Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

When A Surgical Superhero Has To Cut… Wind?

Yes, I have an alter ego. Yes, I dress in funny clothes with a cap covering my head and a mask covering my face. And yes, dressed as such I try to fight the powers of evil (mainly sepsis and bleeding and cancer and the like). I am … a superhero. But there is often little understanding for what goes on under the paper thin masks and baggy gowns we wear. certain …um…occurrences, well, occur with us just as much as with other people.

A common cold behind a theatre mask is no small thing. Remember you can’t blow your nose. Sniffing loudly only works for a while and attracts all sorts of strange stares. Just leaving it is really the only option. The positive side of this is you suffer less from the mild dehydration that accompanies massive loss of …mucus. There is, after all, fluid replacement (it is a very short trip from your nostrils to your mouth over your upper lip). ‘Nuf sed. Somehow this never appealed to me though. So, for all you budding surgeons out there, when you have a cold, plug your nostrils with tissue before scrubbing up. once you’re scrubbed, it is too late. The side effects are only a slight change in voice which is a small price to pay to avoid the constant lip licking and salty taste throughout the operation. Read more »

*This blog post was originally published at other things amanzi*

True Story: An Anesthetist Attempts To Sabotage A Surgeon

There is a sort of love/hate relationship between the surgeons and the anesthetists. Neither one can survive without the other. We supply them with work and they get the work to lie still while we cut and dice. Yet their job is to keep the patient alive while we challenge their ability to stay alive. At the moment of surgery they play good cop and we play bad cop. Of course after surgery the good cop is suddenly the surgeon through and through. But that is another story.

I really appreciate a good anesthetist (I‘ve had bad ones) and to tell the truth these days I’m spoiled by the quality of the gas monkeys that I work with. However many years ago I remember a case where the anesthetist and I had a misunderstanding about time frame.

I was doing a laparotomy in Kalafong. The gas monkey was a long term medical officer. Read more »

*This blog post was originally published at other things amanzi*

Waiting To Die

Surgeons are not so good at standing back, yet sometimes doing nothing is exactly what needs to be done. I remember one time that this turned out to be slightly humorous in a morbid sort of way.
I was in my vascular rotation which was not too much fun (except for a short moment). Generally if a patient came in in the late afternoon requiring an operation, your entire night would be destroyed. And there was pretty much nothing worse than an abdominal aorta aneurysm (AAA). Scratch that. A bleeding AAA was a lot worse than an AAA. So when casualties called and said they had a bleeding AAA my heart sank.

The patient was pale and clammy and his heart was racing. But the thing that struck me the most was his age. The man was 89 years old. The casualty officer also mentioned that he had previously been diagnosed with ischaemic heart disease. So, in summary we had a man just this side of ninety with comorbidities and a condition that was known to kill most of its victims thirty years younger than him. The chances of him surviving the operation were dismal. I called my senior. Read more »

*This blog post was originally published at other things amanzi*

Identity Theft In A South African Morgue

Amazingly enough, no matter how crazy our country gets we are a darn sight better than many of our neighbours. Many people from countries around us flee to South Africa for a better life. Only problem is for the better life you sometimes have to produce a South African identity document. These can be easily bought from corrupt government officials, but why buy one if you can borrow one?

I was working in Qwaqwa. It was an amazingly poverty-stricken place with what seemed to me to be almost total joblessness. I truly don’t know how the people survived. And yet people from neighbouring Lesotho would still move there illegally. I’ve never been to Lesotho personally but if Qwaqwa was a better proposition, then I can’t even imagine how bad life in Lesotho must have been.
Anyway, one day I got to work and was confronted with a sticky problem. The police were there and they apparently needed my help. You see as it turns out, a Lesotho illegal had died a week before in our hospital. In order to qualify for admission to our hospital she needed to be South African. Luckily her sister was the proud owner of a South African identity document and had simply lent it to her, along with her name. I assume they looked similar enough that the clerk working in admissions hadn’t noticed the picture in the book wasn’t that of the patient. More likely she simply didn’t check. The problem was that the patient had been declared dead by the doctor on call that particular night. Or rather the patient’s sister and her ID had been declared dead. At that stage no one yet knew who the patient was. Read more »

*This blog post was originally published at other things amanzi*

Book Review: “Steeped In Blood: The Life And Times Of A Forensic Scientist”

This post is a bit of a diversion from my usual posts, but I think it may still be worthwhile. You see, I want to promote a book.

I’ve just read the book, “Steeped in Blood: The Life and Times of a Forensic Scientist” by David Klatzow. What a stunning book. It really gives insight into the South Africa of old and possibly what South Africa of future may end up being like. I suggest that everyone get ahold of it and read it.

However, David, I do feel I must challenge you on one point. Towards the end of your book, you say one of your surgeon friends told you a story of one of our Cuban import surgeons who tried to do a tonsillectomy through the neck rather than through the mouth, the normal way of doing it. I know this story and have heard it often myself in the corridors in Pretoria. Unfortunately it’s urban legend and nothing more.

I have worked with the Cubans, and they aren’t too shabby. Don’t get me wrong — they aren’t a scratch on a South African specialist (although the standards are dropping as you rightly point out, and quite soon they may be far better than homegrown specialists), but the point is that they wouldn’t do something so bizarrely stupid. I even suspect I know who your surgeon friend might be, especially if he presently finds himself in Pretoria rather than Johannesburg, where you no doubt got to know him.

Anyway, still an absolutely brilliant read for anyone who wants to get a peek into the workings of the apartheid government of old. Go and buy it now.

*This blog post was originally published at other things amanzi*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles