So, I've been upgraded from intern to community sevice medical officer, but I use the word upgraded lightly because I've been downgraded from the lovely Cape Town to the less lovely platteland 'dorpie' of Potchefstroom; I went from working in a hospital with an MRI and CT scanner to one where the phones sometimes work and most importantly I seem to be getting paid a lot less?
Here follows an exerpt from my catch-up email that I sent out this month; a snapshot of 'Platteland Practice'.
• Post call is a rumour here...2pm, that’s the earliest I can leave. I might be tempted to let a few people suffer and then they might be forced to review that decision.
• Lunch is a rumour here too. I think I might have had it once since I arrived.
• My threshold for irritation is decidedly lower after 1pm (funny how that correlates to the time of day when lunch is usually consumed) ...if you’re going to ask a stupid question, or make me sign a stupid form, or be a stupid patient after that I apologise in advance.
• For such a small hospital there are a phenomenal amount of forms that need to be filled...I maintain if I had wanted a career in admin, I would not have spent 8 years at varsity and I will be grumpy about if I want to.
• Last week I couldn’t refer a patient up because you couldn’t phone out...every time the power goes out the phones stop working and the power goes out at least once a day.
• The female theatre staff here makes Sr Frankish and Carol and Paddy in MK (Groote Schuur Labour Ward) look like Sunday school teachers. The 2 males however are great. Once again my theory is proved...too much oestrogen in one room is toxic.
• I am getting so much better at my sonar’s...I can do gestational age, RI’s, AFI’s, find the placenta, and tell if it’s a boy or a girl. I am getting better at calling it an incomplete or a complete miscarriage. I have started to practice looking at cervical length and shapes but I still suck at finding the ovaries.
• I scan a lot of women for gestational age for the purpose of Termination...I always ask them why they want the termination and the answer always makes me sad...either because they have no real reason or because they have a perfectly valid reason. I wrestle so much with this issue because of my religious convictions. Different people draw the line on this issue in different places. It’s so easy to say don’t get involved if you’re not on the front line.
• The top 5 things I hate about gynae OPD...
o Making a diagnosis of cervical cancer by smell.
o Amenorrhoea...(the absence of periods)...you would think most women wouldn’t mind this, but for some reason they all freak out.
o Finding the cervix for a pap smear in a beach ball (overly nourished person)
o The paperwork (lab forms, histology forms, x-ray forms, TTO’s, motivation forms, sick notes and occasionally admission books.)
o Chronic Pelvic pain.
• We actually have an awesome bunch of comserv’s and interns (about 30 in total). Which should prove another theory of mine...you can work in an awful hospital, if you have nice bunch of people with you it can still be the greatest experience ever.
• I question being a doctor at least once a day.
• My new favourite post call food is a magnum and ginger ale.
• It’s unlikely to be Pelvic Inflammatory Disease in a 45 year old plus woman, but because she’s got a funny smelling discharge they land up as our patients. The only reason the surgeons get away with this is because the treatment's basically the same.
• It’s been raining a lot here...almost every day for 3 weeks. The Vaal Dam is 110% full. I’m not complaining...I love the thunderstorms. I’m just saying ‘cos it feels like its winter in Cape Town.
• My most memorable patients....
o That old man in casualty yesterday who is dying from emphysema. I saw his ID book picture and how much weight he has lost and it broke my heart.
o The man in casualty who had some industrial size door fall on top of him. He broke every rib on the left side of his chest, some in 2 places, had a pneumothorax and was paralysed from the waist down...but he was one of the most co-operative patients I have had for a long time. It was also the first time I have diagnosed a flail chest.
o The lady who I admitted with a Community Acquired Pneumonia, who told me she had tested HIV negative 3 months ago and then I got her old folder and she’s been admitted before with TB which she defaulted treatment on, Bacterial meningitis, defaulted ARV’s and was restarted and then defaulted again. When I asked her why she didn’t tell me she had HIV she started crying and said she didn’t know she was positive! I was trying to figure out if she was intellectually challenged or encephalopathic (stupid but with a good medical reason for it)!
o The lady who arrived at 4:30am on Monday morning, fully dilated and a breech presentation that subsequently turned out to have undiagnosed twins. It was my first breech delivery (x2) and my first twin delivery. Fortunately not my first neonatal resuscitation...and both babies survived with no hypoxic brain damage.
o The abruptio (when the placenta detaches before the baby is born) that I diagnosed, took to theatre, got the baby out just in time, closed up and saw in clinic 2 weeks later looking just beautiful.
o The old lady who came into casualty, discharged from the medical wards two days earlier where she’d been worked up for first onset seizures and treated for meningitis. She just smelt like a Cervix cancer patient, I couldn’t believe no one had bothered to look for it. It would certainly account for new onset seizures if there were cannon balls of it in her brain. What do you know...all you needed to do was a pelvic exam.
o This 8 year old little girl who was operated on in November for and appendix by an American surgeon who has subsequently quit and is rumoured to not even actually be a surgeon, who I admitted last week. She developed an obstruction post-op which was never opened up again, settled on her own and went home but has been coming back almost weekly over the last 2 months with abdominal pain and bile stained vomiting and sent home. I admitted her as a partial obstruction. They took her to theatre the next day where she nearly died on the table (these are medical officers giving the anaesthetic and medical officers doing the laparotomy so you’ve got to give them points for trying), the peritoneum was sutured into the wound and they had to take out a large amount of small intestine because it was dead. I don’t know how she is doing now.
1 month down, 11 to go... you could call this an adventure if other people's lives didn't depend on it!
