My little superheroes

It’s easy to forget that this is actually a hospital up on the E-floor. 

These super specialist paediatric wards become second homes for so many of these kids. They come with their broken livers and kidneys and carve out a place for themselves in this little family. 

In this ward there is no such thing as a short stay - an admission here is typically never less than a week, and sometimes stretches out for four or five months. 

It is well described that kids eventually adapt to any environment - although it may trigger a few abnormal and sometimes worrying coping mechanisms. 

It doesn’t happen overnight, as is certainly evident in the more general wards where the kids are being exposed to the hospital environment for the first time. There they regard every approach with cautious apprehension - never sure if something unpleasant and painful is about to happen.

But upstairs they slip into the routine of the ward. They call the nurses by their first names. They know the names of all their medications and when they have to take it.

If you spend more than 2 days in the ward with them they greet you with running hugs in the morning and blow you kisses from their beds on ward rounds. 

They get beyond excited when they are well enough to join the other kids at the hospital school. They all know Bubbles the clown comes on Thursday morning. 

Downstairs in the B-wards it’s easy to remember you’re in a hospital for sick kids. 

Up here I have to actually remind myself that these kids are sicker. These are the babies who have had more general anaesthesia than I will probably ever have in my life. These are the kids who have survived transplants, life threatening infections and cancer after the immunosuppresants we gave them stopped them from keeping the abnormal cells in their body in check. This is where most of the blood that you donate lands up - not in a trauma ward, but in a ward with chronically ill patients. 

Yet they have so much life in them I struggle to imagine them not living a full one.

I forget when in the afternoons after the dialysis machines and gancyclovir infusions have been disconnected, and the kids are racing around in the corridor wearing their ‘duck-bill’ masks, that this is not a playground.

I forget when Tracy comes around with her arts and crafts that this is not a classroom.

I forget that they have chubby cheeks not because they are fat and flourishing, but because of the steroids that keep them from rejecting their organs. 

I forget when it’s time to drip one of them and she points out which veins are better - that kids are supposed to be afraid of needles. 

I forget that these  kids  are living on borrowed time and that big school and dreams of being ballerinas or pirates may never come true. 

Working with them has been an eye-opening and humbling experience. 

My little superheroes. 

The Universal Pen Theory

Some people may think that the essential tool of any doctor is maybe their stethoscope? Maybe needles and syringes? Perhaps a defibrillator (picture a flatline on a monitor, someone shouts Vfib and then they pull out these paddles and call "Charge to 300")? Perhaps an ENT set or those nasty ice-cream sticks that no one loves?
No not true.
You see surgeons' stethoscopes gather dust and I don't think a radiologist would know what a defibrillator was if you showed it to him and said the word r-ea-l-ly sl-oooooow-l-y.

No. The essential tool of any doctor, the one thing that unites us all and leaves us lost and useless at work in its absence is a pen. Specifically, a black pen.
Blue is apparently tantamount to giving an A+ patient, B+ blood, it would seem. I once dared to use a blue pen because I could find no other pen to make notes with, and the sister in charge of the clinic sent the whole folder back and informed me with a very straight face, that I had to rewrite everything from the consultation; notes, prescription, admission forms and consent documents, because no where in the hospital would they accept blue pen notes!
Allegedly, blue does not photocopy well - and makes keeping records of the records problematic, which becomes problematic when you need your notes to defend you in a lawsuit somewhere down the line. Hey - you hear the word lawsuit you do what people say...but I think the bureaucrat that came up with that fallacy had a standard issue government photocopier that probably hadn't been serviced since the stone age.

I digress...the point I actually wanted to make is a secret of the universe that I have discovered which is guaranteed to cut down on pen frustration everywhere.
You see, pens - like socks and teaspoons, have this annoying tendency to disapparate. One minute they're in your pocket and the next minute they're gone.
Any doctor worth his MBChB salt avoids pen frustration by firstly never buying anything more expensive than a standard Bic Click pen, and never having less than at least 2 in your bag. Drug reps also usually provide handy emergency stashes, but emergency is all that they qualify for. They are designed to get you to the end of the day only - their life force is simply not strong enough to survive more than a few hours of government doctor writing.
The loss of a trusty Bic Pen produces profound pen anxiety. There simply is very little you can do in your day without one. It is somewhat alleviated by borrowing a pen from a colleagues emergency stash.  Some anxiety still remains however, as the possibility of returning the pen is slim to none. No one intentionally steals a pen. Everyone does it purely by accident...but the stigma remains in our minds none the less.
Failure to locate a good samaritan results in you taking on a desperate search of the local environment looking for a lonely pen that has been neglected by it's owner. The charge on your head is so much greater for the day though...kidnapper!

