Things my Mother Taught Me

1. There are more important things than chocolate:

My earliest Mother’s Day memory is those chocolates we ordered at school… I didn’t know they were supposed to be gifts! They were so pretty and since they got sent home with me, four-year-old Me thought it was mine. And Mom gracefully let me have them. I would have a hard time giving my chocolates to anybody…

2. Humility has rewards

I knew my dad’s story from a young age and I hero-worshipped him. I knew my mom kept them going while he was finishing his studies, but it took many years before it dawned on me that her selfless sacrifice was also worth hero-worship. Not once was she bitter about us not realising the immensity of her acts. She is a wonderful woman.

3. Do your work with passion

Mom is a social worker – a scarce skill in South Africa, and a thankless job anywhere. She has been chased by dogs and thrown down stairs, but she continues to do what is best for the families under her wing. Mom is a an excellent witness to have in court. She is an excellent supervisor if you are an intern with her. Despite exhaustion or pain, she does her job wonderfully.

Mom and I had difficult times when I was a teenager. I am stubborn and opinionated, and I know I have hurt her so much sometimes. But she continues to love me. When I was having a horrible day, she calmed me down enough so I could study for the next day’s OSCEs. All this over the phone, as we are 1000km away.

Mom convinced me to join debating and karate – two things that would change my teenage experience forever. I don’t know how she guessed that I would excel at them – she clearly knows me better than I know myself.

She has always supported me and my siblings, and lifted us as high as possible.

4. Be the Lioness

Mom appears a little timid and gentle, and she is a gentle soul. But touch her family and she becomes a lioness. My mom will weep and fight and rage for her loved ones.

If I become even half the woman my mom is, I will be more than I could ever dream of being.

The Importance of Clarity: A Story

Today is fibromyalgia awareness day. I find it quite apt that this happens the day before Mother’s Day.

For as long as I can remember, my mom has suffered from pain. She has always been particularly sensitive to noise, bright lights and abrupt touch. It was only when we were little and clumsy that it didn’t seem to bother her. An overriding maternal instinct I suppose.

I inherited my migraines from Mom. I remember trying to occupy my little sister and baby brother when I was eight and nine, because Mom was in pain and I wanted her to rest and feel better.

 

I remember waking up in the dark hours of the morning with all the lights on, finding that our help had been asked to babysit us in an emergency, so that Mom could go to the ER for pain management. She had severe backaches.

I remember there were nights when Mom went to the ER twice, in tears. Returning with no more than a diclofenac injection.

Mom’s pain is one of the reasons I have trust issues with doctors. For more than a decade, while Mom had exhausting and debilitating pain, she was not referred for a single X-ray. Her hands, swollen with osteoarthritis, were not looked at. She was told, “Ma’am, it could be so many things.”

As if that was a reason not to do a pain workup.

When I came to med school I became more and more convinced that Mom needed a better doctor. Little by little I learned new things: backache is bad. Night pain is bad. Patients deserve a diagnosis.

Last year we learned about fibromyalgia. And I knew, this was it.

In early January, while I was home for the holidays, Mom returned from shopping in tears. She was in pain again. I took her to the new doctors’ complex in town and made an appointment with the youngest doctor on duty.

She was from a school I trust. And I trust the young doctors: they are all too aware of their shortcomings and afraid of litigation. They will rather perform too many investigations than too few. And in this case, it was what Mom needed.

She struggled to get a history because Mom was crying. I don’t know how much of it was pain and how much of it was relief at meeting a doctor who didn’t tell her it was all in her head.

It’s five months later and Mom has a diagnosis. It’s not a diagnosis many people believe exists. There are some doctors who believe that FM doesn’t exist. But I look at my mom – an exceptionally strong woman who gave birth without pain medication and refuses to go for stitches when injured – and I simply can’t agree with them.

Mom is on medication now. It mostly keeps her pain under control. She is part of a Fibro trial, where she is receiving remarkable help.

Mom is emotionally better too. She has a physician that cares about more than just her blood pressure. Oh, and her OA is being managed too.

I want to be like that. I know there are many contentious diagnoses out there, but I want not to be blind to that which I do not necessarily understand.

Here’s to the exceptional people struggling with pain every day. I salute you.

Pouring My Heart Out About Birthing Plans

I’m not going to whine today. I’m not even going to be diplomatic.

Because I’m annoyed.

Because I believe in the rights of the patient, and because I love obstetrics and neonatology I’ve been reading a lot of blogs where women share their birth stories.

