive oil and the few left over chick peas are added and then paprika is sprinkled over the whole thing.

After the hummus was done and showered, packed and got in my car. I filled my petrol tank and then drove 60km to Simon’s Town. On my way there the paprika jar opened and spilled all over my car.

I arrived, vacuumed my car and was shown to my room, which was a little cupboard with 2 beds at the bottom of the neighbours house. It was more than I was expecting, so I was happy. The dinner was excellent. There was Israeli hummus as part of the starters and mince musakah and fantastic tasty soft chicken for the main course. I got drunk on pear juice with southern comfort and went to my room quite early. I did not sleep well, despite being drunk, medicated and tired.

The next morning I woke up, packed, moved my car and went to the 60th wedding anniversary of my friends grand parents. I helped elderly people up and and down stairs, moved things and served drinks. I ate copious amounts of amazing food: assorted caramelised nuts, cheese borekas, salmon, salmon and salmon, tuna lasagne, cheese cake, brownies, balaclava and some few other delicacies.

Full and happy I drove home. I stopped off at uct and downloaded some crap that I didn’t even use or need.

At home I relaxed a bit, did some computer stuff and then missioned off again.

I went to the waterfront where I met Jas to try to see the curious incident of Benjamin Button. For the second time in a row the movie was sold out. We missioned through to the labia and managed to get in and see it. It was beautiful, moving and sad. I shed a tear. My tear. I cried it. I haven’t cried in years. When I want to cry my throat becomes tight and saw but the tears never come. I think it’s because I hold too hard onto myself. I don’t know how to let go.

I miss Lolita. There is so much loss and loneliness and sometimes I don’t think I can handle it any more, then I realised that handling it is a passive thing that just happens. Not handling it requires doing something else and I don’t know how else to do anything or else I would do things differently…

Anyway. I’m home now and off to bed.

Learning about Dying

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I have quite a rigid sleep routine, which includes not having caffeine. Last night I thought that I would try to drink a cup of tea at 6pm. I made the tea and brought it with me to my room. I was busy working so the tea sat for while. I get getting a whiff of some really awful smell. I thought that it might have been something on my hands or maybe coming from the water bottle I take to uni. When I had the first sip of my tea I discovered that the tea was the source of the smell. The smell was quite fishy, not the smell of off milk. I put the cup of tea under my father’s nose. He said it smelt like bait.

The expiry date on the bottle of milk was 19^th March, which is tomorrow. I smelt the milk. It smelt fine. I tasted the milk. It was probably one of the worst things that I have ever tasted. I think that some soft of fish died in the milk and had been rotting there for some time. I went to the local spar from where I had originally bought the milk, and got it replaced. My cup of tea, which taste a hell of a lot better, was consumed at 7pm.

I ate supper with my family and played an enjoyable game of Command and Conquer Generals: Zero Hour just before bed.

The weather in Cape Town changed yesterday from summer to winter. The average temperature dropped more than 10C. So I was a bit chilly in bed under my usual thin duvet. So after lying in bed for a while I got up and put my sleeping bad on top. Then I was too hot. After tossing and turning for an hour and twenty minutes I got up, ate some junk food and got back into bed. I think that I got up at least one more during the night to remake the bed and allow myself to cool off.

I had a terrible dream once I had fallen sleep. I dreamed that I needed to have surgery on my bowels and that once I had been anaesthetised I could almost feel what they were doing and follow the operation, so I had to try and keep my mind busy.

My clock radio started playing 5FM at 6am. Then somehow it was 7h20, 20 minutes after I was supposed to have left. I jumped out of bed, got dressed and got ready. I ate my packed uni lunch in the car for breakfast.

I arrived at St Luke’s Hospice, Kenilworth at 8h40. The place is really beautiful with a warm happy air to it. My clinical partner and I were assigned to see a 73 year old gentleman with oesophageal cancer. We took a history from him and examined him. Besides a hopefulness that he would one day wake up and the cancer would be gone he s happy and comfortable.

We then had an excellent tutorial about palliative care where I learned a lot about morphine. I felt like a learned a lot more about dying and am less worried about when my time to die comes.

I dashed home, got into my pajamas and went to sleep for a few hours, which was fantastic.

When I woke up I played CNCGZH, then typed up my patient, ate supper and did some accedemic research.

Tomorrow I am going to Lotus River CHC in the morning and am going to buddy for supper.

Exams

There must be something wrong with me. The longer I study the worse it becomes. For each exam I study less. For each exam I stress less. I have gotten to the point where I just don’t care. The exams come and pass and I am the stone sitting at the bottom of the rushing river. The chaos and the exam pass over me and I pass and the pattern gets reinforced.

Studying for 6th year obgyn

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Tomorrow is my last day at the cancer ward. I am looking forward to leaving that place behind me. I have seen too much sadness. 35 year old women, beautiful and sad like the elves – 5 year survival probability 1%. Friendly kind elderly ladies from all over; of different ages, from different cultures. I do not understand why they didn’t come to hospital sooner. I suppose they were scared. They had large masses arising from their pelvis. They will get single agent chemotherapy with carboplatin and then delayed primary surgery. The cohort doesn’t do well.

I spent a dull week at Jooste gynae department. They see between 1 and 5 patients with incomplete miscarriages, 1 ectopic and between 2 and 12 patients for their out patients clinic. Their out patients clinic is a dysfunctional thing that probably shouldn’t exist. The people who are in charge of obstetrics and gynaecology in Cape Town don’t know it exists. The registerar that runs the clinics steals acurettes from the other second level hospitals when he is their and brings them back to Jooste. The patients that I saw there were ridiculous. They were either referred from the casualty officers, who, for lack of time and desire, did not adequately assess the patient and just discharged and referred them. They had no gynaecological problem. The other group of women we saw had problems requiring a higher level of care, or problems that could have been followed up at the day hospital. Jooste was an important time during my block because I got many proceedures signed off in my log book.

During my last week in the oncology I grew incredibly pissed off with the nursing staff in our ward. On Wednesday Prof Deny asked me to go to C16 to collect two viles of contrast and take it to F5. The nurses were too busy to go. I walk from medical school to C16 then up to F5. The nurses were sitting around laughing loudly and doing no work. For the rest of my time there I was annoyed with them.

I have read the green gynae handbook issued by UCT’s OBGYN department this weekend, plus a few additional things on gynaecological cancers. I will go in tomorrow and take Tuesday off. Our exams are on Wednesday and Thursday.

I struggled to study. It was hard to force myself to read through everything. My mind just didn’t care. I enjoy to learn and to let myself explore and grow. I don’t enjoy being forced to learn about that which does not interest me.