Where did all the tomatoes go?

I seem to have lost the title of “trauma magnet.” The trend over the past few months is that I would walk into casualty to show my face and say: “Hi, I’m on call,” the nurses would sigh and say: “Aybo! Doc, you get too much traffic.” What they are very politely trying to say is that whenever my name is on the rota, I seem to attract chaos – be it the result of a fracas, a road traffic collision or obstetric and gynaecological problem. This means work for me and work for my nursing colleagues. My blood stained sneakers are good evidence of how messy some affairs can be. However, I think I have lost my magnetism. Friday night saw only one gunshot wound in the knee and nothing else. I had some very sweet dreams.   

The expansion of our medical team has meant that we are all on call a lot less (probably why I am no longer so magnetic – probability always wins). The downside of fewer on calls means that I don’t get to deal with so many “juicy” cases. However, the upside is that we can really start to think about how we can develop Holy Cross into a centre of excellence. I may have used the wrong abstract noun there, but it is all relative – we need to strive to provide a better service at least.

This week saw our first meeting, to be held monthly, where we discuss issues with clinical and non-clinical staff and attempt to resolve them. In fact, the meeting was held on the same morning as the teaching programme that I have started. Needless to say, I have postponed the discussion until next week as the forum went on for some time. There were plenty of topics debated – our water supply (currently we only have running water between 6 and 8 in the morning – obvious dilemma with hygiene, but also with hydrating our patients and staff); out of hours radiology service (the radiographer said that he was on board with the idea if he gets paid extra. However, he also said that if he did get paid, it would still be voluntary.); management and fast tracking of sexual assault victims; broken machines all over the hospital (including the monitor in theatre – quite essential to monitor a patient’s heart rate, blood pressure and oxygen saturations.); pharmaceutical supplies. It was actually a very interesting and dynamic meeting, with some good contributions from nearly everyone present – although, I’m not sure about the views of the radiographer and his volunteer paid out of hour’s service. Surely that is a massive oxymoron. I just hope we can be productive and put plans into action rather than just debate issues over and over.

***

Whilst on call yesterday, during a lull, I found enough time to donate blood. The donation van comes around every two months, but quite ashamedly, I hadn’t donated until now. This is largely because I either had no idea it was here or I was too busy. I’m not sure if giving blood at the start of a 24 hour shift is a good idea – fortunately, Friday night was super quiet. I was quite surprised by how many people were reluctant to donate. There were plenty of vague excuses, although I’m sure some of them had good foundations, such as being HIV positive but, quite reasonably, not wanting to disclose the information to me. There is a massive shortage in blood stocks everywhere, so, if you’re reading this: GO DONATE TODAY.

***

My car Mitch has recently been accessorised with a lovely hat and pipe, more commonly known in the industry as a roof tent and snorkel, respectively. This is all in preparation for the two months I am taking off in July and August to drive up to Uganda (if time permits).

“Why have a snorkel?” I hear you ask? “To drive through rivers,” I say. “Oh,” you say.

The tent has already been tested for sturdiness by my neighbours, who decided to clamber all over the canvas. It shall have its maiden voyage next week when I drive to the Karoo Desert (near Cape Town) for a festival called AfrikaBurn. It’s based on the Burning Man in the Nevada Desert. Hopefully I won’t come back zombified and wearing nothing but a loin cloth.

***

The vegetable patch has been coming on just swell. Unfortunately, for all its luscious looks (the flowers are radical – my house has lots of empty beer bottles donned with pink, yellow and red bloomers) I haven’t been able to be self sufficient. There seems to be a tomato thief lurking in the shrubs as every time I go away for the weekend, the toms that were about to get that “sun kissed” look disappear. I just hope they go to a good home. Thyme, parsley and coriander play a heavy role in my cooking – it just so happens I have an abundance of them growing in my patch.

First festival of the season: Splashy Fen. Friends walking down the promenade - no need for wellies (although people were still wearing them). 



Splashy Fen, this man had the most incredible mullet. One cannot really appreaciate it in this photo, but I quite like it nonetheless.



First meeting of clinical and non-clinical staff since early 2011.

The neighbours modelling alongside Mitch and his new accessories.

Giving blood between patients - it's in their interests, but maybe not in the short term if I start feeling a little faint.

