Cheers to 2010

Here’s to the people who packed up their lives and handed it over in boxes and bundles to brothers or movers or your new hospitals HR department (as was the case for a few friends). To people who said goodbye to places they loved and good friendships they had fostered and went where everyone was a stranger. Here’s to the ones who gave up hospitals with CT scans and department calls and seniors!

Here’s to those of us who found themselves the most qualified on more than one occasion. The ones who taught themselves how to do forceps deliveries and then taught themselves how to suture a 3rd degree tear.
To the unsuspecting anaesthetist who landed up resuscitating a newborn or 3 at the same time as the mom was dropping her blood pressure dangerously.
Here’s to surviving 24 hour calls, end of the month calls, calls when the anaesthetist was 45minutes away or the surgeon’s phone went to voicemail.
Here’s to surviving the theatre sisters and their diet week; 90 patient wellness clinics, Ventersdorp, HR, management.

Special mention goes to Valium and Ketamine, to the genius that figured out intraosseus access and staple guns! How did people survive Saturday night without staple guns!
That being said, thank goodness for smart phones and Google, for Woolworths Food and 24 hour Wimpy Coffee.

Here’s to the glue that keeps all of this from falling apart… The friendships that come from staying in casualty until the last folder is discharged, the bonds forged on long clinic days. The memories made around dinner tables or drinks tables or theatre tables.
I loved working with you. I wouldn’t have anyone else second rounded in your place. I hope this is not the end of our stories although realistically I know a lot of us collided only for this season.
I wish you well – a lifetime of good calls, minimal J88’s and successful resuscitations.
Mostly though I hope wherever you land up, I hope you land up with a great bunch of people, like us.

There's something wrong with this stomach

I had a breakthrough moment today.
I know you all think it involved some important medical concept like, understanding the concept of a direct and indirect inguinal hernia, or recognising type II respiratory failure on a blood gas.

No, this is nothing you will ever find in a text book and it probably won't be relevant to a lot of people out there, but for a select few who pay appropriate attention, and who work in this hospital and or department in the future, this little gem is going to make your life so much easier.
(Also, the only reason I'm not selling it and making millions so I can retire early and sleep in my own bed every night, is because it's not marketable...else I would have.)

For 6 months I have been working in surgery, and because I am NO surgeon and occasionally; ok, make that daily; need a bit of advice on 'what now?' it's nice that in this little almost-middle-of-nowhere dorpie, we have a really-real surgeon (with and FCS and everything).
Like most 'Cnsultants' though, he's virtually impossible to actualy track down and keep in one spot for an opinion, unless you can use the words 'stab heart' or 'toxic megacolon' somewhere in your sentence.
Since my sentences usually have the words, "Come to clinic" or "There's a guy in the ward",I get ignored a lot.
He ignores pages(please refer to previous blog on pagers), he ignores sms's, he occasionally answers his phone, but if he's in theatre and operating, even if the anaesthetist takes a message and you impress upon them the need for a referral decision before 15h30 in the afternoon, he's probably only going to get back to you at 15h55.( Not 16h05 when it's technically the on-call persons problem either)

It's been 6 months and I've just accepted it.
The way I've accepted that pharmacists only give 1 week supply of antibiotics even if the protocol/Essential Drug book and your prescription say 2.
The way I've accepted that even an urgent CT report will take 48 hours to make it's way in cyberspace from Klerksdorp to Rand Clinic, back to Klerksdorp and then faxed to Potch even if you call every hour for those 48 hours to impress upon them the urgency of URGENT CT Report.
I've accepted that unless you harass him, he won't get back to you and your patient's gangrenous toes will eventually just auto-amputate themselves.
Today I get to a patient in my ward who was admitted during the night with what looks like a bowel obstruction. I see the patient, ask a few questions, feel his stomach and pick up the X-ray. Something is wrong....I mean I've seen a fair amount of air fluid levels in my life, but this is one impressive air fluid level, this needs a 'What now?' decision.
I know if I page him, he won't answer. I know if I sms, he won't respond. and it's not even 9am. It's too early to start whining.
So I put the X-ray on the light box, take a photo and then thanks to my very cute little Blackberry, BBM him the pic with the caption
'Something is wrong with this stomach'.

It wasn't even 30seconds...phone call.
Consultant: "What X-ray is this?"
Me: "It's a patient in the ward"
Consultant: "I'm coming"

And what do you know, without having to whine all day, without having to use the words "stab heart" or "bleeding varices" my patient was seen in 10 minutes and was in theatre before lunch.
I've been taking pictures of X-rays and patients all day.

27 patients

1 doctor, no intern, 27 patients; one of them being the guy in room 12, who stabbed himself in the abdomen, intentionally, deep enough to injure an organ...because of a girl. 90 percent of the time it's because of a girl; the other 10 percent they weren't doing anything. They had had one beer and they were going home and these guys just attacked them for no good reason...yes, it's all fun and games until someone lands up with a chest drain hey? worse of course, is the guy in 6 bed 1, learning how to walk again after he was stabbed in the spine.
Who else is in the ward...it was 'break-one-mandible-get-a-black-eye-for-free' weekend this weekend, so I've got a couple of those in the ward. Shame, the guy in room 1 bed 2 looks pretty bad. I mean his face literally is swollen the shape of a soccer ball and he can't talk his lips and face are so distorted.
Then there's conundrum in room 4 bed 5. He's my 'Dr House' patient. Seriously. I keep going through this list of differentials and getting nowhere and then today he went all 'acute flaccid paralysis' on me and I had to do an LP - in a surgery ward!Lucky I'm not really a surgeon otherwise I wouldn't have known what to do and then we would've been in trouble and by we, I mean the patient...not me really. Surgeons don't care.
Speaking of LP's, can you believe they admitted a 'bacterial meningitis' into my ward! I was tired and I didn't feel like seeing him properly so I turfed him to medicine (appropriately so) without a phone call. Didn't feel bad though, Dr Grumpy in ward 9 had turfed a sinusitis/intracranial abscess back from Baragwanath without a phone call. Ha, at least my patients fixed. Your's is still broken!
Ah, but my absolute favourite was the patient admitted by my Consultant with an appendix mass, who I suspect has a bit of a psych history (generally only patients who have required an admission at Witrand know about Witrand) because when I examined his super soft and non-tender abdomen this morning and asked him what was wrong he only had 1 thing to say..."I want Beer".
That my friend, is the get out of jail free card in ward 6...except if you're the 1 doctor.