In 2010 I shared this picture via Youth Journalism International of a skeleton in our faculty dressed up for the Fifa World Cup. (Click the link and scroll down to the middle-left.)
Today we had a rather long clinical skills session for our anaesthesiology block.
This little guy met us there. I laughed:
I saw Janeway lesions the other day. Janeway lesions are rare and elusive, and usually present due to an underlying vasculitis or endocarditis.
The registrar on call had seen them only once before. In theory blocks we were told not to bother looking out for them because they are so rare.
My first reaction was to jump up-and-down with excitement. Fortunately I didn’t do so in front of the patient or her family. Her circumstances were not reason for excitement: a textbook-case of Systemic Lupus Erythematosus, fairly common in this part of the world. She was young and had signs of advanced renal failure.
The Janeway lesions were from a sterile endocarditis due to the serositis accompanying lupus.
It made me realise how excited we, in the medical community, become when we see a rare or textbook presentation.
A few days later I had a patient with advanced Huntington’s Disease. Something I’d never seen before. And I thought, “That’s too cool” – and then remembered again, it wasn’t.
It really, really isn’t.
Interesting, but by no means “cool”.
I’ve been told before, “You’d be a better doctor if you weren’t so emotional about life.” I don’t consider myself a superbly emotional person in public, but yes, I am touched by stories. If you scan through this blog you will see that stories of compassion or triumph are dear to me.
I’ve always believed that as long as it does not affect the way I treat a patient, it will be okay.
But maybe not.
If I am touched by the mother who brings her teenage rheumatological daughter pink milk and a favourite blanket to hospital, then I am also affected by the injectable drug-user who shouts at me for drawing blood “incorrectly and from the wrong vein”. Or the patient who tells me to “hamba” (leave) when she sees me entering the room with a drip-set.
And if I am happy because of a compliment given (probably without second thought), then I will easily be saddened when the same doctor is rude because of something I presumably did wrong. Or the nurse who is in a bad mood and tells me I will “just have to do without a blood culture bottle.”
I begin to understand why doctors are disillusioned about their jobs. I begin to see why they choose to change careers. I begin to see why they feel unfulfilled.
Sometimes, “helping people” just isn’t enough. When other healthcare workers are rude, and when patients are moody, and your employer (in this case the State) does not look out for you, and working conditions are terrible… it’s difficult to remain positive.
I’m not even qualified yet, and I feel like this already. I used to promise myself I wouldn’t become dulled to this work, that I wouldn’t become one of those sad, dissatisfied doctors.
But I don’t know if that’s possible anymore.
So for about five months I’ve been meme-ing along with The Broke and the Bookish on a weekly basis – and I had no idea there were so many book blogs out there.
This week, TBTB asks about the Top Ten Blogs or Sites we visit regularly that aren’t about books. I think I’m going to like this, because I will finally get to know a little more about the bloggers behind the TTTs.
Here are some of my favourites, in no particular order:
1. Terribly Cute - I am very broody. And since I am nowhere near ready for kids, I want puppies and kitties (or anything smaller than a fully grown human, actually). But living in student dorms means that’s not really a possibility either. This site is the next best thing – and it really is terribly cute! They update several times a day. One of my favourites:
2. Street Anatomy combines anatomy and pop culture, and it is simply amazing. Anatomy is so not my strong suit AT ALL, but I’ve become more and more intrigued with it after Forensic Pathology. Be warned that some of the artsy stuff can sometimes be a little graphic – it is anatomy, after all. The picture alongside is Parisian Pole Ka‘s work. Click the image for the original post.
3. Semester at Sea does not really need introduction, but if you’re new to this blog you can check out my post about it here. It’s awesome and I keep checking it out because I’m just fascinated I guess. Also, I was in their blog the other day!
4. The Underwear Drawer is a blog by Michelle Au, about whom I have written before too. She writes about medschool, becoming a doctor (she’s an anaesthesiologist now) and motherhood. Her medschool cartoons are absolutely wonderful. You should visit them here.
5. Youth Journalism International is an organisation really close to my heart. I still write for them occasionally, and I now also focus on an “ambassadorial” role. YJI is a non-profit journalism organisation. I joined them in 2008. They offer students all over the world the opportunity to write, and students have covered things like natural disasters and the revolutions in Egypt and Syria last year. If you want to know what the future of Journalism and our world’s leadership looks like, you should visit here.
