Don't Go Chasing Waterfalls

 

  

Myself and the elective kids.

January would have been an exceptionally challenging month – a distinct shortage of doctors and nurses (what’s new) and an overwhelming number of sick children. To top it all off I was meant to be preparing for UK job interviews. However, the arrival of three medical students from the UK helped me keep my sanity in check. I love having students around, whether I’m home or abroad; it makes for a stimulating and exciting environment: sharing ideas, knowledge and stories. In addition, what made this group (Dom, Mal and Georgie) particularly good was the fact that 

Malik getting sized up for some
new trousers during a ward round.

they like to eat, play and explore: which, is exactly how I roll.  The big house that I live in was finally buzzing with life and now that they’re gone, I must say it is rather quiet. However, they’ve left their footprint – pictures all over the walls from weekend japes, blood smeared from floor to ceiling after several mosquito massacres and some truly excellent memories.

I had initially taken two weeks off to return to the UK for interviews, but cut my trip to 4 days and returned early for an impromptu trip to Madagascar with them. They say you only live once, and the South African government does pay me rather handsomely. Needless to say I am rather broke now, but it was definitely worth it. If you ever get a chance, I would recommend Madagascar to anyone: beautiful people with a real joie de vivre, scrummy food, charming architecture, magnificent scenery and, of course, loads of Lemurs. I only stayed for a week – Holy Cross was beckoning me – but, it was enough to get a taste of its wonder.

Smiley Madagascan children.



"LOVE FOAM" - the only mattress to sleep on in Madagascar.

***

Whilst the students were here, we embarked on some truly excellent weekends; keeping it local and exploring the Wild Coast, a.k.a. my hood. On their last weekend with me, before I flew home for a quick interview, I organised a trip to Mkhambathi: the beautiful nature reserve at the end of my road. There were twenty of us and a lot of fun was had, which included some excellent beach volleyball (courtesy of the students spoiling Holy Cross with a brand new net – I now have to dig up a pitch: watch this space) where Great Britain slammed the Netherlands; plenty of braais (BBQ’s) with some devilishly good dry rubs over the meat; sunsets; sunrises; swimming; frolicking; green shooting stars; and my good friend Ben having a near death experience.

I have mentioned in previous posts that the thing that makes Mkhambathi so special is this magnificent waterfall that dumps straight into the sea. Last time I visited the falls the water level was pretty low; this time, being the wet season, the river was engorged, creating a spectacular thundering aquatic feature.




Friends absorbing the magnificent power of the waterfall.

Ben is one of my dearest friends and also happens to be a British doctor working in South Africa. The story is a little vague, but he was walking along the top of the waterfall, lost his footing and slipped. Fortunately, he landed on a ledge. Unfortunately, he was stuck: pummelled with white water and a potential 15 metre drop into a shallow pool, he was holding on with his bare hands to a couple of small rocks and getting very cold. The other great thing about Mkhambathi is that it is really isolated and there is no phone signal; this isn’t so good when one needs help.



Ben - a little stuck. We didn't really take any photos
 as it was shortly after this snap that
 my friends realised he was in trouble.

My initial reaction to what was going on involved a lot of expletives from me, directed at Ben, and complete dismay. I had actually been lagging behind, taking in the scenery and checking out the swell rock pools with a friend before we knew what was happening. By this point, Ben had already been stranded for about 20 minutes. A party had run off to get help: one car was sent to get phone signal and beckon a chopper, if need be, and another returned to the scene with food, blankets and some equipment. Obviously, the car that returned to the scene was Mitch. Unfortunately, a barrier on the track meant we couldn’t get him close enough to use the winch. Instead, four car tow ropes were tied together and thrown down to my stranded friend. At this point he had been in the water about an hour. There was quite a bit of discussion as to how we would pull him out: the rope didn’t have much slack and it would take several people to pull Ben across with the added weight of water pummelling him. We agreed to shimmy him across the waterfall, on its ledge.

The thundering noise of the falls made it almost impossible to communicate with Ben; hence, there were a lot of gesticulating hands. Without further ado, we attempted to pull him across. At one point, he disappeared under the falls. I happened to be the one at Ben’s level, trying to give a few instructions to him or the burly crew handling the rope. Imagine me, shouting at my friends who were pulling him, trying to get them to tug more as I lost sight of Ben under the dramatic blanket of water. It felt like an eternity, but couldn’t have been for more than ten seconds. Minus one pair of shorts, we pulled my dear friend to safety and I gave him the biggest bear hug I have ever given any man. Whether he remembers or appreciated this, I do not know. The relief from everyone was massive; it was one of those “999” (the TV show) experiences, but with a very happy ending.

Once we got Ben back to bed, the fun recommenced, but not before an impromptu dance to the TLC song “Don’t Go Chasing Waterfalls.”

You may be pleased to hear that I managed to get this event into my job interview in response to the question: “So Dr Craver, can you tell us of a time outside of work where teamwork was important?” My answer: “Well, as a matter of fact, yes I can. Just last week…”

 

***

This is probably as good a time as any to mention the fact that I shall be leaving Holy Cross at the end of March. After about 20 months of work, I have finally handed in my notice. It is with mixed feelings that I am leaving, but something I am ready to do; the prospect of returning to my dearest family and friends fills me with glee, but I shall be sad to leave my Holy Cross family.



Busy at work in casualty. One could say it looks like we have too many doctors. Oh how I wish that was true.

 

Dom and Dom.

 

Good TB preventative measures: fashion always wins.

One Sunday in January

 

 

Before you read this, I have an announcement. My good friend Kim Turley, out of the good will of his heart, has kindly constructed a website for Holy Cross. It is still a work in progress, but do have a quick browse.

http://www.holycrosshospitalza.org

***

The weekend was coming to a close: it was Sunday night, I had triaged all the patients in casualty, maternity was quiet and the wards were sleeping. I got to bed at around one am and drifted immediately into slumber land. Within the hour I was awoken by the extremely unpleasant screeching of my house phone– the sound is far worse than any bleep I have ever carried back home.  The sister in casualty had some urgency in her voice – there were two young children with, as she put it: “serious burns.” Now, the staff at Holy Cross see burnt children all the time and they are well versed at managing the less severe cases. On that basis, I knew that I wouldn’t be going back to bed for some time.

I threw on my clothes and ran down to casualty in the rain. What lay before my eyes were two sisters of five and nine years old who were in a really desperate state of affairs. A candle had fallen on their bed whilst they were sleeping and set fire to some extremely flammable bed sheets. Both had deep burns covering almost 60% of their little bodies, which in itself carries a poor prognosis. However, to confound matters both children were freezing: they had been brought by their family through the pouring rain and were sodden.



This is the younger sister, all wrapped up in
 a red bin bag and ready to get in the ambulance.

The girls were in a state of shock, but still alert, talking and crying. I turned the heating on to “full” in our resus department and proceeded to get very sweaty whilst I resuscitated them. With burns, one loses a lot of fluid, hence, what goes out must be put back in. I placed a femoral line (a drip in the groin) in both girls and filled them with warm intravenous fluids as well as catheterising them. Now, I thought, how can I keep them warm? I looked around the department and came back with two large red clinical waste bags. The idea, in burns management, is to reduce the amount of fluid that is lost by creating a synthetic skin; hence, cling film would have been ideal. With my girls relatively stable, lying in bin bags and under several blankets, I referred them to our burns unit.

My colleague on the other end of the line was reluctant to take them at first, given the severe degree of their injury, but eventually agreed to have them transferred. The ambulance took eight hours to arrive – our commonest and most frustrating rate limiting factor. The sisters both got into the ambulance and seemed relatively stable, but neither made the 4 hour drive.

Deep down I knew that their prognosis was poor, especially with my limited experience in such cases and the sub-optimal facilities that we offer. However, I had to try; we had to try. The nursing staff at Holy Cross really do try hard, despite all the barriers that they are faced with. Those few times when it works and when things go well, even if there’s an unhappy ending, at least we can say we did the best we could; we achieved something.

***

This fella has a massive pericardial effusion (fluid around the heart).
Normally the heart (the big white thing in the middle) sits snugly in the middle of the rib cage and is rather small. He was exceptionally short of breath as the fluid was causing a cardiac tamponade (squeezing his heart so it cannot function correctly)...

 

...The only way to relieve the tamponade is to remove the fluid. Under ultrasound guidance I inserted a cannula (large needle) into the sac around his heart: a rather frightening, but lifesaving, procedure....

...Out came over 2 litres of blood stained fluid. This is the classic for TB pericarditis. The guy was started on TB treatment and steroids and is now doing very well.

Belated New Year's Greetings



The all too familiar "jump'n'shoot" pose at the top of Port St John's
 airfield with the UK student clan.
Left to right: Me, Mal, Dom (there's another Dom) and Georgie.

I must apologise: Job applications, a couple of flights to the UK, impromptu trips around the Wild Coast, falling in love, working like a dog, playing like a pig in roses and a lack of sleep has put this blog on hold for the past month or so.  However, it hasn’t been for a lack of tales. Oh no, there is plenty to be told, except that I do not want to bore my audience with pages and pages of script. To make things more palatable I shall write a couple of instalments on January.



