The Uni Gap

Yesterday was my first day back in the breast, thyroid and other tumours firm. I had a decent time in trauma but it was nice to be back. I arrived at 7h15 for the post-intake ward round after which we had patient allocations and then a tutorial by the head of the vasular firm who felt that it was completely justified to open two Fogerty catheters, the cheapest of which was valued at over R1000. He openned them just to show us and probably threw them away afterwards.

After the tutorial I went to the medical school library where I took a fantastic crap.

I then went back to the hopsital where I saw a 28 year old male with with treatment resistant immune thrombocytopaenic purpura. He had a strong smoking and ethanol use history and had facial features of fetal alcohol syndrome. He initially presented to a second level hospital with epistaxis echymosis and rectal bleeding. He has been at Groote Schuur for the past month and is currently on predinsone 2mg/kg/day and still has a bicytopaenia with platelettes between 5-10 and haemoglobin between 5-10. He has undergone numerous transfusions. When I examined him he had 2/6 ejection systolic murmer and tender hepatomegally extending 1cm bellow the costal margin. The total liver span was 6cm. He liver was smooth and non-pulsatile. He was pale.

The second patient I saw was a 48 year old female with a strong family history of breast cancer presenting for sentinel lymph node biopsy and radioisotope occult lesion localisation. The tumour was found on mammography. Histology and cytology point towards it being a grade C3 papillary carcinoma. She also had a single thyroid nodule which will be investigated after the surgery.

I went to the computer labs for a while. I printed some documents for my meeting with the dean on Friday and I work on something for a friend. We had a ward round after which I went to a friend to help him with a computer problem, then I dropped my phone charger at another friend.

I went to bed quite early because I had had a late night on Sunday.

Today I assisted in the S ROLL which was very smooth. The surgeon removed the tumour and we found the sentinel lymph node which was radioactive and blue, but did not have malignant histology. I took a break then I watched a massive spleen being removed. I went home just before the ITP guy’s procedure started. He had had plasmaphoresis and was transfused with platelets and blood.

I am not going to go in for the rest of the week because there are just lectures and tutorials and I don’t pay attention in them. I need to go to aftercare. I need to get a better handle on my surgical studying and I should write up my patients. It feels weird. I feel bad, in a way, or not going to uni. I also feel like it is completely justified because I cannot handle any more boring lectures or tutorials.

Things are difficult at the moment

I’m feeling pretty low at the moment. I feel miserable, cynical and petulant. I am bored with my studies. I feel boring. I feel like I am struggling to make conversation with people. I feel uninteresting. I continuously feel let down by the social interactions that I struggle to organise.

I feel useless and worthless. I know this is a completely absurd statement, but it’s how I feel. I am know that I will be a doctor soon. I feel skilful and able to be a important and helpful part of any hospital team, but, at the same time, that doesn’t seem to matter.

I am so incredibly frustrated by my relationship issue. I am tired of chasing shadows and I am tired off all my shattered dreams, yet I do not know how to move on. I don’t know whether to run away or run towards.

This are difficult at home. My dad has been quite down lately. My step mother has been going through her own stuff with her own family.

This past week I rotated through trauma at Groote Schuur hospital. I generally had freakishly quiet shifts. I met good, friendly and kind doctors who taught me and treated me well. I was able to help out and felt part of the team.

The best that I have felt all week was after I had been awake for about 27 hours and donated blood. I was over tired and found my long lost sense of humour, for a while. It is now gone again.

I help sort out a friend of mine with a new PC and got another friend of mine an external IDE laptop hard drive enclosure.

On Monday I saw one of my friends and his partner for supper. On Tuesday I took myself out for a movie and saw a friend who came over to collect some computer hardware I had collected for him. On Wednesday I gave a friend a lift to the airport. On Thursday I was meant to see one shadow but, predictably and very frustratingly, she cancelled. I saw another shadow afterwards then I worked for the whole night. I slept the whole day on Friday and then worked from midnight to 8.

I saw a few people die. I saw my first rape patient. I saw people in agony.

I am struggling so much. I feel so alone. I waste vast amounts energy keeping myself going and chasing after my friends and shadows.

The lady who was loosing blood from an unknown source

30 year old female whose folder was locked away in the closed down out patient department with known #neurofibromatosis #bellow knee amputation of left leg secondary to neurofibroma eroding into bone #spinal fusion with prothesis broken at coccyx. Presents with collapse at her physiotherapy out patient appointment. She arrives at casualty with a blood pressure of 50/20mmHg, pulse 160 beats per minute, she was apyrexial and was not in respiratory distress. She was pale with cold, clammy extremities. Her respiratory system was normal and her cardiovascular system showed signs of shock: tachycardia, hypotension, weak / absent peripheral pulses. Her heart sounds were normal. Her abdomen was soft and non tender. She had no guarding, no rebound and no organomegally. She had no neck stiffness and her pupils were equal and reactive to light. She was confused, with a decreased level of conciousness. Her haemoglobin was 9.1g%. She was resuscitated, receiving 7 litres of fluid without any marked improvement in blood pressure. She reached a point where she was no longer protecting her airway and required intubation. Blood results came back showing her haemoglobin dropping to 4g%. Her white cell count was 45.0, CRP 1.2, procacitonin < 0.5, lactate 4-5 and eveything else was unremarkable. A nasogastric tube was passed which drained stomach contents and no blood. There was no blood per rectum or per vagina. An radiology registrar was called. Her supine chest and abdomen x-rays were unremarkable and an ultrasound of her abdomen showed nothing of note. The medics insisted it was a haemorrhage and surgeons insisted it was a sepsis. Her folder was retrieved the following day showing that she had: #recurrent abscesses on left inner thigh #previous fracture left inner thigh She was sent to ICU where she was ventilated and kept on quite a high dose adrenaline infusion to keep her blood pressure high enough to ensure her brain was oxygenated. She received more than 10 units of blood yet her haemoglobin remained low and no site of bleeding was found for 4 days. She was found to have a left ruptured popliteal artery pseudo aneurysm. She was taken to theatre where the aneurysm was occluded using a balloon catheter and the aneurism was repaired. She lost 4 litres of blood in theatre and received 11 units of crystaloid, 7 units of blood and 1 megaunit of platelets. She remains restless yet not fully concious in ICU following the recent withdrawal of sedation.

The end of my Valkenburg Block

My time rotating through Valkenburg was come to its end. I really enjoyeed my month rotation in the male high care ward. On Tuesday and Wednesday I saw all of my patients.

The gentleman who was keeping the peanuts and an olive in his mouth is unchanged, though I did find out that he has been living in ward 6 for the past 30 years. They think that he has stomach cancer. He had a barium swallow, which was suspicious, but he keeps not consenting for the gastroscopy. He will probably die soon.

The perseverating gentleman who got stepped down to ward two, then his family didn’t come collect him for weekend leave and he started fighting with the nurses and causing problems so they stepped him back up toward 4. I assessed him and felt that he was apsychotic. He has an underlying intellectual disability, and I felt that he was at his baseline and needed discharge.

The young man with the second or third schizophrenic episode remains virtually unchanged since I started working at Valkenburg a month ago. He is apsychotic, but has absolutely no insight into his condition and remains guarded. Last week he has this strange delusion that he was going to be able to support himself by blogging and getting corporate sponsorship. The delusion has now become an overvalued idea. He remains in ward 4 and will stay there until he gains some insight.

The psychomotor agitated gentleman in ward four is settling down nicely. He is still suffering from akathesia and tardive dyskinesia. He is calm, engages well and I don’t think he’s psychotic.

The floridly psychotic gentleman with the good insight went on leave for a weekend and he was gone for a very extended period of time, I think over a week. He came back and had a good report so we discharged him.

A gentleman said that his brain was melting and he had a genie on his cock. When he came into the ward round for an assessment he bent forward to show us where the genie was on his head. Another patient, Mr Emergency Delta March has remembered his name, and more recently, his date of birth. A patient in ward 4 no longer feels that his blood is eating him. He did say “I don’t understand why my brain is being roped and scalped. My jugular vein has been slaughter and I don’t think my Adam’s apple can handle it.” He then requested ointment for his Adam’s Apple.

A Bangladeshi gentleman with psychotic depression and a 20 year substance abuse history of heroin and codeine containing cough mixtures was transferred to ward 4 but had to be sent back to high care because he continually made inappropriate sexual comments at the nurses and was also touching them inappropriately. He developed multiple medical complaints which were probably drug seeking behaviour.

I enjoyed working with the the team in which I was placed. Our consultant was an amazing man and the registrars were superb.

Today I wrote my written paper, which was quite straight forward. The oral exam also went well.

I upgraded to 4gigabytes of RAM.

I am currently playing Warcraft 3. I am really enjoying it. I was running it in Wine, but I kept getting this memory error when I saved. After searching the internet for quite a while there seems to be no good solution.

Lolita was in touch with me a few days ago which was nice. My reply to her message was a bit too expressive.

I saw a friend of mine and we were discussing this girl I was with a while ago. She has schizoid personality disorder. We were discussing how she was becoming so withdrawn and nobody ever sees her and she failed uni last year. I then got incredibly worried that she was developing schizophrenia and that there issues she was experiencing were a prodrome. After worrying for about 2 hours and actually contacting her for the first time since she ignored me on my birthday, I realised that schizoid personality disorder is so named because it resembles the prodrome of schizophrenia.

I am happy to be on holiday for the weekend. I am still feeling quite lonely, but not that bad. I need to redo a part of my family medicine portfolio this weekend, to which I am not looking forward. I start surgery on Monday