October 3rd, 2009 by Bongi in Better Health Network, True Stories
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Some things make me feel so powerless (yes, even i can be powerless in the face of incompetence).
I have previously mentioned a thing or two about my opinion of where medical training is going in this country. Basically the powers that be are not-so-gradually degrading the degree. To them somehow it seems like a good idea. Ideas I suppose can easily seem good when you are safely hidden away in your nice air conditioned office far from the reality of the consequences of essentially negligent doctors released into the community. Well I get to see the consequences up close.
He was referred from an outlying hospital on a Friday. The peripheral hospitals so like to empty their wards for the weekend. After all there is some good fishing in these parts. Thank goodness for good fishing. Otherwise many more would die unnecessarily. Read more »
*This blog post was originally published at other things amanzi*
September 27th, 2009 by Bongi in Better Health Network, True Stories
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Of the things I encounter in my work, the one I find most disturbing is family murders. For some reason they happen with too much frequency in our country. It seems that some people, when life is too much for them are not happy to only put a bullet through their own head, but they feel the need to wipe out their entire family first. In my opinion it is a dastardly and cowardly act for which there is no excuse…ever.
The last one I was indirectly involved in was a typical story of a man that had lost it. He killed himself. But just before doing that he shot his wife and two children. His little girl made it to the hospital. I was asked to evaluate her, but she died before I even got to her. I was so disturbed I decided I didn’t want to see the body. I did, however see the scan. Besides the two bullet wounds through the head, the thing that struck me most were the two hair clips clearly visible on the scan in her hair on the back of her head. it was somehow disturbingly poignant and it stayed with me for some time.
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*This blog post was originally published at other things amanzi*
September 20th, 2009 by Bongi in Better Health Network, True Stories
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Recently a plastic surgeon I know was called out to fix a lacerated ear. It is the domain of plastic surgeons pretty much all over the world. But in my neck of the woods it may be tricky to extricate a plastic surgeon from his warm bed on a cold night. Let me also say that back in those days all registrars of all disciplines earned the same overtime each month. Even opthalmologists and dermatologists and pathologists earned exactly the same overtime as surgeons. They weren’t complaining. We, however, were.
As calls went it was fairly standard for us general surgeons. I had found a moment to empty my bladder which was a nice change, but other than that one reprise there had not been a moment to even realise that I hadn’t eaten all day. At least there hadn’t been any lethal disasters…yet.
Somewhere in the madness the house doctor asked me to evaluate a patient with a lacerated ear. He had had half his ear detached in a bar brawl. It was hanging precariously from what still connected it to the body. Now at this time in that hospital there was a policy that once a patient had been referred by a casualty officer they would not take the patient back. If the referral was erroneous then we would be required to refer further as appropriate. So when I heard my house doctor had accepted the patient I was not impressed.
“You suture his ear.” I told him. Poor guy, he hadn’t studied at our university and therefore wasn’t used to our sink or swim approach to medical training. He freaked. My level of being impressed dropped even more. I’d have to phone the plastic surgeon myself.
The plastic surgeon was not keen. By that I mean he basically said he was not coming out. By the tone of his voice I assumed he was getting a back rub from his significant other under the warm duvet on his bed. Who could blame him. If you’re not in the trenches why would you want to go into them, even for a short while to suture an ear.
“Anyone can suture an ear. you’re there now. I’d have to come in to the hospital. You just do it.” I considered telling him that I’m at the hospital because I have so much bloody work to do and that he is drawing the same overtime that I am and that it is his bloody job and not mine. But I knew that at that stage, even if I walked on water and then turned it into wine he was not going to come out. I hung the phone up. my house doctor looked at me questioningly. He had already told me he couldn’t do it. But he was not from our neck of the woods. I needed a student. One walked past, unsuspectingly.
“You! have you ever sutured an ear back on?”
“No.”
“When I ask this same question tomorrow, you will answer yes. Come with me.”
He did quite well.
*This blog post was originally published at other things amanzi*
September 15th, 2009 by Bongi in Better Health Network, True Stories
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M and M was never fun. Sometimes I would walk out feeling I’d just escaped by the skin of my teeth. Sometimes I would feel like my teeth had had too close a shave. But once…just once, it could have been worse.
It was a pretty standard call. It was very busy. In the early evening I was called to casualties for a patient with severe abdominal pain. When I examined him it was clear there was something seriously wrong inside. He had a classical acute abdomen with board like rigidity. He clearly had a perforated peptic ulcer and needed surgery. I set my house doctor to work to get him admitted and on the list. Meanwhile I went back to theater to work through the number of equally critical patients already on the list.
Things then settled down into a rhythm. I was in theater with a student operating the cases one after the other while the house doctor separated the corn from the chaff in casualties. Finally it was time to do the laparotomy for the guy with the acute abdomen. I needed to shoot through casualties before we started so I decided to swing past the ward and make sure the guy was still ok.