Miracle Makers

Easter has begun and I am fortunate enough not to be working the long weekend. Word in the hospital is that Easter is much like Christmas: families and friends coming together with knives and fists. People keep telling me it’s a cultural thing. I am sure there is a simple enough equation that can explain the festive fun: ((Money × Alcohol²) + difference of opinion) ÷ (Love + rational thought) = x. ‘x’ may be a kiss on the cheek or a stab in the face, depending on the weight of the different variables. Take away the liquor and I expect one would see a massive reduction in violence.  However, life isn’t that simple and one cannot simply things down to a silly equation. The social issues and inequalities here in South Africa are gargantuan – something that I am still trying to get my head around.

Not working Easter apparently means I should be spending it at Church, according to my nurses. “Gawping amazement” is how I would describe the look on their faces when I tell them I don’t subscribe to their school of thought and that I shall be spending most my time at a music festival. However, occasionally I feel I could almost believe in some kind of supernatural force: the seven month old infant that was shot in the chest last week in the hands of her dying mother came back today. By some miracle, the bullet prodded it’s way around the lung and ended up in the muscles surrounding her abdomen.  She was giggling and smiling while I stood there with a massive grin slapped over my face. I discharged her with the bullet still lodged inside. The aunt will look after the baby. On a side note – the aunt found the helicopter ride terrifying.

***

Often one is presented with an interesting history written on the casualty card. Often this is the result of a dodgy Xhosa to Zulu to English translation. The first time I saw: “Struck by lightning,” written down I felt my own heart beat accelerate rapidly – however, a quick glance at the smiling patient swiftly relieved my initial fear. Being struck by lightning in the physical sense is a very loose term here – however, the social and cultural connotations are massive. A home that has been “struck” by lighting must be abandoned and if a person is “hit”, they may be ostracised by the community. Lighting is the ancestors saying: “We are not very happy with your affairs at the moment – you must be punished.”

This week I have seen two patients where I assumed the history on the casualty card was misinterpreted.  The first was a girl in her early twenties who came with the story: “glass stuck in foot for three years.” Obviously it was three days, and not years. No, I stood corrected, it was three years. Being slightly cynical of her story I examined her. She was rather tender in the said area, but still I didn’t believe it. Glass shows up remarkably well on an x-ray, especially the two large shards that she had in her foot. I referred her to my surgical colleagues.

The second history was that of: “Tick in ear.” How can one possibly know it’s a tick in the child’s ear? It could be anything – far more likely to be a bean or cotton bud. The mother hadn’t seen it, but, without giving any reasonable explanation, she was adamant it was a tick. Much like the other pathognomonic sign for worms that grandmothers often like to describe: “The child is grinding their teeth at night.” Low and behold, the child had a gargantuan tick in their ear gnawing away at a tasty bit of ear canal.

***

I thought I had turned into a miracle worker yesterday. I reduced an angulated forearm fracture of a child under ketamine with that satisfying grinding click of the opposing bones realigning under a bit of manual pressure. The subsequent x-rays looked as if he had never broken his arm in the first place. For a brief second I thought that I had manipulated and plastered the wrong arm; then I thought I had performed some sort of divine intervention; finally I realised the two repeat x-rays were of the same view (one always needs to look at the bones in two angles to create a kind of 3D picture). The second x-ray showed that the results were not perfect, but pretty good if I do say so myself.

***

I should probably mention that this week was my last on the paediatric unit. One of the sister’s in charge was extremely upset when I told her the news – very flattering. However, it is time for a change and with our new cohort of doctors we can spread our wings a little. I shall be spending the next four months trying to help the medical ward recover from a dismal year of neglect and try to clear the cobwebs from my murky medical brain.

The mega tick that I fished from a toddler's ear. Notice the hunk of ear canal still being gnawed on by a very alive critter.

I shall miss paediatric ward rounds - the kids start to join in once they've been around for a while.

Now you see it, now you don't. The fractured forearm that I thought I had miraculously reduced. Unfortunately, the image on the right shows the same view. However, the arm is much better than it was.

Happy punters.



"slash and burn" next to the diesel generator tank.



Happy punters make happy workers.

The nature reserve (Mkhambathi) at the end of my road is magnificent.



Burger boy.



The South Africans love a braai (BBQ). I have turned my fire place into an indoor braii - my new favourite cooking station.

Improvisation can be key sometimes - this lady was referred from clinic with a septic operation wound. They have used sticky labels as tape - the adhesive, unfortunately, can be an irritant. Her skin was fine, however.

Here she is - the 7 month old infant who was shot in the chest. A very moving tale and a true wonder that she survived.