The Big 5

Since I am working like a dog & don't have the luxury of being close to the Kruger National Park, I have been forced to look around me & appreciate nature from the confines of the theatre walls.

I present to you - the BIG 5 à L'Afrique du Sud State Theatre...

1. Blattodea
I call this little chap Nelson. Nelson is a nice cockroach. He eats all the dirt that the cleaners shift from the middle of the floor into the corners of the theatre.
Nelson has a very large family, but they are rather camera shy. They scurry away so quickly before I can get the shot. They look just like Nelson, only some are even larger & some smaller.



2. Diptera
Meet Louis XLCIXIVII. He is from famous lineage - as in Louis THE Fly, from the advertisements that grossed the hell out of me as a child.
Well Louis has moved on from rubbish bins to theatre drapes, where he finds excellent meals in the form of laparotomies & evacs (the photo of him conquering the summit of Mons Pubis was deemed inappropriate for publishing here).
Louis is of the brazen variety. It takes a lot of "shooing" and flailing to get him to move along. But he studied at the Aboriginal School of Boomeranging, so he's back on the drapes before very long.







3. HIV/AIDS
You probably can't see these little suckers with the naked eye, but given our statistics I can assure you they are there.
So, good to know that the sharps bin safely conceals the bevelled little bearers of the "groot griep". Pity it doesn't get disposed of more regularly.
I arrived on call with the biohazardous sharps bin looking like this. Although, I must say that I have seen worse!








4. Ascaris Lumbricoides
This is Willy the Worm. He made his appearance via a lap for stabwound abdomen of a rather uncouth, intoxicated gentleman - let's just call him Willy Warmer.
Willy Warmer told me, quite proudly that he takes drugs, drinks, smokes tobacco & dagga and is on Nevirapine (probably black market/stolen). I'm quite amazed at how resilient ascaris is, to survive despite an assault from all of the above!

(btw Willy told me to send you his regards, Bongi)





5. Anopheles
Mildred the mozzie is sitting (quite ironically) in the caution area - around 610 mmHg of this pressure bag.
I still question that HIV cannot be transmitted by mosquitoes. How do you know that this specific mozzie doesn't suffer from oesophageal reflux?
The assistant in this case (Mildred also made several guest appearances on the drapes around the open abdomen) wondered if the patient's intestines would itch post operatively... hypothetically.



But my gas-mechanic nurse was fully prepared for such invasions as is evident in the following unstaged photo. Quite tickled my fancy & scratched my itch! Wonder if this photo would pass as evidence of a theatrical (?) epidemic?

P.S. Anybody interested in being a co-author in my trial - "Tabard Nebs - an Accidental Cure for Malaria".

Five Surgeons...

from big cities were discussing who are the easiest patients to operate on :

The first surgeon, from Cape Town says, "I like to see accountants on my operating table because when you open them up, everything inside is numbered."

The second, from Johannesburg responds, "Yeah, but you should try electricians! Everything inside them is colour-coded."

The third surgeon, from Durban says, "No, I actually think librarians are the best, everything inside them is in alphabetical order."

The fourth surgeon, from Bloemfontein chimes in, "You know, I like construction workers.... Those guys always understand when you have a few parts left over."

But the fifth surgeon, from Pretoria shut them all up when he observed, "You're all wrong. Politicians are the easiest to operate on. There's no guts, no heart, no balls, no brains and no spine, and the head and the ass are interchangeable."

Responsibility & Telephones & Lazyness, Oh My!

I am unsure whether it is a total lack of insight or just plain laziness which is the doctrine of state sector hospital employees. My concerns are with those occupying the other very important positions in health care delivery who avoid responsibility. A telephone is the wicked accomplice to those in question.

Here ensues three stories to illustrate my point.