The ward was dark. Pretty much everyone was asleep. Without wanting to wake the other patients I turned on the small bedside light of my patient. Even in that dim light I could see a bit of oral thrush. I was surprised. I was thinking to myself how the hell did I miss that in casualties. I felt his abdomen. It was no longer quite so tender. I turned to the student.
“See why it is important to make your decision before giving opioids?” I said with an air of authority. “Now he is actually not so tender but he definitely had an acute abdomen. We must go ahead with the operation.”
I quickly felt for lymph nodes. He had them everywhere. Once again I was quietly thinking that my clinical skills must be slipping because that I also didn’t pick up in casualties. I kept this new information to myself. Imagine the shock to the student if he realised I was not all knowing. i just didn’t want to be responsible for that level of devastation in his life. But I started considering other causes for his condition. It was clear he had AIDS and TB abdomen started looking like a possibility.
While we were still with the patient, the theater personnel arrived to take him to theater. I told them to get things going so long while I quickly shot down to casualties to evaluate a patient the house doctor was unsure about. And off I went at a brisk walk.
I walked into casualties. The house doctor led me to the patient in question, but as we approached his bed my blood went cold. In the exact bed where my acute abdomen had been lying about four hours previously was my acute abdomen still lying there!! I turned and ran back to theater. Fortunately I was in time.
Later I found out what had happened. Once we had admitted the acute abdomen, the porter had come in to take him to the ward. One of the patients lying in casualties was a guy that had just come in. His HIV had wreaked havoc in his life causing a number of unpleasant things, including AIDS dementia syndrome. The exchange went something like this;
“Timothy Mokoena? Is there a Timothy Mokoena here?” the porter called out.
“Here I am, but it’s not Mokoena. It’s Magagula.”
“Ok, Timothy Magagula, I’m going to take you to the ward.”
“Ok, but it’s not Timothy. It’s Michael.”
“Ok, Michael Magagula. Let’s go.”
And thus Michael Magagula, the AIDS dementia patient (not to be confused with Timothy Mokoena, the acute abdomen patient), thinking he had just jumped the queue to see a doctor was carted off to the ward and prepared for theater. He even signed for a laparotomy without even having seen a doctor.
In the end it all turned out well. Timothy got his operation and the hole in his stomach was patched. Michael was referred appropriately to the physicians. But I couldn’t help wondering how this could have looked in the next M and M meeting.
“Well, prof, the patient died on the table basically because I operated him unnecessarily.”
“And how is the other patient? The one you should have operated?”
“Well, he died too because I didn’t operate him.”
200% mortality for one operation. Not easy to achieve.
*This blog post was originally published at other things amanzi*
September 5th, 2009 by Bongi in Better Health Network, True Stories
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When I got accepted into medicine as a last minute add-on due to one of their other applicants turning down the post, I knew how lucky and privileged I was. It was the first step in a very long journey and I wasn’t going to mess it up.
The first year in those days was spent at the main campus and we would only be at the medical campus from second year onwards. Second and third years would be spent on the pre-clinical campus and only from fourth year onwards would we be in close proximity to the big boys. All this I didn’t know when, during first year orientation they bussed us to the medical campus so we could see the preclinical buildings and watch with a fair amount of jealousy when the higher year students walked past. The whole medical training thing was very hierarchical. It didn’t bother me. I had been in a similar system before and had moved up the ladder. I could do it again.
The preclinical campus was a very relaxed place. There were essentially only two buildings (ok, ok there was also the dentistry building but we didn’t go there) with a large grassy lawn between them. There were a few trees providing shade for groups of students lying on the grass and reading or chatting. Our group of first years on orientation clearly didn’t seem to fit in. None-the-less we found a tree to sit under during a short break in the orientation program.
And there I sat in a state close to euphoria with my hopes and my dreams all layed before me. I knew I stood at the beginning of a journey that would lead me to what I one day would be. What I was at that stage was of little significance other than the fact that it was a pointer to what I would become.
I lay under the tree and, as best I could, told my friend who was with me about these thoughts. I then added that I would use the tree as a sort of temporal marker that I could come back to when I was finally what I would be. Then I would stand under the tree and remember that exact moment when I looked into the unknown future with innocent hopes and dreams.
Recently I had the opportunity to go back to the preclinical campus. I remembered that moment so many years ago and was quite eager to stand under that same tree and reflect about the years that had passed and what I had become. On that day, so long ago, I would never have guessed that I would have gone on after medicine to specialise in surgery, so I actually achieved more than I dared dream. I was really looking forward to a moment that would link one specific moment in the past with the present.
The campus was just as I remembered it. The lawn was still there and there were still students sitting in small groups. they just looked so much younger than I remember being. Then Iwent towards the far side of the lawn to have my moment under the tree.
They had cut the tree down! It was gone. Everything else was exactly the same except my tree. Is there nothing sacred?
*This blog post was originally published at other things amanzi*
