January 23rd, 2010 by Bongi in Better Health Network, True Stories
2 Comments »
After having spoken about when you seem to know more than your consultant, I was reminded of another incident from my internship year where a colleague of mine taught me that sometimes it is best to do certain things under cover of darkness.
The patient (a sangoma) turned up at the surgery clinic one day. My colleague asked her what the problem was. Without uttering a word she lifted up her shirt to expose her breasts. The left one had a massive tumour that had fungated through the skin probably some time ago. There was a large stinking cauliflower-like mass with central ulceration that caused a fist sized cavity right up to the chest wall. The smell was also remarkable. Read more »
*This blog post was originally published at other things amanzi*
December 8th, 2009 by Bongi in Better Health Network, True Stories
1 Comment »
I have already spoken about the hazards of doing favours, but recently I was reminded of another example when I was still a registrar where I only just escaped the proverbial falling anvil.
It was not an unusual case but still fairly challenging for a registrar like myself. The old man presented with an acutely tender abdomen and free air revealed on x-rays. If you ignore the outside horses for a while, this is either a perforated peptic ulcer or complicated diverticulitis (some people would throw complicated appendicitis into the mix, but I’m going to leave it in the stable with the outside horses if there are no objections). The patient needed an operation and soon. So with the sun shining happily over Australia somewhere, I took him to theater. Read more »
*This blog post was originally published at other things amanzi*
November 12th, 2009 by Bongi in Better Health Network, True Stories
No Comments »
I thought of not telling this story at all. Recently when it was in the news here it seemed wise to rather bury it altogether. But it is something I experienced and, after all, this blog is about my experiences, so…
Six years in a department gives you enough time to do a few things that can be legendary (like this story). This was one that most at the time thought was one. However, at the time it impacted me on a different level.
The surgery department had a fairly intensive academic session every Tuesday. The highlight was a discussion delivered by one of the registrars on some or other topic. He was required to reference the absolutely newest literature and the standard was very high. It was a big deal. Most guys spent a few months putting their talks together. Read more »
*This blog post was originally published at other things amanzi*
November 6th, 2009 by Bongi in Better Health Network, True Stories
No Comments »
Recently I had a moment to reflect on adrenaline and adrenaline inducing sports. It was a bloody moment. But I’m getting ahead of myself.
Bleeding peptic ulcers occasionally cross the path of general surgeons. Usually they stop bleeding with conservative treatment. But sometimes they don’t. Then you need to whip out the trusty knife. Even then usually the operation is little more than routine. This case, however was exceptional.
He was white as a sheet. He had been bleeding for three days but only decided to come to the hospital when he started falling over. It seemed he could at least recognise falling over as not normal. The initial gastroscopy showed a penetrating duodenal ulcer with no active bleeding. the body had managed to curtail the bleeding, partially because of vasoconstriction, but mainly due to a low blood pressure which in itself was due to loss of blood. Read more »
*This blog post was originally published at other things amanzi*
September 20th, 2009 by Bongi in Better Health Network, True Stories
No Comments »
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*
After having spoken about when you seem to know more than your consultant, I was reminded of another incident from my internship year where a colleague of mine taught me that sometimes it is best to do certain things under cover of darkness.