Switchboard Operator & Nurses
I receive a call from a very flustered colleague. She has her hands full with a patient who has complicated intra-operatively and needs an urgent ICU bed. She is working in another hospital nearby, which only has a high care facility without ventilators. So she has been trying to arrange for a bed in the hospital where I am on call. She is calling from her personal cellphone to mine. Apparently, she can't get through to our ICU or find out who the doctor on duty is because switchboard is not answering the phone.
"Not a problem", I reassure her. "Just sit tight, I'll get this sorted out from my side"

This shouldn't be a problem since I have the advantage of the internal short dial for ICU & will arrange the bed on her behalf.

4121 - engaged
4122 - rings, rings, rings
4123 - engaged
4122 again - engaged
(the nurses are making private phone calls)

9 - rings, rings, rings
(switchboard operator still sleeping/on tea/away)

After retrying for 10 minutes or so I finally get through to ICU.
I tell the sister I am trying to urgently arrange for a bed et cetera. She abruptly tells me to phone the doctor on 4137 & puts the phone down in my ear.

4137 - rings, rings, rings

Phone back to ICU. Engaged or ringing again. Persist & finally get through. I tell the sister the doctor is unavailable on 4133. I ask her who the doctor on call is, but she doesn't know!
"Ask one of the others, please"
"We don't know, we are the new shift." (so much for handover rounds, which was 2 hours ago mind you)
"Please could you look on the roster for me, Sister."
"Where is the roster?"
"I don't know, I don't work there - you do"
"Find out from switchboard" and she puts the phone down in my ear again before I can tell her nobody is answering at switchboard.

By now I am breaking out in a sweat from fury. I am about to sprint to ICU in person to wring a few necks & vent my frustrations. Lucky for them, I have a case on table.

We eventually solved the problem by phoning a random ICU doctor & asked who was on call. All was sorted out in 2 minutes.

This is the reason why I pay for a business cellular phone contract, privately. Many of my calls are for the state, which gives me no phone allowance and pays me peanuts in thanks.

Laboratory Technicians
We had a patient on table the other day - very ill, very urgent. I was unwilling this time (with the patient's best interests at heart) to blindly start the procedure in good faith that the blood results would be available "soon".
We knew the specimens were at the laboratory because an Intern had kindly made the two kilometre round trip to deliver them in person (you see, the messengers don't respond to sentences containing the word "urgently").
Problems :

1. nobody answers the phone at the laboratory - it just rings & rings & rings
2. when it rings too much, it is irritating to the lab tech's, so they take it off the hook
3. then the phone stays engaged
   
4. there is no computer system for us to personally check results
   
5. it is far to run to the laboratory each time
   
6. smoke signals would contravene certain laws (besides, they would be too stupid to understand it, or be too busy sleeping to notice)
   

So we had no choice. I left the patient under the care of my intern. The surgeon & I climbed into the car & drove to the laboratory.

The techies didn't even notice us standing at the counter. Music was blaring. One was sleeping in the laboratory & two were having an animated conversation in the corner near the phone which was ringing because I had dialed it on my cellphone.

We were only noticed after my earsplitting whistle. I thought the two of us standing there, in theatre attire, would perhaps draw at least an apology for the inconvenience caused or mild embarrassment at such poor service rendering. In fact, they didn't even flinch when I asked them if they weren't going to answer the phone whilst waving my cell in the air.

Blood Bank Technician
I'll spare you the details. We called for 4 packed cells, 6 fresh frozen plasmas & 1 mega unit of platelets.
The blood bank technician felt our order was overkill and only dispensed 1 unit of packed cells and a message via the porter that we can ask for the remainder as we need it.
After struggling with the phones and eventually, much explaining to the insightless but frugal-due-to-low-blood-stocks tech, the rest of the products finally arrived just as the sisters were preparing the corpse for the mortuary.
I KNOW she would have made it, but we missed the window of opportunity.
And the struggle continues because blood bank doesn't have to break the news to families, therefore no culture of responsibility.