And a lot of them write about how they felt cheated out of a normal vertex delivery. Because their labour didn’t progress. Because the CTG showed decelerations. And so the doctor rushed them to theatre, and delivered their baby in one piece, and saved Mommy and Baby’s life.

And that makes Doctor horrible. For saving two lives.

I believe in listening to a patient’s wishes. I believe in trying as much as possible to stick to a mother’s birthing plan. But I also believe in saving lives. And I will not stick to someone’s birthing plan if it will cost their life, or impede in any way upon their or their unborn child’s livelihood.

Dear mothers, if you do not like your doctor’s opinion, get a second opinion. If a doctor saves your life, or gives you a live healthy baby, try to see the bright side. It’s not that difficult.

Women and their babies DIE daily in developing countries because they don’t have access to theaters and C-sections or even the knowledge that a section is required.

If a doctor ignores your wishes without good reason, if he is a paternalistic arse, find another doctor.

Just know that had something gone wrong, you would have blamed the doctor, and would quite likely have good reason. So be grateful for your happy bouncy baby child. Please.

Blog it for Babies: About How I Almost Wasn’t

In keeping with my general broodiness and my current Neonatology rotation, I couldn’t let “Blog it for Babies” go by.

BIFB is an attempt to raise funds and deliver equipment to a clinic in Bangladesh, where infant mortality is extremely high. They want to raise awareness too, so if you can’t afford to donate (like me), just be aware.

BIFB encourages bloggers to write about their own birthing experiences and reflect on how things could have been different. I don’t have children (being a student), but both my and my sister’s births were extremely difficult, so I’ll share that.

We were born in a time where many non-white South African citizens did not have access to good healthcare. I’m pretty sure that if I were of a different race, or if my struggling parents had not managed to give birth at a private facility, my mom and I may not have made it.

Mom’s pregnancy went well. I was her first, so she did everything by the book. As with a primigravida, labour progressed somewhat slowly, but surely. There was no cause for concern until I was supposed to be crowning and things weren’t going as anticipated.

I was in occipito-posterior position. Normally, babies are born occipito-anteriorly. This basically means that instead of the sharpish backside of my head crowning, my forehead was the presenting part.

But that’s not always a problem. Last year during obstetrics I delivered two occipito-posterior babies. My head was poorly flexed, so much of my face was presenting. If you think about physics, this is not conducive to an easy passage.

Mom had a wonderful obstetrician. He did shout at her often, she recalls. There were times when he shouted that if she did not stop pushing now, she would break my neck. And then there were times where he threatened her with a C-section if the baby didn’t come now. After all that exertion she did not want to be wheeled to theater.

First an episiotomy happened. When that didn’t help, they decided to attempt a ventouse delivery. That’s basically delivering the baby by means of a vacuum. It’s not an easy procedure and can often lead to a massive subaponeurotic bleed.

Fortunately it was successful.

Things that could have happened in the absence of good doctors:

• they could have not realised that something was wrong and tried to deliver without further interventions
• they could have not performed an episiotomy, leaving Mom to experience a third-degree tear
• the episiotomy could have been poorly looked after, leading to infection
• I could have died

The same thing recurred with the birth of my little sister four years later, so the doctors diagnosed cephalopelvic disproportion and my little brother (four years after that) was born via C-section.

My family, even in South Africa, were so blessed with access to good healthcare. If possible, please donate to any organisation that helps mothers and babies. And if not, count your blessings and be aware.

Easter Away from Home

My family is big into family-stuff. I can’t say I have always been appreciative of that (I am often a grumpy, anti-establishment child), but I love my family. And there is nothing I love more than spending family-time with my family.

Easter is such a family-holiday. And this year is the first time that I spend Easter away from my family. It’s difficult, and what’s worse is that it’s not even a matter of clinical obligations. It’s just that for the first time, plane tickets were flat-out unaffordable.

I hate petrol prices.

Fortunately, The Boy is making this long-weekend very special.

Yesterday we went to the V&A Waterfront. Neither of us really like the place, because it is teeming with tourists and so everything is super-expensive. But he needed to buy something there. And I suppose it’s kind of pretty.

There’s a Haagen Dazs Ice Cream Parlour there. Their ice cream is really expensive in South Africa, so I’ve never eaten there. But he decided, “Try everything once.”

So we did. This ice cream cost ZAR70! That’s about 7 Euro. Ridiculous. But it was delicious. Not that ANY ice cream should ever cost that much. No matter how wealthy you are. He said, “You should enjoy it, because as long as I’m paying we are never having this again.”