6. The Oatmeal – I’m not even sure how to describe this site. Part cartoon, part sarcasm, part satire. It’s good and entertaining, but be warned that there is sometimes some use of crude language and allusions to violence. Some “safe” cartoons for sensitive viewers include 15 Things About Coffee, What Your Email Address Says About You and How to Pet a Kitty. I must admit, finding non-PG stuff on there was a little difficult. But the three above should be enjoyable if you are an oatmeal-ish person.
7. Creating Motherhood – I definitely try to stay away from those mothering blogs… It’s not that I am judging, it’s just that it’s not really me at all. There are some exceptions, like Dresden here. She writes about her long struggle with IVF, looking after her gran who had Alzheimer’s disease and now recently has a guest-blogging theme called In Times Like These, about difficult financial times (I wrote a guest post too).
8. PostSecret should really not be new to readers of this blog. It’s full of secrets and creativity and it’s awesome. A new set of secrets is published every Sunday. Just visit it, you will love it. You should also check out this TEDtalk byFrank Warren, who started it all.
9. New England Journal of Medicine 200th Anniversary Site – Okay, I suck at the whole medical journal, critical appraisal thing. I really don’t get why people can’t just write in normal English, so I can understand all their wonderful studies. So I don’t exactly have a favourite journal or something like that. But NEJM has this amazing site for their 200 year celebrations, and part of it has a great medical timeline as well as a library of classic clinical images that every physician should know. Yes, I guess I’m a nerd at heart.
Guess what happened here?
Click the image to be taken to the article.
10. Calcutta Kids is a NPO community health program in Kolkata, India – where I hope to do my elective soon. They’ve just launched their new website. They have done some amazing things, especially when it comes to reducing low birth weight and treating/preventing diarrhoeal disease. They also have a blog. This post about helping a little boy who was malnourished should give you an idea of the work they do.
Have you heard of the latest birthing fad?
It’s called the “Lotus Birth”. I thought it had something to do with the lotus flower, but apparently it’s just the name of the first woman to encourage the practice.
A Lotus Birth is one where the umbilical cord isn’t clamped once the baby is born. Unlike delayed cord-clamping, the cord and the placenta remain attached to the baby until it falls off. This can take anything between three and ten days.
The biggest reasoning given for this concept is based on the fact that the placenta is formed from the same egg-and-sperm that gives rise to the baby, and therefore it is part of the baby, and therefore it must not be violently severed from the baby.
There’s a largely metaphysical argument, relating to the baby being calmer, being more gently introduced to the world, and feeling closer to its mother.
(Hey, here’s an idea: practise Kangaroo Mother Care. That should help Baby to feel REALLY close to Mom.)
I could say that my cord was clamped and I don’t experience lingering trauma; but that would be as unscientific as the evidence for LB.
What really gets my goat is the so-called health benefit of lotus birth. Proponents claim that it reduces risk of infection, because there’s no open stump.
No. You’re right. There’s no open stump.
THERE IS A FREAKING OPEN PLACENTA!
Have you seen a placenta lately? The whole thing is a portal for infection.
It is said that the placenta must be liberally covered with coarse salt to prevent infection. Why, pray, is that then any better than protecting the stump from infection?
Studies show* that babies with delayed cord clamping have higher intermediate-term HB, which is great. These babies are also, however, at risk for complications from polycythaemia, including jaundice.
Nevertheless, delayed cord clamping has some health benefits. But only when the delay is up to a 10-20 minutes, after which the cord clamps internally and stops pulsating. So then it literally is just a dead weight. Like a necrotic toe that’s really no use. And a risk to the remaining living tissue.
For bonus marks: What’s wrong with this picture?That’s right. The baby is above the cord. Which means if the cord hasn’t been internally clamped yet, there will be a retrograde flow into the placenta and Baby actually loses blood.
If it’s after ten minutes, the blood in the placenta itself has started to clot and is of no benefit to the baby.
Also, have you smelled a placenta recently? It stinks really badly. It’s impractical to carry around. It’s a piece of raw meat.