I wish I could enlighten those who hide behind the telephone :

You may enjoy the anonymity and use it as a scapegoat for sloth and ducking responsibility....
You may enjoy ignoring the phone because you know it brings more work...
You may enjoy removing the phone off the hook because your sleep is then uninterrupted...
How corny, but what if that phone call is your life hanging in the balance?

People die everyday because of phones, lack of responsibility & lazyness.
Shameful!

Kodak Moments

It has been suggested to me, by several people on numerous occasions, to keep a
diary of the frustrations we as South African doctors in state hospitals have to
endure. So here begins a series of "Kodak Moments" I wish outsiders could
witness. Oh, and these recounts apply to every State Hospital I have worked in
thus far.

It has happened once again. The damned electricity is down. There have been serious problems with the airconditioning for months. Working in a sauna is already a debilitating circumstance.

Impeccable timing too as I had just started slipping drugs into the next patient on the maxillofacial list, sending Queen Mab in her chariot riding over the patient's, in this case, badly marred face. The generators did kick in. Is it me, or is that lagtime before backup power resumption increasing at a exponential rate? Well, my "Chillin' on da Beech" cocktail of Sublimaze, Robinul, Morphine & Decasone is already in - I'm reassuring the patient and telling her to breathe big ones for me when... I felt the tap-dance of a split-hooved creature on my left shoulder.
"Go on, do it. You've started already! Things will be fine."
I picked up the Propofol syringe and connected it to the injection port when the theatre doors gave way to Matron (our villiage crier) brandishing her officious clipboard. "Finish up the cases on table now. Don't start any new cases. We will resume once the electricians have sorted out the problem" That could take all day. They have been busy for months & there is no sign of improvement.

So I apologised to the patient & made off to the anaesthetics tea room, for a nice hot cuppa java. With the entire theatre squad sitting there... idle time... idle minds... I now declare the January 2009 Slagging Olympics open.
"we can't even boil the kettle"
"the milk is going sour in the fridge, and my coke is tepid"
"wonder what's happening with the cricket"
"it won't help to phone the superintendent - it's a waste of time"
"Ray phoned the superintendent the other day when there were no porters & we had came to a standstill. Do you know what he said?"
"So, what's wrong with the doctors? Are they crippled?"

I was gobsmacked. I already push the patients into theatre myself, get them onto the table. I have carried patients post-operative "like a bride over the threshold" to get them onto a guerney. Pushed them to recovery room alone. Let alone all the other fetch & carry I do with the equipment myself. Since that day I have become crippled on principle.

Some of the surgeons mop the blood & mess off the floors themselves. I am sorry, I draw the line right there!

But this all got too depressing so I raised my eyes to stare distantly at the roof & hope for better times only to be distracted by a swarm of blue-arsed-flies circling the tearoom just waiting for the sour milk to be left outside the fridge. First it was just the mosquito's in the corner by the flea-infested on-call bed, next to the cockroach cupboard.

"Eish, I've explained to our patient that she will be cancelled & postponed until next week. She is totally happy and accepting." my Maxfax tells me.
I think to myself, with Fentanyl & Morphine on board, I would also be totally happy & accept anything.

Pressures & Pulsations

It all transpired on a burns list. Dr Esmeralda* sought her consultant's advice on a patient who had extensive injuries. She was unsure as to how she would record the patient's blood pressure during the procedure, since both arms & both legs were unspared of what was no doubt the result of another shack fire, or paraffin-revenge of a lover scorned. Her solution would be to put in a radial arterial line, but fixing it in position was once again a problem.

Glancing at the extent of the patient's burns, the Consultant said, "Don't bother with an A-line, just use a BP cuff & put it over the dorsalis pedis artery".
Esmeralda exclaimed, "Oh, can one take a BP there? Amazing, I didn't know."
Consultant, "Of course, one can take a BP anywhere an artery can be circumferentially occluded. It might not work, but at least give it a try. If the cuff fails, then you can always cannulate the artery."

