Highlights of today's blog include another rant about an aspect of the South African healthcare system, much more blood and gore and the occasional funny.
***
Let's hit the ground running with a rant. I'd like to consider myself a pretty positive guy. In general you have to do a fair amount that gets on my nerves for me to think badly of you. Taxibus drivers definitely met my quota and after our shifts last week South African radiographers have now joined the exclusive club. As the lowest members of the clinical team we are quite often given the generally mundane task of taking patients round to the CT scanners. General etiquette is to ask the radiographer when to bring the patient round so they can fit you in amongst their other patients. For some patients this is important because as they're coming from the trauma resus they are unstable. Here it is pretty common practice for me to take fully ventilated and sedated patients round to CT keeping them topped up on sedation as I go (because yes apparently that is all it takes to be an anaesthetist). Before now we've had to rush patients back to resus because their oxygen tanks have run out or their ventilator has stopped working. Given the stress transporting these patients causes us it would be nice to get them scanned as soon as possible. Unfortunately the radiographers don't seem to take our concerns in to consideration. After one radiographer had lied to Riki about being able to bring someone round immediately it sparked a very heated argument with both Riki and the radiographer screaming at each other over the patient as we wheeled him in.
Radiographer: 'Your patient is stable. He can wait'
Riki: 'HE'S BEEN SHOT.'
Needless to say, I will be minimising my time transporting patient's to CT from now on. Rant concluded.
Saturday brought a nice change of pace with the arrival of my old room mate Julian who had come all the way to South Africa to see me. At least that's what he tells me, I am slightly suspicious that he booked it before I told him where my elective actually was though... We spent the day driving to and from our favourite food places we've discovered so far in Joburg feeling significantly fatter and happier by the evening. Our peaceful day of foraging was contrasted with a pretty hectic Sunday back in Bara. Without a doubt it's the most drama I've seen before 8am. Riki put in his first chest drain and we saw the interns manage a crashing patient on their own - whether or not overzealous morphine and ketamine administration had contributed to the plummeting saturations is still up for speculation.
We decided to attempt a run of nights starting Monday which resulted in some of the most eventful shifts we've had so far. Someone once said that 'Chaos is a condition of the mind, not of the world'. That person clearly has not visited bara post 7pm.
Monday night got off to an interesting start when we turned on to the road outside the hospital. I can now honestly say I think I know what it would be like to drive through an apocalypse. There were fires smouldering on the roads and rubble strewn sporadically. Then the traffic built up and we could see in the distance a double length lorry parked blocking both lanes of traffic that cars were having to swerve around. We would later learn that there had been a big strike and protest the bulk of which we had fortunately missed. The theme of chaos was one that would continue for the rest of the night. On entering the pit we had to step over a man rolling around on the floor with one of the registrars looking on unimpressed, at the desk another patient was on the floor vomiting and the whole room had a distinct smell of urine (I blame the innocent looking old man in a wheelchair with a suspicious puddle growing beneath him). The interns had changed over that day so it was the 2 doctor's first day on Trauma and they were pretty stressed. It was a bit of an odd shift in dynamic to all of a sudden probably know more than the interns about how things worked in the department but it gave both Riki and I hope that in our foundation years we'll be able to pick up most of the important info within a few weeks.
Riki's first job of the evening was the glamorous task of suturing a women's bum. And this thing was MASSIVE. The wound I mean, though the bottom was also sizeable. This gash extended basically along the whole of her left butt cheek. The poor lady had had a seizure and cut herself on a broken toilet seat. Speaking of seizures I would like to take this opportunity to defend myself after the slanderous accusations made by Riki Houlden concerning my competencies in managing a patient having a seizure in the last post. The guy that I saw was pretty confused after his initial seizure to begin with and when I started pressing on his abdomen and asking if he had any pain he grimaced and frankly looked a little bit like he needed to shit. Confused I asked again if he was in pain and if he could stop moving. It was at this point that he started convulsing violently. Now I was the one who felt that they needed to be wearing the brown trousers. Panto memories anyone? - 'And then I shit myself! He's having a seizure doo doo doobee doo'
Getting back to Riki, he was suturing for about an hour and a half having to hold his face in close proximity to certain aspects of the lady's anatomy to see properly, quite an ordeal. In my opinion though all worth it for what has to be my favourite Riki quote to date in the context of his worsening cough: 'Can you get TB from an anus?'
