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.

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.

Migrane

I have migraines. Yesterday I felt the potential of a migraine as that subtle, almost impalpable pain on the right hand side of my head, superiorly on my temple. I felt it coming on slowly. At first it was just the potential to have a migraine that I might be able to ignore and it might go away. A point came when I knew that it would be. I took two panados in the hope that the decreases gastric emptying associated with migraine wouldn’t delay or prevent paracetamol’s blissful absorption.

I kept speaking to my seductive poison, hoping that the pain wouldn’t come, wondering how it would show itself. Suddenly it fell like a guillotine; from nothing to 7 out of ten on the pain scale. I wanted to quickly leave my poison but I couldn’t. I waited, trying to want to leave quicker but failing

After I logged off I went to the toilet, brushed my teeth, flossed and went to bed.  I thought that when I hit the pillow I’d be able to blot out the pain with it some how. I hope that the pain and consciousness would fade quickly, but I was not afforded that luxury. It was agony beyond words, beyond hope, beyond fear. I rolled, thrashed and writhed in my bed. I fought the pain like I’d fight for my life. It was like somebody was continually stabbing a new wound through to the lateral aspect of my left eye socket, somewhere agony where I don’t ever touch or feel. I pounded my head, I tried to compress that pulsing artery on my temple, I tried acupressure, I thought of taking more medicine,  I thought of screaming for help, for somebody to take me to hospital. There was NO escape

After a period of agony, fighting and hopeless came the nausea with its inevitable vomiting, sleep and escape. My medically trained mind, between the throws of agony, started trying to work out exactly what about the nausea and vomiting made the migraine get slightly better for a short time in order for me to escape. Migraine is caused by abnormal blood vessel dilation within the meninges, nausea and vomiting is causes a huge parasympathetic drive in the body leading to bradycardia and decreased blood pressure. Maybe that’s the trick, so while struggling to the bathroom I try the Valsalval manoeuvre and carotid massage, both of which lead to slight relief followed by more agony on top of agony with added agony.

I get the bathroom and I am sweating, but I mean sweating worse than I have ever sweated, its flooding off of every micron of my body. I’m nauseous and I’m finished. I don’t really want to vomit but every smell, every small whiff of toilet freshener, soap, urine, anything make me want to vomit, but I’m trying to control it now; to control my reaction to the migraine. I’m taking slow calming breaths, focussing on slowing my heart rate, thinking about my parasympathetic nervous system. I take my top off because I’m overheating and drowning in my sweat.

I’m lying on the floor and slowly, slowly getting better. Feeling my body stop fighting the pain, feeling my body work with the pain, work with itself and conscious control to completely give up the fight and relax; to give up all hope of wining and accept my loss; to win by loosing all hope and just give up.

There, like I’d always known in theory, lay my true salvation, lying half-naked and drench in sweat on the floor, came the peace that brought me enough freedom from the pain for me to go back to my room and sleep; Freedom in completely giving up. Freedom

Fate and the wait

Last night the girl and like and I met up again. We watched Simpson’s. The night ended with us lying together, her head on my shoulder and her smell permeating my brain. I still wasn’t allowed to kiss her, but it felt good.

Where things are going I don’t know. I wish I did and I wish it was somewhere good.

The coldness

Today started off at 6am. My clock-radio switched on at 6am and informed me that it was going to be freezing cold. It then started to pour like a motherfucker outside. On the brighter side of the pitch black 6h05 rainstorm a friend smsed me to tease me about how early it was.

I had a pounding headache and the first time I moved I realised that I must have missed a dose of my Cymbalta (dualoxetine) because I was having the characteristic shooting shocking feeling on movement that I get when I miss my meds. It usually starts on the same day that I miss my meds, but I’d been sleeping a lot so I did not notice, I suppose.

As the day progressed I came to realise that I had missed two days of it and my noradrenaline levels must be very low. I felt shit.

Fulminant liver failure lady is still hanging on. 2 of her enzymes, which when increased are a sign of liver damage, where 500 times higher than normal. She has kausmal breathing, the characteristic air hunger which is associated with acidosis. She also had a blood glucose of 3.2 on 10% dextrose. She is much more comatosed today than yesterday.