It's all been for no good reason.
You see, pens are not property of individuals (the one exception being fancy Parker pen sets with names engraved on them).
Pens are property of the universe.
Bic pens especially are so standardised they gave themselves away immediately. I myself on many occasions have unintentionally neglected to return a pen to it's rightful owner and on one occasion I can remember being desperate enough to kidnap one. At the same time, I lose a pen a week, at least, and as such I am constantly adding to the universal pen fund. If I manage to get a Bic pen to the point where its ink runs out before I lose it, I basically throw it a funeral. I also keep more than 2 in my bag so that I can give them out freely to the universe without needing them to return.
I haven't had pen anxiety for ages...and neither should you!

R.I.P.

(This is not a post for sensitive readers. )


We had a lovely Pup that lived with us once. She was a real ‘pavement special’ - the markings (and the mind) of a Jack Russel but with the coat of a maltese mongrel. I have loved all my dogs equally, but Pixie lives in a special memory box.

She could beg before she was house trained. If she didn’t want to sleep outside she would jump up and down outside the bedroom window until you let her in. She followed you around all day if you were at home...from room to room just keeping you company while you got on with your day. 

She loved cheese. Loved it. 

But Pixie developed a heart condition, which presented with the most awful epileptic-type seizures. She had a dilated cardiomyopathy and spent her last 2 years on blood pressure medication and a diuretic. She aged but never lost her character. And when her heart failure got so bad that she swelled up like a balloon and was struggling to breathe we asked the Vet to put her down and he obliged.

In my year of being a medical officer in Potch a baby was delivered in labour ward who had the misfortune of being knitted together wrong.

He was born with an oesophageal atresia and so basically his oesophagus dead-ends before it gets to his stomach. While it is surgically correctable, in the interim feeding such a tiny poppet is tricky. 

It took about 3 days to get him transferred across to Baragwanath, the only paediatric surgery unit for about 3 provinces, by which time he had developed a bit of a cardiac murmer suggesting that more than one system had developed abnormally.

I can’t be sure, but I vaguely remember that the Baragwanath doctors confirmed him to have a Trisomy 18 - and largely because of this and his cardiac issues he was denied any surgical intervention - based on the fact that we are in a resource stressed environment, are dealing with a child who is unlikely to survive anaesthesia or post-operative care based on his abnormal heart and has a lethal genetic condition. Even if they could put him vaguely together again - he probably wouldn’t see his first birthday.

So Bara sent him back...

And here we sat with a not-even-2kg-baby and no way to feed him. Sent back to die...slowly. 

We had a drip up because it just seemed cruel to let the kid die of dehydration. Instead we waited for him to die of starvation instead. Waited for 3 weeks.

He lived in a little incubator in room 4. He spent most of his days alone because I literally saw the mom once about 2 days before he passed away. The only time he was touched was when his nappy was changed or when he was examined or when he was dripped. 

After 3 weeks he became undripable...the few veins left hidden under swollen soft tissues because he must have had no albumin left to keep the fluid in his veins. 

I probably spent 6 hours of that day trying to get a drip up on him because I couldn’t bear the thought of him lying there and getting thirstier and thirstier and unable to drink anything. And I left completely defeated and prayed all night that God would take him before morning.

He didn’t. 

He was still there. 

And the next morning too....

We seriously considered euthanasia - despite the fact that it’s illegal we put it on the table. None of us could bear to watch this baby suffer any longer. We picked a drug and called the parents in to explain what our intentions were. 

As if all he had been holding on for was a chance to say goodbye, when his mom arrived and cradled him in her arms he finally breathed his last. 

So in the end we never needed to, but it’s always going to bug me...

We treat our animals better than our people.