While Riki was dealing with the gargantuan crevace that this lady had created I was getting quite stressed. The 2 new interns who generally monitor the pit had disappeared off to do other things around the hospital so for quite a while I was running the pit solo and it was the busiest I'd ever seen it. Not a single bay free. Fortunately no one was particularly sick and I just had to clerk and send 4 or 5 people to X-ray after which the patient load seemed more manageable.
The rest of my night took an unexpected turn. For those with sensitive constitutions I suggest skipping to the next paragraph. I was sent to theatres to assist with a wound debridement. Great I thought. I'd seen some washouts and wound debridements before in ortho, lots of wound washy washy, bone drilly drily. Ideal. I would have been a little less excited if I had been given this much more accurate description of what my life would consist off for the next few hours: Unwrap 4 horrifically burnt limbs that have been producing puss for 6 days, scrub off all of this pus and any dead skin and then spend another hour redressing everything. I am honestly finding it hard to describe the horror this procedure entailed but here are the three things that will stick with me:
1 - The blood. When I was scrubbing down the patient I was using maybe the softest brush I've ever felt. A slightly unusual thing to emphasise but important when you consider that for every scrub of the patient, blood would begin oozing from his pink (previously olive brown) flesh so by the end it looked like all 4 of his limbs had been dipped in red paint.
2 - The feeling. Whilst scrubbing down and redressing I was having to move around this man's limbs. As essentially all of his superficial skin layers had been destroyed what was left was fleshy and slimy and sort of felt more like holding an eel or a fish than a human.
3 - The smell. Seasoned anaesthetists were backing away in horror from the smell that this poor man was producing from his significant quantity of exposed flesh. And for the whole while I was right up close in the action. Thankfully I'd put on a surgical mask before entering the room so don't think I was ever exposed to the full brunt of it.
Thankfully following the scrub and once the blood had been patted away, everything actually looked quite clean and the surgeon seemed fairly happy. Night coming to an end we left excited to reach our beds and then managed to miss our exit resulting in a 6am drive through one of Joburgs townships. Will NOT be repeating that mistake.
A fully restocked supply of different kinds of sutures. I was so happy it felt like Christmas and my Birthday had all came at once.
Tuesday evening was much more chilled and we began to feel like we were really getting a handle of things here. In a manner that would make Dr Lillicrap proud, our powers of pattern recognition have been honed to the point that as soon as the patient walks/is wheeled in to the trauma unit you can tell from glancing at them from across the room what has happened. Allow me to demonstrate:
- Head blocks and oxygen mask plastered on their face - probably a car crash victim
- Already intubated - probably a pedestrian hit by a car
- Covered in dirt with a swollen face - mob assault
- Moaning in agony - Probably an open fracture
- Brought in on a stretcher, no head blocks, looking too comfortable to be on a stretcher - probably a through and through shooting or stabbing
There are of course very memorable exceptions to these heuristics. Take a patient I looked after on Tuesday night for example. He'd been shot in the head. If I had to use a single word to describe his condition, it would have been..... fine. Absolutely fine. He'd been shot in the head and was absolutely fine. When I asked the man sitting comfortably in front of me what had happened and he responded he'd been shot in the head my first reaction was to ask 'sorry do you mean someone shot NEAR your head?' 'No. They shot me in the head'. Right. Miraculously the bullet had entered at the back of his skull and exited just behind his ear, apparently causing no significant damage. Wow.
After a memorable few days we're gonna take a bit of time to plan for our onward travels and recuperate before what may be our last Friday night shift in bara!
