Dr Zhivodka

After an hiatus from blogging & life in general over the past few months, I have been re-reading a few of my more venomous (and thus unpublished & archived) posts. Having read bongi's amusing post today, doctors for africa I have decided to lift the ban on a post I wrote on Spring Day last year (oh, the joys of spring!).

Now, there is a REASON why I don't buy lotto tickets, gamble, play dice games, go fishing, overtake on a blind rise or walk barefoot on the lawn... I am one of the unluckiest SOB's alive!

It feels like yesterday. My first day at work as an Intern. Triple whammy! I found out :

1. first rotation is Internal Medicine (my fave, right up there with root canal treatment)
   
2. my Registrar is one newly appointed, Dr Zhivodka
3. I'm on call (aargh, Monday Firm - the worst. Weekend-wreck dumping ground.)
   

Typical! I'm not surprised! As an irritating, whistly tune from Monty Python repeats in my head, I try to take advice from the lyrics. Let's not judge Dr Zhivodka by his cover (something like Fargo meets Deliverance, set in Khayalitsha) and give the guy a chance.

Walking off to the medical block, students in tow, I try to make some idle conversation. I notice he says "OK" a lot, even to questions. What I did manage to ascertain was, despite coming from Southern Africa, he studied abroad because of the injustices of the past. Very strange I thought, to not only study medicine in a foreign language, but one which has a completely different alphabet! Sounds dodgy deluxe... But hey, I'm sure they did their background checks before hiring this guy - so just relax. In which case, I'm quite impressed & wonder about the logistics of it all : "It must have been challenging studying in such a vastly different country & language?"
"It was too much nice," he tells me, "we drank so much of vodka and smoked so much of cigars. I miss it too much." Besides sidestepping my question, he stoked the coals of dubiosity & my scepticism is back with "too much of" vengeance. Houston, we have a problem!

Rounds were going nowhere fast. The students seem to notice this too as was obvious by their indiscreet eye-rolling, whispering, giggling & yawning and eventually blatant chatting about what they got up to in the holidays. What became rapidly apparent as the morning developed, I was the new captain of this ship (by default) & we were sailing plumb into the Bermuda Triangle. I got rounds out of the way by emulating what I had seen the Consultants do... we drew blood for everything on everyone.

Right, rounds out of the way - let the call begin.

Dr Zhivodka is very, very slow. For each patient he is seeing, I am seeing three. Dr Zhivodka works according to a pattern, I notice. The referrals come in with a query diagnosis e.g. ?Meningitis and he admits the patient with the diagnosis of Meningitis. He receives a patient with ?Infective Endocarditis and he admits the patient with Infective Endocarditis . Can you guess what the patient with ?Guillain-Barré gets admitted with? I, on the boring hand, was striking one PCP or HIV or PTB after the other (in various permutations, some even hitting the South African Trifecta).

My first big problem case arrives early evening. A young, healthy looking guy but with one impressive tremor on him. No chronic illnesses & kidney functions fine, but a Potassium of 9mmol/l. I phone the lab just to ease my mind and confirm the specimen was haemolysed, only to be told NO HAEMOLYSIS! Shit, I remember this is an emergency - something about the heart & fatal dysrhythmias. I phone Dr Zhivodka, who had conveniently gone home for dinner, to rattle off about the horrific situation. So he tells me, "OK"... and then nothing... I thank him profusely for all his help & slam the phone down in his ear. Once again, problem squarely on my shoulders. No Calcium gluconate in referral room, but I've got the students getting an ECG and hanging up Insulin & Dextrose infusions. In the meanwhile, I'm on the phone again - this time for a high-care bed.

Of course, the ICU Reg starts giving me flack about not accepting consults from an Intern, rhubarb, rhubarb. A concoction of irritation, fear & desperation can create a monster. Having morphed into Frankenstein on steroids, I begin yelling down the horn like Gatiep on spirits :
"Dr Zhivodka is at home right now, but I can give you his telephone number if you wish. He knows nothing about this case... in fact he knows nothing full stop. He is a fool. Incidentally, I am stripping him of his title - let's just call him Zhivodka from now on, shall we? So take your pick. Intern or Retard?"

I got the patient turfed to safety, only too pleased searching for the cause of the hyperkalaemia was now the problem of somebody with more than 24 hour's experience. I managed to survive the night (only just) but knew we were in for one very long & painful post-intake round with the Consultant.

Walking back to the medical block, following the distinct scent of urine and heading for the source of the medical morning procession of tented guerneys, I am once again reminded of Monty Python.

Let the show begin! Like two cats been out on the prowl all night, we presented our carrion at the feet of our Consultant. I was first up. I had a very emaciated lady with what I suspected was pulmonary TB. Having come in severely dyspnoeic & with a massive pleural effusion of the entire right hemithorax, I proudly presented how well she improved once I inserted an intercostal drain & sent off the fluid for MC&S, biochemistry, ADA & cytology (I thought all these tests were bound to impress). My smile was very quickly erased from my face when the Consultant tells me, "You idiot! What is her albumin? By the looks of her shadow, it's in the ground. Now we're never going to get that drain out." I had switched off to whatever else he had to grumble on about and took solace in the fact that I was soon to be upstaged by Zhivodka. The smile returned.

What a mess. My heart actually bled a little for the fool. All he could get right was the patients' name, age & gender. The Consultant was making mincemeat of him. As in an exam, one could tell he wasn't doing too well as the questions were becoming progressively easier & easier, to the point of ludicrousy for a post-graduate. I clearly remember some of the interchange :

• "What is the cause of meningitis?"

"Protozoa"
"I say meningitis & your first thought is protozoa!"
"Fungus?"

• "How do we treat infective endocarditis?"

"Warfarin"
"You have just killed the patient."
"Heparin?"

• "Do you even know what Guillain-Barré is?"

(Fifth Amendment)
"But you have just told me you diagnosed Guillain-Barré. How can you diagnose something if you don't know what it is?"

The Consultant told me he wanted to see me in his office after rounds. Turns out it is very difficult to get somebody fired, even if there is evidence of gross incompetence. I was asked to document all misdemeanors with dates, times & witnesses (something I would have to quickly get used to doing in state practice).

I was amazed at Zhivodka's resilience. He was treated very harshly by all, but could not be broken. He would be back at work every day, until he was was eventually asked to see the Head of Department after a month or so. Acting as a sounding board after his meeting, Zhivodka shared with me how the HOD told him that perhaps Internal Medicine was not his forte & he should think of pursuing other avenues of healthcare. How typically diplomatic of the HOD! I would have told him that perhaps his forte is NOT healthcare.
P.S.
As a matter of interest and in stark contrast to my hyperkalaemia patient, Zhivodka's Guillain-Barré had a potassium of 1.8mmol/l (hypertensive on diuretics). Hallelujah, he got up and walked after a few bags of PotChlor.
Even more interesting/shocking, a quick search (or should I say, quack search) on e-Register & Zhivodka's still on the roll!