Where’s my sole

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The suffering

In the past few days I have born witness to an unreasonable and inhuman amount of suffering for which I cannot find meaning.

In the hospital every day people are unreasonably sick and dying. There is a woman there with at least 5 different life threaten condition, one of which will kill her in the next couple of days. She is swollen everywhere, she has pericarditis, chronic obstructive airways disease, a urinary tract infection, pneumonia, etc, etc. I do not understand why she needs to spend her last days conscious, suffering, having needles poked into her, in a smelly hospital ward.

A man presented with diarrhoea and I needed to do a rectal examination on him. He screamed and writhed in pain while I tried to feel inside his rectum for god knows what. It was the most dehumanising torturous things I have ever done. I feel freaked out and unhappy about doing it, but medicine is not about quick fixes or only joy and health

Today one of the saddest things happened. A patient that we had seen a week ago with AIDS/TB came back. She had been discharged in decent health and well on the way to living a long meaningful life. She is 18 years old.

Today she presented with fulminant liver failure, crazy off her head, jaundice yellow, screaming in agony and probably on her way to the afterlife. We had to stick a IV up in her neck, restrain her and sedate her so she wouldn’t pull her drip out. Her blood glucose was 0.9 and she had stage III encephalopathy, both of which, along with the fact that her liver failure was induced by the TB drug isoniazide, are very poor prognostic indicators. I spent a few hours watching her and trying to encourage her to lie with her head to the left so that her 10% dextrose drip ran. This was very difficult because she was complete non compos mentis.

In my social life I feel loney and isolated. In my day to day social life I am exposed to things that are beyond the realm of normal human experience, which I am unable to relate to my peers and friends, at all.

The non communication between my old friend and I, the one with the long shul fight story, continues despite my best efforts. It hurts me terribly. I will not apologise and pathetically chase after her, but I miss her and I feel intensely hurt and unhappy.

I am lonely at university. I am not happy waking up at 6am to go watch people die; to watch the truth of the human condition in all its indignity, suffering, pain and eventual silence.

And as so far as my quest to find and bring meaning to my actions and life go I am left with the burning after-shadow of what I have born witness to recently, coupled with other life-long personal experiences of suffering and no answer.

“Where do we go from here? All the words are coming out all weird. Where are you now? When I need you!”

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Surrender

The last
couple of days have been a reflective, intense period of time for me.

On Friday I
went for my last day of job shadowing the GP that I have been going to for the
past 4 weeks. As always, I thoroughly enjoyed it and learned a lot. At the end
of the time spent with him he gave me a hug and told me that I would be a good
doctor. It felt really good and made me feel hopeful. It felt meaningful.

Thereafter I
went home for lunch and then off to university for an Ethics tutorial on
Abortion. Despite my very negative perceptions of what I though the tutorial
would be on, I actually found it thoroughly interesting. The tutor is a very
clever person who engages with the glass more like a madrich then a tutor. He
also seems to have a legitimate, logical answer to everything. I was the most
radical pro-choice person in the class to the extent that when he asked whether
anybody thinks that killing a new born baby was ok I said yes. He presented all
of the most common arguments for and against abortion and then slashed them to
bits. At the end of the day it turned out that he was pro-abortion. This is the
opinion that every woman who becomes pregnant should have the pregnancy
aborted. He wrote a book called “Better to have never been,” which I intend to
read

I then had my
usual Friday Nargilla session on the UCT rugby field. One of my class mates
joined us. We had an interesting discussion about religion. I was concerned
that I had offended him, but it turned out we both enjoyed it and gained a lot
from it.

Then off to
Simon’s Town for a supper. After supper I visited this beautiful acquaintance
in Tokai who had had an operation. I enjoyed her company and left at around
23h00.

At the Habonim
meeting I met up with one of my dearest friends who has been living in Joburg
for the year and running the show. After spending some time saying hello to
everybody I sat down with this girl that I didn’t really know and had the most
absolutely incredible conversation that I have ever had with anybody in my
entire life. Never have I been so well understood. We both shared concepts and
understandings that I do not know how to articulate properly. I am still
reeling from it and at a loss for what to do with it. 

