It's been a while...

So I have been quite bad at updating my blog and think it's time I try again... My love for surgery has been renewed. I was on call yesterday, Sunday, and really thought that it was going to be a relatively quiet one. It's the middle of the month, no huge soccer games were on, the weather was quite cold, so plenty of time to study on call for those upcoming surgical primaries. Well, I think I jinxed myself, because as I arrived at the hospital and did my scan through the surgical wards for problems, I heard that we, my senior and I, needed to take an acute abdomen to theatre. Her bloods showed a raised white cell count and clinically she had generalized abdominal tenderness, with a history suggestive of appendicitis. In theatre we found a perforated appendix with quite a bit of purulent fluid in the abdomen, but after doing an appendicectomy and a thorough washout I think she'll be okay. That may have seemed pretty mundane and the norm for a weekend call but what came next was anything but. The intern phoned us as we were waking the patient up and informed us that a gunshot abdomen had just arrived in casualty and was fairly stable clinically and on blood gas. But, we needed to come down and see the patient and he was getting the patient prepared for theatre. My heart skipped a beat at the news. I really do love the fast-paced part of surgery that gets the adrenalin flowing. The times when we get to take critically injured patients to theatre and save their lives. Yes, that's the part i love. And, we get quite a few cases at Natalspruit, which makes me smile. In theatre, I learn that this 24 year male patient was actually a hi-jacker who attempted hi-jacking an off-duty police officer who was armed. He was shot once in the abdomen, with the entrance wound in the area of the left renal andgle and the exit wound was on the left upper abdominal quadrant. He had large bowel diembowelment, but was not actively bleeding from the wounds. Well, once we opened him up, it was a whole other story, the abdomen was filled with 2 liters of blood and continued to fill as we tried to find the source of bleeding. After packing the abdomen and searching for the source of bleeding we realized the disaster we had to fix. Two large holes in the jejunum that needed to be resected and primary anastomoses done. There was also a large 5cm hole in the sigmoid colon that needed resection and luckily we could anastomose. And, lastly the lower pole of the left kidney was shattered by the bullet and we were unable to stop the bleeding so we had to perform a left nephrectomy. aftre 4 hours of nail-biting action, we closed the abdomen up and transferred the patient to ICU. You may be reading this and think how hectic it was and may even be angry that we saved this criminal's life. I must admit I had those same emotions when I heard about the circumstances surrounding the shooting. But, whenever I am faced with those feelings, I have to remind myself why I became a doctor and the Hippocratic Oath I took when I graduated from medical school. I have to treat all sick people and may not discriminate. In the end, all patients have the right to emergency medical care and if I am the practitioner involved in giving that care, I may not choose who I treat and who I don't. In a way I hope that by helping these criminals, they remember me and don't target me or my family when going about their crimes. But, I know that in actuality they don't care who they have to kill to get what they want ad if I have what they want, I'll become a target. It's the sad reality of living in South Africa.

Breaking Bad News

So today was not the best of days. One of the least favourite parts of my job is breaking bad news. It's one thing to do it in English and I don't even mind speaking in layman's terms, but breaking bad news to a patient when you don't speak his/her language and have to use a translator is something else. And, unfortunately that is the case in 90% of the patients I work with.

Anyway, my two years of internship gave me plenty of practice but. I still get awfully nervous right before doing it. Today, my patient with CML, the one I have mentioned before who came with a grossly distended abdomen, ascites and a pancytopaenia had her abdominal sonar. It showed gross ascites with multiple masses within the abdomen. None of which could be readily identified and a CT scan was therefore suggested. But, knowing her previous diagnosis, the masses are most likely metasteses, which puts her at Stage 4 disease and unfortunately incurable. She also deteriorated over night, and this morning she was in quite severe respiratory distress. On the grand ward round, the seniors decided that she'd be for palliative care and we should make her comfortable as she probably wouldn't make it through the weekend.

