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When Cultural Practices Affect The Treatment Of Patients

In quite a few of the cultures in south africa people tie ribbons, strings and tassels around their own and their children’s wrists and waists. These tassels are imbibed with power to keep evil spirits at bay, I am told. If these tassels come off then the patient is completely unprotected from any and all marauding evil spirits that may be lurking around. Of course, not wanting to be responsible for the unopposed assault by multiple evil spirits, most people are fairly reticent to remove these things. I saw it slightly differently.

As a student I took my lead from my senior. If he removed the tassels then I would be ok with it. If he felt that we should respect the culture of the patient and sort of try to move the tassels out of the way of the operating area or even operate around them, despite the increased infection risk, I sort of reasoned it was his patient and even if I medically didn’t agree with him, the reasoning of respecting the patient’s culture surely held some water at least and I didn’t argue. The fact of the matter was that a number of the sisters would become quite aggressive with the doctor if they thought he was going to remove the tassels and strip the patient of his evil spirit protection, and I think some of the doctors were scared. Then one day something happened that cemented my views and actions for the future. Read more »

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

A Surgeon Watches Helplessly As His Patient Dies

Sometimes different people see the same thing from a slightly different angle, giving a completely different perspective. In my line this can turn out to be quite macabre.

It was one of those cases. It was probably hopeless from the beginning, but he was young and we had to give it a go. As soon as the abdomen was opened everyone knew things were bad. There was blood everywhere. It took a while to even see the damage to the liver because I needed to get rid of the blood in the abdomen before I could see anything. However, once I saw the liver even I was shocked.

The liver was ripped apart with one laceration dropping down to where the IVC sat menacingly behind it. It seemed to spit and splutter at my efforts to bring the bleeding under control in defiance of me. But I did what I could as fast as I could. At times like this the unsung hero is the anesthetist. If he can’t get fluid and blood into the patient fast enough, no matter what the surgeon does, it will be in vain. That day the anesthetist was great. Somehow he kept some semblance of a blood pressure in the patient against overwhelming odds. Read more »

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

Death Threats For Hospital Pecking-Order Violations

The consultants didn’t always need to know what was happening on the floor. But sometimes keeping things away from them became downright clandestine.

I was a senior registrar at Kalafong (hell). An old friend of mine had just taken up a post as consultant in the department of Internal Medicine. One day he approached me.

“Bongi, what are the chances you can do the occasional open lung biopsy for me?” Now there was no thoracic department in Kalafong so it seemed to me to be a reasonable request. In fact I was quite excited. It would give me a chance to do a few thoracotomies, something us general surgeons don’t do all that regularly.

“Sure! Anytime. Just let me know and I’ll book them on my list.”

“Uhmmm, there is just one small problem,” he continued, “I’ve already asked your consultant when the previous registrar was here and he bluntly refused, so I suppose you would need to convince him.” Read more »

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

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*

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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…

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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…

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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…

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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…

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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…

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