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.