A while later, a mexican wave of raucous laughter had reached the anaesthetics tearoom. The consultant wanted to know what was going on, but he was told to go & look in burns theatre for himself - there was a Darwin Award Nominee at work!

Hanging in the doorframe, Consultant asked if everything was OK.
Esmeralda replied, "I am absolutely amazed! It is working like a charm. It took a while to find the right sized BP cuff, so we are a bit behind schedule, but we are getting beautiful systolic readings. It just doesn't seem to register a diastolic though..."

The Consultant was a little confused. "What size BP cuff did you use? Why a neonatal BP cuff?" when the penny dropped, "Not the dorsalis penis artery, you idiot, dorsalis pedis".

I shudder to think, had there been no systolic reading, how & what she would have done to that poor patient in order to "cannulate the artery".

Esmeralda didn't leave too much longer after that incident. Apparently, she had developed quite a reputation in the city. It wasn't so much her professional- as her social reputation which was to be the deciding factor. Ironically both concerned an organ which apparently doesn't have a diastolic blood pressure.

*apt pseudonym (if you knew her history)

Favourite Things

Feigning an illness for sicknotes I've written,

By ladies in labour, my arms have been bitten,

Brown faecal packages, by god it mings!

These are a few of my favourite things.

Cream coloured pustules & crisp panga slices,

Breath smells & foot smells and species of lices,

Wild taxi drivers cause crashes & dings,

These are a few of my favourite things.

Sr Pleses in green dresses that phone about rashes,

AIDS blood that squirts on my nose and eyelashes,

Clinic referrals & the crap that it brings,

These are a few of my favourite things.

REFREIN :

When my salary bites,
When the bullets sting,
When crime waits at my gate,
I simply remember my favourite things
And I want to emigrate.

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!

I'll Take the Stairs

In our public hospitals, the cherry on my irritation-cake is the lifts (South African elevators). Often, it's not so much the lifts as the people that (ab)use them - but nonetheless, the lifts are bloody irritating.

Elevator Etiquette (or lack thereof)
It would make sense to me, or any civilised person for that matter, that when the lift doors open, people leaving would have right of way. If you have ever witnessed the Wildebeest Stampede through the Mara River you might know what I am talking about. If you have not, spare yourself the trip to the Serengeti - it would be much cheaper (and way more daring) to visit a South African public hospital, stand inside a lift & wait for the doors to open.
Don't think that people have a sense of priority either. If I were in a lift when the doors open to a scene of tubes, cylinders, cables, alarms & monitors, a blood-spurting patient & a doctor brandishing paddles screaming "Stand Clear" - I would get the hell out of that lift to make way... ehem... well not here. Instead one is greeted with a sea of eyes wielding a "screw you, we were here first" expression.
Or, you would actually make it into an empty lift hoping to get a patient speedily to ICU, when the lift stops on every floor to squeeze in another ten people who bump your elbows & stomp on your toes while you try your utmost to maintain possession of the ambubag.

Streamlining
I always imagine that there is some sort of circuit board or computer coordinating the various lifts in a building for maximum efficiency. One would assume that with four lifts (plus two patient elevators and a service lift), the fastest way from the 7th floor down to ground & back again would not be via the stairs. This theory and assumption was first disproved during my student rotation through vascular surgery.
Professor Atherosclerosis* was notoriously vicious, but in a very creepily calm way. He asked told me on our first academic rounds, to fetch a patient's angio from radiology "on the double!"
When I got to the lifts, all of them were on floor 6 & were heading downwards - one floor at a time. I decided (decision driven by terror) I could manage the 7 flights of stairs at a sprint. By now, I'm sure you can pick up on a trend. When the elevator circuitry left me in the lurch again, I decided the punishment of a 7 flight ascent was way more lenient than what Prof Ath could dish up, should I keep him waiting.
I arrived back at rounds both with the angio & living proof that a person can be both a pink-puffer & blue-bloater simultaneously.