***
Let's hit the ground running with a rant. I'd like to consider myself a pretty positive guy. In general you have to do a fair amount that gets on my nerves for me to think badly of you. Taxibus drivers definitely met my quota and after our shifts last week South African radiographers have now joined the exclusive club. As the lowest members of the clinical team we are quite often given the generally mundane task of taking patients round to the CT scanners. General etiquette is to ask the radiographer when to bring the patient round so they can fit you in amongst their other patients. For some patients this is important because as they're coming from the trauma resus they are unstable. Here it is pretty common practice for me to take fully ventilated and sedated patients round to CT keeping them topped up on sedation as I go (because yes apparently that is all it takes to be an anaesthetist). Before now we've had to rush patients back to resus because their oxygen tanks have run out or their ventilator has stopped working. Given the stress transporting these patients causes us it would be nice to get them scanned as soon as possible. Unfortunately the radiographers don't seem to take our concerns in to consideration. After one radiographer had lied to Riki about being able to bring someone round immediately it sparked a very heated argument with both Riki and the radiographer screaming at each other over the patient as we wheeled him in.
Radiographer: 'Your patient is stable. He can wait'
Riki: 'HE'S BEEN SHOT.'
Needless to say, I will be minimising my time transporting patient's to CT from now on. Rant concluded.
Saturday brought a nice change of pace with the arrival of my old room mate Julian who had come all the way to South Africa to see me. At least that's what he tells me, I am slightly suspicious that he booked it before I told him where my elective actually was though... We spent the day driving to and from our favourite food places we've discovered so far in Joburg feeling significantly fatter and happier by the evening. Our peaceful day of foraging was contrasted with a pretty hectic Sunday back in Bara. Without a doubt it's the most drama I've seen before 8am. Riki put in his first chest drain and we saw the interns manage a crashing patient on their own - whether or not overzealous morphine and ketamine administration had contributed to the plummeting saturations is still up for speculation.
We decided to attempt a run of nights starting Monday which resulted in some of the most eventful shifts we've had so far. Someone once said that 'Chaos is a condition of the mind, not of the world'. That person clearly has not visited bara post 7pm.
Monday night got off to an interesting start when we turned on to the road outside the hospital. I can now honestly say I think I know what it would be like to drive through an apocalypse. There were fires smouldering on the roads and rubble strewn sporadically. Then the traffic built up and we could see in the distance a double length lorry parked blocking both lanes of traffic that cars were having to swerve around. We would later learn that there had been a big strike and protest the bulk of which we had fortunately missed. The theme of chaos was one that would continue for the rest of the night. On entering the pit we had to step over a man rolling around on the floor with one of the registrars looking on unimpressed, at the desk another patient was on the floor vomiting and the whole room had a distinct smell of urine (I blame the innocent looking old man in a wheelchair with a suspicious puddle growing beneath him). The interns had changed over that day so it was the 2 doctor's first day on Trauma and they were pretty stressed. It was a bit of an odd shift in dynamic to all of a sudden probably know more than the interns about how things worked in the department but it gave both Riki and I hope that in our foundation years we'll be able to pick up most of the important info within a few weeks.
Riki's first job of the evening was the glamorous task of suturing a women's bum. And this thing was MASSIVE. The wound I mean, though the bottom was also sizeable. This gash extended basically along the whole of her left butt cheek. The poor lady had had a seizure and cut herself on a broken toilet seat. Speaking of seizures I would like to take this opportunity to defend myself after the slanderous accusations made by Riki Houlden concerning my competencies in managing a patient having a seizure in the last post. The guy that I saw was pretty confused after his initial seizure to begin with and when I started pressing on his abdomen and asking if he had any pain he grimaced and frankly looked a little bit like he needed to shit. Confused I asked again if he was in pain and if he could stop moving. It was at this point that he started convulsing violently. Now I was the one who felt that they needed to be wearing the brown trousers. Panto memories anyone? - 'And then I shit myself! He's having a seizure doo doo doobee doo'
Getting back to Riki, he was suturing for about an hour and a half having to hold his face in close proximity to certain aspects of the lady's anatomy to see properly, quite an ordeal. In my opinion though all worth it for what has to be my favourite Riki quote to date in the context of his worsening cough: 'Can you get TB from an anus?'