Delayed cord-clamping has some proven health benefits, whereas Lotus Birth has none. You want to do something on a whim, believing that it will make your child happier in the long run, fine by me. But do not go around claiming that keeping your child connected to it placenta til it rots off is a health benefit. You will just irk anyone with some understanding of basic life sciences. Albeit an as-yet unqualified opinion, I would not encourage this practice – and I have received similar feedback from my consultants.
*References:
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.
This is a link-up with Nisha360. Read the end of this post for more info.
I am disabled.
I don’t have broken retinas, like Dad. And I am not in constant pain like Mom. The only body parts I’m missing are seven teeth and my tonsils. And actually my tonsils have grown back.
But I’m not perfect. I’m not completely capable.
I can’t drive. I’m 22 years old, with all my limbs and senses in mostly-working condition. I’m not exactly attention-deficit either.
I’ve been taking lessons. I wrote about it two years ago. It was funny back then. I was only twenty. It’s worse now.
My baby sister is turning 18 this year – the legal driving age in South Africa. I have a good feeling she’s going to be driving legally before me – heck, she already drives more confidently than me.
I could blame it on the fact that she has a patient boyfriend who teaches her. She lives in a small suburb with non-scary roads. Cape Town has scary roads and scary drivers. She has Mom by her, who can teach her whenever they have a moment.
Little Sister is wonderfully athletic. She has great hand-eye co-ordination.
Put me behind a steering wheel and I want to freak out. I don’t know how to handle gears and pedals and a wheel and all those damn mirrors all at once. My eyes are weak, my hand-eye co-ordination is weak…
Can’t I just get rich and have a chauffeur?
Truth is, I know disabled individuals – with actual recognised handicaps – who can drive with their handicapable vehicles. If they can do it, why can’t I?
Am I lazy? Wow, I’m ashamed to admit it, but perhaps I am. I don’t book lessons regularly. It takes me forever to book license appointments. But it’s more than laziness. I think. I hope.
Fear is one, that’s for sure. Driving isn’t safe. South African roads are a nightmare. But many things are dangerous. Do I want to bubble-wrap myself? Hell no.
I’m tired too. But that’s another disability, and I’ll write about it soon.
I need to learn to drive. I must. I just don’t see it happening.
* * *
Nisha is a young lady from my home town with Cerebral Palsy. She is remarkable and blogs about her struggle for independence. She has raised funds for a well in rural Kenya. She is breaking down stigma little by little.
Nisha experiences discrimination and misunderstanding of her CP regularly. Just browse through her blog and see. To address the stigma associated with disabilities she started a campaign called #IamDisabled. This campaign aims to show the world that everyone has things they want to do but can’t – like Nisha can’t fully use her right hand and I can’t drive.
Yet. Nisha’s hand gets stronger and (hopefully) I’ll fix my deplorable driving.
Link up with Nisha for this campaign here and let’s break down these artificial boxes society insists we belong in. You can be diagnosed disabled, or be like me. We’re not all the same, but we kind of are, too.
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.
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:
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.
It’s cold in Cape Town today. It reminds me of a time where hundreds of South African babies died for a lack of incubators. Incubators are wonderful things, the way they protect the little children who arrive in the world a little too early.
Something else that saved a lot of lives was the simple knit beanie. Babies have huge heads compared to their bodies, and they love a lot of heat through it. Volunteers knitted and donated beanies to NICUs, and suddenly babies thrived.
A lot of money is spent to keep neonates alive.
But the most valuable commodity in the Neonatal ICU is not the incubator or the oxygen tank or even the doctor.
It’s the mother.
I’m in awe of those little bodies, but I’m absolutely dumbstruck by the mothers who sit by their tiny babies, holding them skin to skin even when they can’t nurse. The babies who have contact with their mothers thrive. They breathe more easily, they understand human touch, they regulate their temperatures better.
There are those mothers who don’t go visit the NICU. Some of them are stuck in an ICU of their own and really have no choice. Others… I don’t know. Do they not care? Has nobody told them that there baby needs them? I don’t get to judge them. I don’t know their story.
But mothers? Mothers should be invested in. They are more vital to the child’s survival than any other thing the medical sector might devise.