On Saturday I
got an email from a friend that had a link to a website where this guy who was
in charge of my gap year had posted an open letter to people who had been on
the gap year in the past couple of years. I spent about two-and-a-half hours
writing him a very detailed account of my gap year and the issues I had during
it. I called him to account for some of the issues and now wait half-heartedly
for the reply. I forwarded to the email to 3 people who were on my gap year
with me.

In the evening
I went to a birthday party. It was a really awesome party because everybody put
so much effort into it. The theme was “It’s a kid’s dream,” so naturally I came
as a paedophile. I shaved a ridiculous facial-hairstyle where my chin and neck
were cleanly shaved and the rest was hairy like a mother-fucker. I smoked a lot
of nag, and chilled. That chick I had the fight with arrived and proceeded to
do the guy who’s party it was. I was happy for him. I will not pretend that
nothing happened between me and her and move on. If she wants to that’s fine,
but I will behave how I feel.

I then saw my
friend’s band play in obs, followed by going with people who wanted drinks to a
bar a little down the road. When I got back to my car somebody had reversed
into the driver side back door. He left his number, thank god, and so I went,
against the bouncer’s better judgement, to the Woodstock police station to report the
accident. I was feeling a little shaky and did not check my blind-spot when
changing lanes to park. I almost side-swiped a mini. Then the mini-hooted, overtook
me, slammed in its breaks and produced an absolutely massive black man who
wanted to physically assault me. I reversed as fast as I could to get away and
then had to change gears into first because reverse is slow. The man got his
hands in my car, but I managed to away into an alley where I put my lights off
and pretended that I did not exist until he drove slowly passed. I felt very
shaky and unhappy afterwards. What’s wrong with people? What gives them the
right to attack me? I apologised. They cannot just hit me?

Sunday was a
bit of right-off. I have not been feeling amazing since the attack, although I
came out of it fine. In the evening I went out with a friend from Durban. We went to 5
restaurants, four of which were closed, before we found one to eat at. It was
good to catch up with him. I feel very close to him I then saw the girl from
Friday night. We went to town and sat on the balcony of a bar and spoke to each
other for 3 hours. I had peripheral neuropathy in my right arm from leaning on
my elbow for the whole time. We spoke about our feelings and more about life.
She is not interested in having a relation (with me/generally?) at the moment. At
least she was direct. I now need to do that thing where I need to convince
myself that I do not care and try and move on or move.

Monday at
university was so boring that I have decided to run a euthanasia clinic for my
class mates. We had a lecture in which a greasy large man spoke to us about
statistical measures for an hour; we also had a “seminar” on environmental
health where the dude read us a list of different pollutants – for 20 minutes.
I walked out of that lecture, wrote the course convener an email explaining
that it was Pesach and I couldn’t make it into university on Tuesday.

I then went to my best friend in the entire
world’s house. He is also living in Joburg for the year and running the show
for Habonim. We chilled, ate, I fixed his computer,  and then we went to the bayit. I smoked nag
with a girl I liked, watched a movie with the girl then went to my usual Friday
night family for first night Pesach. I absolutely love Pesach at their house.
Everybody gets drunk and we sing a lot and almost feel like a family. It was
amazing. My one friend there got so utterly wrecked. We ate good food and
generally had an amazing time. I then went back to the bayit where we smoked
nag on the balcony under the most gorgeous African sky, then watched who wants
to be a superhero until 04h00 and went home. 

Yesterday I
slept till 12, and then went out for lunch and a walk with my dad. In the
evening we went through to my mom’s house for Pesach round two. Besides the
allergies and the fact that the house reminds me of where I grew up and invokes
very negative feelings and memories the event was nice. I fixed their DVD
player and Nintendo. I also copied photos off my sister’s camera.

Today we went
to Radio Zibonele to develop our health promotion project. We have come up with
a few really good ideas. I love working with my group. I slept a lot when I
came home.

