It is difficult to decide on what to write about when every day I am encountering new, often exciting, commonly daunting, situations that I want to share. But, if I did that then these entries would be very long and probably quite dry. Surely I need to keep my readers engaged? I guess I shall start with a quick round up of a few of the things I have done so far. As an aide memoir I have created a log book of procedures and the occasional interesting case. It’s a little geeky, but so what. I try to document as much as I can remember; however, I often let a few days slip here and there. Since commencing the record on October the 11th I have done 14 spinal anaesthetics; 6 lumbar punctures; 2 evacuations of retained products of conception (that’s when someone has a miscarriage or abortion and they have the “products of conception” still within the womb. They need someone to tempt them out); 1 dilatation and curettage; 1 incision and drainage; 2 joint manipulations; and today I performed my first caesarean section and tubal ligation (sterilisation). It took me a steady hour and a half (I think the average time for the doctors here is about 20 to 30 minutes). I sweated out half my body weight – it’s quite nerve racking when there is so much that could go wrong. Fortunately nothing did; it all went swell and the little thing that popped out made the very reassuring sound of “whaaaaaaaa whaaaaaaaaaaaaaaa [crying].”
I guess some of you must be wondering what else has happened the past couple of weeks, no? Well, here are some highlights (or lowlights, depending on how you look at them):
Yesterday I was woken by the night doctor to give me a handover. A young gentleman had been shot at close range in the abdomen whilst robbers tried to hijack his car. When I arrived in casualty, there he was, obviously unwell. However, unlike the normal young kids we get who turn up intoxicated with a few friends, this chap, a teacher, was accompanied by an ever growing mass of family and friends. There must have been about 100 people, which was rather a daunting sight when I first assumed they were all patients. Whilst I made sure the gentleman was stable and tried to get him, unsuccessfully, transferred by air, the growing mass kept coming in to pray, a few at a time. For an outsider like me, it looked and sounded like they were all trying to perform an exorcism, as one man chanted: “Jesus, make this evil spirit leave him. LEAVE EVIL SPIRIT. LEAVE, LEAVE, LEAVE.” Maybe the bullet that was lodged somewhere deep in his viscera, was the evil spirit – in which case, I definitely had to agree with them. However, I think an experienced surgeon would be more effective than shouting at the metallic object. After five nervy hours in the department, the paramedics and a doctor arrived (this was a man with health insurance – the level of care one gets is far superior. We are so lucky to have the NHS in the UK) and shot off into the mist. The mist is what stopped the helicopter coming. I’m waiting to find out how he does.
I’m quickly getting used to dealing with sick kids. In my first week on the paediatric ward I had two infants die within hours of admission. I remember feeling a little helpless. I recognised that both children (one had a severe HIV related pneumonia and the other bronchiolitis) were absolutely exhausted. It doesn’t take rocket scientist to spot this. However, I also knew that both probably needed respiratory support as they were starting to struggle. The problem, as I may have mentioned before, is that we don’t have any higher care (e.g. ICU) here and the nearest centre is at least 5 hours away from the point of referral to arriving at the Nelson Mandela Academic Hospital (NMAH). In fact, that is not strictly true – we do have a “high care unit,” but it is not up and running yet due to staffing issues. I have absolutely no experience in looking after a ventilated child, but I may have considered intubating the children if I was present at the time when they stopped breathing and I knew we could manage them in house or refer them safely. Unfortunately the local ambulance service we have here has some serious limitations, unlike those in the private sector. It is more of a glorified taxi service where the driver wears a uniform and gets to drive with flashing blue or red lights; there are no paramedics. It can be a desperately sad and frustrating situation, especially when limited by one’s own inexperience and lack of facilities locally. However, I hear there is a helicopter that comes with a paramedic or doctor. Unfortunately it’s only dispatched in certain scenarios. I’m waiting to find out what these are and eagerly awaiting my first transfer in the chopper.
I spent last weekend visiting friends who work up in Kwazulu-Natal, the province north of mine, where Durban lies. The five and a half hour drive shot by as I took in the scenery, blasted out my music and sucked in the clean air of the expansive roads. The journey was only interrupted for a few car viewings. What a weekend – I got my fill of beer, conversation, food, beach, late nights and general hedonism. It appears that we lead quite different lives outside of hospital. I am very happy with mine in Holy Cross, but it’s nice to know that if I want a bit of a release then I can just shoot up north.
More to come. 
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