Funnier part: he locked his keys in his car. I climbed in via his sun-roof. I thought it was funny, but I think he was a little embarrassed.

I miss my family. I guess it’s part of growing up. But Easter and Christmas will always be family-time for me.

So today we eat lots of chocolate. As my Friend says,

“I think it’s a law or something.”

Giraffe Eyes for Great Granny

In a moment of childish impulse, the boy and I decided to watch Disney’s The Lion King.

This movie used to make me cry time after time.

This time, though, the image that gave me goosebumps was this:

My great-grandmother apparently loved giraffes. It was their big, beautiful eyes and long lashes. Such was her admiration that at a ripe old age, my granny who was afraid of thunder walked straight up to a wild giraffe for a photo.

She passed on at the age of 88 – when I was only eight years old. I loved her and she loved me and my siblings – I know that. But I am always a little sad that there had not been allwance for a time where I would be mature enough to bond with her, to learn from her.

Her death was difficult on my granny, who was with her mother until the end. Due to staff shortages, she had to man and watch the intercostal drain. She had to nurse her mother.

May I never give a brokenhearted relative that job. May I learn to give the dying their last moments in dignity.

Waterworks

My heart just breaks when people cry. And I have never had so many teary patients as I have had in Dermatology.

One lady was eighty years old, and drove herself to the hospital. What a lovely person! So lucid, so well-groomed, so independent. And she lives alone.

She had seborrhoeic scalp eczema – basically eczema in the regions of the body that produce sebum, like the scalp, nasolabial folds, groin and axillae. It’s itchy and embarrassing, producing a yellowish scaly plaque, but it’s not dangerous.

This lady had some secondary pustular infection, however, which made it more painful and more concerning. She also has a history of non-melanocytic skin cancer, so one has to check if it could be an abnormal malignant lesion.

The waterworks came when she told us about her scheduled cataract surgery later the week. She was afraid that they would see the lesion and refuse to touch her. She had been waiting for this surgery for over a year. She lives alone. She struggles to see. Then she starts crying, “It’s been too long, Doctor. I can’t go on not seeing.”

I just wanted to give her a big hug, but holding her hand till she stopped crying had to do.

She told us about her many grandchildren and great-grandchildren. She teased with us, and wished us well on the rest of our medical education.

The consultant promised her that her surgery would be able to take place. It was scheduled for today. I do hope that by now, she is in the recovery room. I cannot bear to think of her being told she would have to wait some more, with nobody to understand her tears.

Lost in Translation

It's apparently an iPhone game. I just like the font.

Little Brother (still) says the darndest things.

A while ago I posted the following as a status:

Practising Derms surgery on pig. Yummy!

But in my home language, “derms” means “guts”.

So, Little Brother tells The Family that Big Sister is removing pork gut for med school. Nomnomnom indeed!

The funniest thing is that a few hours later, one of my non-medical friends, ten years Little Brother’s senior, made the same mistake.

And people ask me why I love my country’s many languages…

Oink - look at the face!

Instant Accidents

WARNING: NOT FOR SENSITIVE READERS

There are very few things that kill you immediately. An atlanto-occipital fracture. A brain-stem injury. The other things that Hollywood tells us are instant, gunshots or stab wounds to the chest or head: not so much after all

We performed an autopsy on a four-year-old who landed head-first under a truck.
His skull didn’t have to be opened. It wasn’t flat as one would think either. His liver was split in two, but he had no broken ribs. No broken bones. Massive blood loss. His kidneys and lungs were too pale.

There was little to see of his brain. I am trained to deal with that, but I cannot begin to imagine the shock for the truck driver. A truck driver who was wise enough to stop when he heard the awful crunch under his tires.

What we know is that the atlanto-occipital fracture and the severe brain injury killed him just about instantly – which is fortunate, because the liver laceration would have been a painful last minute.

What we don’t know is what a four-year-old was doing on a major roadway in the middle of the night. We don’t know where his mother is, or if she knows

That is not for us to know.

Healing Hands

Granny says I have healing hands.

I doubt she know how much that – seemingly a casual observation – means to me in this no-man’s land between starting and finishing medical education.

Growing up, I would rub her feet, paint her toenails, massage her shoulders. Perhaps when she said then, “Oh, you should become a physiotherapist,” she planted the first seeds of med school.

I rubbed her feet the other day. Tired from gardening, Christmas shopping, looking after her frail cat; and she says,

“Oh, this is wonderful. Do you do this for your patients too?”

“Patients? No, no. I only do this for special people like you.”

Ouma and her grandchildren