I am feeling…
strange. Firstly I know that I really like this girl that I met and that she
does not really seem too interested. She seems to have a lot of experiences
similar to the one that I shared with her, yet it for me it seemed like this
unique amazing once in a lifetime connection because I do consider myself to be
open and engaging and have never ever experienced anything even remotely
similar in magnitude or meaning. I try to cling on to the concept of surrender,
desperately trying to force myself to reject any power or responsibility in
this situation in the hope I don’t scour the life from my sole with pain again.

Secondly I am
very very bored and disinterred in the goings on at university at the moment.
This block has been so vague and uninteresting. It’s difficult to feel
motivate, excited or capable to get to university everyday. I feel excited for
the long weekend. I once again turn to surrender and oblivion. I cannot have
any affect on university.

I am still
reeling and behind it lies a black pit of emptiness juxtaposed by the fleeting
meaning.

I am the still
silent empty void, unconquerable and unaffected by the passing of time and the
harms of the world.

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More ranting about the driver

Last night, after an enjoyable supper and work session, I received a message from a friend informing me that our site co-ordinator wants us to come to the site tomorrow so that we can work on our reflective commentaries. I had a bad feeling about it, but went anyway. It was raining and the shuttle driver was different. On the N2 highway, in traffic, the driver dropped us on the side of the road near another health science shuttle which had the dick driver in it. Why this manoeuvre was done, I do not know, it got us wet and was dangerous.

We arrived on site and our site facilitator spent all of 10 minutes working with us on reflective commentaries, then we spent 2 hours and 50 minutes doing nothing because the bus driver’s a dick. We spoke shit, walked around Khayelisha a bit. Spoke shit, did nothing, wasted our lives.

We then went to the computer labs to do work, but the entire lab was booked for something else. Another wasted fucking day thanks to the university’s transport policies and drivers.

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Small victories on the road

I concider myself quite a competent driver. The one thing which really bring the worst out in me and my driving is people who cut into long queues of traffic waiting to take a congested offramp right at the turn.

Every day I take the M5 north home to my families house in the northern suburbs. Everyday I sit in traffic for between 5 and 15 minutes and try and imagine what kind a fucking idiot built such a shit offramp/onramp. Everyday I wait and drive close to the left hand side of the road as possible in order to prevent a fucker from cutting in the queue infront of me.

Today a fucker tried to cut into the queue in front of me 1m from the offramp after I had spent 7 minutes in near stand-still traffic so I swerved at her and hooted. It was satisfying seeing her keep a 10m following distance thinking I was a lunatic. I would have liked to pull her over so that she could answer the question that has been plaguing me for ages. Why in the cold cruel world does she think that she does not have to queue but other do.

I am the change I seek

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5:30am

5h30 is a not a good time. It just isn’t. To try wake up at 5h30 is not a good or easy thing. I got enough sleep, so I didn’t feel too bad, but I didn’t feel to good either. I was quite surprised at the amount of traffic at 6am. I thought that it would be less than there was, but it was still MUCH better.

I arrived at 6h45 to Retreat MOU and there was  n o t h i n g  going on. There was a woman who had just delivered being cleaned up, so I got that lovely human smell of placenta and bodily fluids which made me want to crawl under a rock and die at 7am. It was good to see the woman I delivered again. Her baby was quite vocal. The day went very very slowly. I was feeling tired and my joints were hurting as they do when I am not relaxing and distressing enough. I felt seriously unwell during my shift. A patient arrived complaining of decreased foetal movements, but she seemed alright. We referred her to Groote Schuur for an ultrasound. 2 other woman came in in very early labour. I examined them, wrote them up and did PV exams on them. They were discharged.

At 11h30 I got my logbook signed and missioned. There was a floridly psychotic woman having a preach outside the community healthy center. I told a nurse who didn’t seem to care and the security guards said that she is a regular feature in the area, and is never harmful to anybody. I think she has biopolar 1 disorder and should be put onto medication.

I am finding my work in obstetric and neonatology incredibly draining and am struggling to cope with it. One day at a time

I phoned 2 gps in the hope that one of them would be able to unblock my left ear without having to put those irritating drops in them for 2 days before, but they wouldn’t. Feeling sore and irritable I went home and slept. I woke up feeling sore and irritable. Its the circle of fucking life.

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