I knew this deep down, but really thought my consultant would come up with a brilliant plan. It was then, I realized I would need to break the news to her and I wasn't sure if I was ready. But, quite frankly is anyone ever ready to tell someone that they are dying and have hours, days, weeks or months left to live? I told her , even though it was accompanied by getting a lump in my throat, tears in my eyes, and shivers down my spine, but I was honest with her. Even though she looked shocked by the news, I really think that it was the right thing to do. At least now she has the time to contact her family to let them know, say goodbye to loved ones and get her affairs in order before she dies. The nursing sister even thanked me for taking the time to explain what was happening with her.

So, all in all I think breaking bad news is part of being a doctor but, I will get used to it and it never gets easier with time.

Interns!

So I really hate to complain, but the Interns that I'm working with are so stupid! For those of you that don't know, in South Africa, after completing your six years of medical school you are required to do a 2 year internship, where you work under supervision of medical officers or registrars if in an academic hospital. After the 2 years you have to be signed off and deemed competent before you may register with the Health Professionals Council. Anyway, an intern is technically a medical doctor with a degree but hasn't had much hands-on experience. There knowledge should still be fairly good though, especially if they are nearing the end of their 2 year stint.

Well, today one of my interns, who has 3 months left of her time couldn't give me the correct dose of cloxacillin. Nor, was she capable of justifying to the radiologist why our patient with a grossly distended abdomen, a tense ascites and a pancytopaenia needed an abdominal sonar. Besides the fact that this patient has known CML, a medical and not a surgical condition, but she admitted this pateint to our surgical ward. When I told her that even though the patient is not technically ours, we need to work the petient up and give her the best treatment we can, she turned around and told me we must merely transfer the patient and let someone else sort it out. What????? Is this girl being serious. What if this were her mother? Would she just transfer her to another hospital because she was too lazy to try and figure out what is wrong with her. I was so astounded, I actually couldn't believe what I was hearing. I knew that nothing I said would make any difference. So instead I ordered the investigations I deemed appropriate and left it at that. I care about each of my patients and treat each one as if they were my mother, father, brother, sister, aunt, uncle or grandparent. I guess compassion cannot be taught in med school. You either have it or you don't!

Another intern, who is also already into his second year couldn't list the types of pneumothoraces and the treatment of each i the morning meeting. Oh gosh, I guess I need to have patience, they are still learning.

Let's hope tomorrow is a better day.

First day on the job

Today was my first day at Natalspruit Hospital (NSH) as a community service medical officer. Wow! I don't have to work under supervision anymore...that is kind of a scary thought actually. It's kind of surreal to know those two years of hard work as an intern at Bara are over.

I'm working in the general surgery department at NSH, a district hospital in Kathlehong, just south of Alberton. I am so excited for this year and all the experiences and adventures it's going to bring. I've been really interested in surgery for a while and had to fight tooth and nail to be able to work in this dept since all the other CS' also wanted to do surgery. I hope it's worth it and it furthers my interest and passion for surgery. #happydance

The saddest thing I saw today was a 15 year old patient in ICU who has been intubated and ventilated for 14 days after sustaining a severe head injury when her perpetrator strangled her after raping her. I was shocked when my colleague and I were doing our ward round and he just casually mentioned it as if this is an everyday occurrence in Kathlehong. He then proceeded to tell me that most of what we see in the general surgical dept is in fact trauma because this area is incredibly violent. Wow! I think I'm in for an eye-opening experience this year. #stilltryingtopickmyjawup

The reason why I've decided to write a blog this year is that the only regret I have about internship is that I didn't keep a record about my experiences on the job, especially the horrifying jaw-dropping ones, but also the mundane everyday ones that made my life as an intern. Many people have asked me about my experience as a doctor in South Africa, and I generally don't know what to tell them. I see interesting and shocking things everyday but yet these things never spring to mind when confronted by that question. So here goes my attempt at keeping a record...