While Riki was dealing with the gargantuan crevace that this lady had created I was getting quite stressed. The 2 new interns who generally monitor the pit had disappeared off to do other things around the hospital so for quite a while I was running the pit solo and it was the busiest I'd ever seen it. Not a single bay free. Fortunately no one was particularly sick and I just had to clerk and send 4 or 5 people to X-ray after which the patient load seemed more manageable.
The rest of my night took an unexpected turn. For those with sensitive constitutions I suggest skipping to the next paragraph. I was sent to theatres to assist with a wound debridement. Great I thought. I'd seen some washouts and wound debridements before in ortho, lots of wound washy washy, bone drilly drily. Ideal. I would have been a little less excited if I had been given this much more accurate description of what my life would consist off for the next few hours: Unwrap 4 horrifically burnt limbs that have been producing puss for 6 days, scrub off all of this pus and any dead skin and then spend another hour redressing everything. I am honestly finding it hard to describe the horror this procedure entailed but here are the three things that will stick with me:
1 - The blood. When I was scrubbing down the patient I was using maybe the softest brush I've ever felt. A slightly unusual thing to emphasise but important when you consider that for every scrub of the patient, blood would begin oozing from his pink (previously olive brown) flesh so by the end it looked like all 4 of his limbs had been dipped in red paint.
2 - The feeling. Whilst scrubbing down and redressing I was having to move around this man's limbs. As essentially all of his superficial skin layers had been destroyed what was left was fleshy and slimy and sort of felt more like holding an eel or a fish than a human.
3 - The smell. Seasoned anaesthetists were backing away in horror from the smell that this poor man was producing from his significant quantity of exposed flesh. And for the whole while I was right up close in the action. Thankfully I'd put on a surgical mask before entering the room so don't think I was ever exposed to the full brunt of it.
Thankfully following the scrub and once the blood had been patted away, everything actually looked quite clean and the surgeon seemed fairly happy. Night coming to an end we left excited to reach our beds and then managed to miss our exit resulting in a 6am drive through one of Joburgs townships. Will NOT be repeating that mistake.
A fully restocked supply of different kinds of sutures. I was so happy it felt like Christmas and my Birthday had all came at once.
Tuesday evening was much more chilled and we began to feel like we were really getting a handle of things here. In a manner that would make Dr Lillicrap proud, our powers of pattern recognition have been honed to the point that as soon as the patient walks/is wheeled in to the trauma unit you can tell from glancing at them from across the room what has happened. Allow me to demonstrate:
- Head blocks and oxygen mask plastered on their face - probably a car crash victim
- Already intubated - probably a pedestrian hit by a car
- Covered in dirt with a swollen face - mob assault
- Moaning in agony - Probably an open fracture
- Brought in on a stretcher, no head blocks, looking too comfortable to be on a stretcher - probably a through and through shooting or stabbing
There are of course very memorable exceptions to these heuristics. Take a patient I looked after on Tuesday night for example. He'd been shot in the head. If I had to use a single word to describe his condition, it would have been..... fine. Absolutely fine. He'd been shot in the head and was absolutely fine. When I asked the man sitting comfortably in front of me what had happened and he responded he'd been shot in the head my first reaction was to ask 'sorry do you mean someone shot NEAR your head?' 'No. They shot me in the head'. Right. Miraculously the bullet had entered at the back of his skull and exited just behind his ear, apparently causing no significant damage. Wow.
After a memorable few days we're gonna take a bit of time to plan for our onward travels and recuperate before what may be our last Friday night shift in bara!
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