The halo of clear fluid around the blood is CSF
(cerebrospinal fluid) that was leaking from a
 guys ear who had sustained a skull fracture
 following a road traffic collision.

I shall start where I left: in my last entry I was en route to the UK for a festive week at home with my beloved family. My first day back at Holy Cross was New Year’s Eve. Imagine my glee when I found out that I was to be on call alone for the ensuing 24 hours. Not that I don’t work by myself most of the time when on duty, but it is always nice to have that “phone a friend” option in times of crisis. My main concern, however, was the fact that there would be no anaesthetist for the C-sections. So, I planned ahead and called colleagues at my local hospital informing them that I would have to send any mother that couldn’t deliver vaginally to them. I don’t think they were too happy, but I didn’t give them a choice and in the end I only sent one lady.



One of the many mashed up hands: kids,
don't play with fireworks.

The day had an ominous start – at 9 am I put in my first chest drain into an elderly lady who had been beaten, bruised and stabbed in the chest: a grim and exceptionally sad tale, but something that isn’t uncommon. Fortunately, that was all there was for the next 24 hours of any real note. No knives to the heart, no blades through the lungs, no bullets traversing the skull. There were, like last year, several firework incidents that brought in a delightful selection of blown off digits and thumbs. I had to amputate the end of one guy’s finger whose bone had been squashed like a Panini and then chewed on by a very hungry teething child.

After the slight anti-climax of New Year’s Eve, Holy Cross threw a curve ball. All of a sudden we had gone from 7 to 3 doctors: one had left and three were on leave. It was a pretty cruel two weeks: dousing the fire, telling patients who had just travelled a day to see a doctor that they should return next week as their complaint wasn’t urgent; the wards were all but abandoned and left to survive on their own as we struggled to keep maternity, paediatrics and casualty going. Hence, there was little blog writing time for me.

A lot of children died in January, but I don’t think it was entirely because of the doctor shortage. There had been an alarming number of kids who presented in respiratory distress and renal failure as result of herbal intoxication. Traditional medicine is a very interesting subject, and when done well I’m sure is very good, just like the allopathic medicine that I know and practice. Both fields handle some exceptionally toxic substances. Unfortunately, some of the traditional healers have recently been using some exceptionally potent enemas (that’s right – bum is best over here) to cure a mild cough or a bit of diarrhoea. Instead of fixing the sniffle, children have been dying. When they get to us, with a bit of support and care, they sometimes get better. However on several occasions, as if there had been a massive communication breakdown in explaining why their child got ill, the parent repeats the enema and the child dies. For me, though, the most poignant moment during those hellish two weeks was certifying a beautiful little baby who had died as a result herbal intoxication. She wore a T-shirt with the inscription: “I’m not sleeping, just recharging.”

***



"Kiss me," the caption on one of the pairs of slippers that the
night staff were wearing.

It’s not been all doom and gloom though. There have been plenty of smiles, and even tears of joy, brought to my spritely face on a daily basis here at Holy Cross. They say it’s the small things, and when I looked down at the feet of the nursing staff running a busy Saturday night in casualty to see them all wearing pink fluffy slippers I couldn’t help but giggle. Although, it was a two way affair as they find the fact that I wear my wellington boots during the night shifts hilarious. However, I believe they are very practical: I get snake protection for the 300 metre walk from my house to the hospital; blood and other products can be wiped clean; I can pretend I’m at Glastonbury – not so practical, but it keeps me sane.




A gathering of "believers" collecting
 passers-by as they trundle down
 the corridors. To where though,
I have no idea.

During the end of that exceptionally exhausting and emotionally draining first two weeks of January I was greeted by a mass of people blocking my way to the ward. They were slowly marching down the corridor, banging their drums, dressed to the nines and singing the most sublime chorus. It brought a tear, well several tears, to my eyes. I have a real admiration for the faith that some of the people in this community have, even though I don’t share the same beliefs or attitudes towards life as they do. However, I could not help but be moved in a deeply visceral way.

***

I shall leave it there for now and write more on January soon where I had waterfall filled excitement with friends and a swell trio of UK elective students.

Myself and Mitch riding the wind atop of Port St John's airfield.

Myself in an extremely precarious spot above Port St John's.



Remember this guy? He came in weighing 10kg at 10 years old.
 Just over a month later and he now has life in his cheeks,
 a spark in his eyes and is now weighing in at almost 20kg.
 I didn't recognise him at first.