Elevator Mentality
OK, so I have a few observations...
Myth 1 : the more you press the button, the faster the lift will arrive. If the elevator did indeed have some form of sentient circuitry (disproved-see above), it could perhaps be fooled into "thinking" there are lots of people on that certain floor & therefore give it priority.
Myth 2 : By pressing both the up & down buttons, your wait is shorter & reach your destination quicker. But put an idiot like you on every floor & you get 20 waypoints to your journey, which starts by heading in the opposite direction.
Myth 3 : If the light is already shining, you don't have to press the button again. The guy waiting before you did a good job of the button-pressing - the light confirms that he got it right.
Fact : The one hospital I currently work at, has an up & down button on the ground floor!

Murphy's Law
When you need the lift most, it will always be one floor away heading for the extreme altitudinal opposite.
The lift you are waiting for, will never come. A porter or cleaner has wedged an object (trolley, bucket, linen bag) in the door to keep the lift from leaving before they have completed their errands/duties on that floor.
When you give up waiting & take the stairs, you are still within earshot of the arriving lift, but too far away to make it back in a dignified manner.

Did You Ever Think?
...The people who can least afford to, use the lifts.
...There is a worse breed of human than those who take the lift up one storey! The type that take the lift down one storey.
...If the lift cable were to snap, you would jump up on the spot one second before impact.
...Look at the weight restriction plaque, glance around you & give a nervous giggle?

Elevator Storeys (pun intended)
One evening at a dinner party a few years on, I met up with a former Nuclear Medicine Registrar. We got chatting & reminiscing about good 'ole Alma Mater Academic Hospital when she asked if I remembered the one lift that didn't quite line up properly (it sagged about 10cm below the floor). I did, very clearly & was surprised when she admitted responsibility for the damage! Apparently, she had arrived super-early for her first day at work as a registrar. There was a patient who needed a bedside special investigation and she had planned to show her Professor how hard working she was by having everything prepared before he arrived. Instead of using the service lift, she wheeled one of the hulking nuclear imaging machines into an ordinary lift & stretched the cable. She tried the "look & see if anybody saw you - then leave quickly" tactic, but she couldn't pull the wheels over the step she had created. She said she scored a solid 10/10 on the Shit-First-Day-At-Work-O-Meter.

Dr Sanitary Pad*, superintendent of Sandwich Ham Hospital, had made the genial decision to move theatres back up to the top two floors. Due to the very reliable electricity supply in our country, it was decided that the lifts need not be connected to the back-up generator supply since the battery backup was sufficient... The ramifications during long power failures when the battery ran flat, ranged from humourous to most gravid indeed.
At the end of one day, I remember having a chuckle as the dialysis unit on the 3rd floor were taking patients down the stairs in wheelchairs (Come get dialysed now, we'll throw in one Powerplate Session absolutely FREE).
More serious though was getting emergency patients to theatre on stretchers up the stairs.
So as you can imagine, during times like this, the switchboard was jammed with calls needing urgent attention from Dr Sanitary Pad. I wonder if the problem ever got fixed.
One fine day, somebody got stuck in the lifts and was frantically ringing the emergency bell. As fate would have it, Dr Sanitary Pad was not available in his office & his cellphone was switched off. Typical! The eternal ostrich whenever there is a crisis!
But life can be sweet! When the doors of the lift were finally pried open about 2 hours on, there in the lift stood a one very red-faced Dr Sanitary Pad. My mind changed that day - I am now VERY content there is no cellphone reception in the lifts. Apparently his voicemail was inundated with very rude messages regarding his whereabouts during office hours & especially during the time of a crisis.

Conclusion
A good friend of mine (real not imaginary) once told me, she doesn't see the lift-frustration as a negative. While she runs about up & down the stairwell when oncall, she just thinks "calories, calories!".

*not his real name.