Real Medicine

Working in the Land of Milk and Honey

By some kind of dumb luck, I am doing my Community Service posting at an incredible children’s hospital in Cape Town, rather than the archetypal middle-of-nowhere clinic post we all expect for ComServe.

And it’s incredible.

#lucky to work with this view; less lucky to be #oncall Friday and Sunday. #weekend #capetown

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This hospital is just something else. It’s public, but has so much private funding that it might as well be a private hospital. It gets a lot of private patients so clearly I’m not alone in my perception.

Some things that continue to blow my mind:

1. Pain management team

Absolutely essential, of course, but not something we had access to in the Eastern Cape. As part of pain management, our kiddies have access to aromatherapy and music therapy. How cool is that?!

2. Psycho-social services

When adults bring kids to hospital and they have witnessed violent events, the adults get debriefing practically before the kid even leaves the emergency unit. When a kid gets hit by a stray bullet, he gets trauma debriefing. There are support groups for kids with any number of conditions. All of these things should be a given, should’t they? But again, it’s something I’ve never seen.

3. Palliative Care Team

Last year, I often had to decide on my own whether a patient was for active resuscitation or not. It was a horrible responsibility, but not that I’ve learned just how much is involved within the practice of palliative care, I realise how WRONG it is for a clinician to have to make such decisions without an entire palliative care team.

My entire view of palliation has changed.

4. Gorgeous Operating Theaters

There are theaters with views of Table Mountain, and I just… wow. (The on-call room also has a view of the mountain.)

5. Clinicians who love their jobs

I can’t begin to tell you how amazing it is to be surrounded by senior doctors who are still passionate about their work. It gives me hope.

 * * *

One thing that is not available in the land of milk and honey is small-size theater scrubs. I still have to use a whole host of improvisations to prevent my pants from falling down when I scrub in for theater.

Oh well.

Current Affairs, Real Medicine

Patients Don’t Want Exhausted Doctors

Before you read what I have to say, you should read Dr Nikki Stamp’s post: How tired is too tired?

One day, I’d like to have a study to prove the post title. But for now, we’ll have to settle for another anecdote:

tired doctor Continue reading “Patients Don’t Want Exhausted Doctors”

Getting to know me, Real Medicine

One Year On

Exactly one year ago, I started Internship. Hard to believe that the terrifying days just kept coming, until one day they weren’t so terrifying anymore.

Today marks the beginning of my second year of Internship, as the new interns arrive. I am excited for them, mostly. I also have quite a few friends coming!

I’ll be on call today on the surgical service. I anticipate a busy busy 24 hours; because with great celebration comes great trauma, unfortunately.

One year from now, if all goes well, I’ll be starting my community service year – in a different province, different hospital.

I don’t really know what to expect for the year ahead. To be honest, I haven’t even had time to make goals or plans. But I trust it will be a year of great learning and experiencing.

What a time to practise medicine, indeed.

Getting to know me, Real Medicine

Working the Festive Season

Christmas and New Year’s is such a fun time in South Africa. It’s the middle of Summer. The weather is gorgeous, perfect for swimming and braaing, spending time with family, and reading.

It’s my first festive season of working full-time.

nurse-working-christmas Continue reading “Working the Festive Season”

Current Affairs, Getting to know me, Real Medicine

Sometimes I Don’t Want To Know

a4c50964f550a70443d53e51fe887a82I didn’t want to know that the man with the compound skull fracture had fallen into a sewer drain while being chased by the police because he was the man that had been scamming poor people out of their grant money for months.

I didn’t want to know that the man with the gangrenous arm had been bitten two weeks ago, by a girl he was trying to rape.

I understand the importance of a good clinical history. But right now, while I’m saving their lives, can I not simply know that he fell in a ditch? Or that he suffered a human bite?

I don’t want to know WHY these things happened to them. Not right now in any case. Tell me later, when they have pulled through the worst. Tell me then, if you must.

Is this wrong? Continue reading “Sometimes I Don’t Want To Know”

Real Medicine

A Sadder Stabbed Heart

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By Redmer Hoekstra

When I got a call one morning at 06h00 to notify me of a stabbed heart in Trauma, I was not filled with trepidation like the last time I received such a call. I thought, “I’ve done this before. I know what to do.”

But I did also get the call while I was busy crushing an arresting person’s ribs, so it took me a while to get to him.

When I arrived in Trauma, the stabbed patient had also arrested. The Trauma docs were already doing compressions. We put in a chest drain. We got him back for a few minutes. I called to theatre, but they were already scrubbed on another emergency. Our hospital only has one emergency theatre after-hours.

As the most junior in the room, I ran to blood bank to get emergency blood.

While I was away, our patient coded again. The doctors and nurses in Trauma resuscitated, again. One of my seniors briefly scrubbed out of theatre to perform an emergency thoracotomy. Continue reading “A Sadder Stabbed Heart”