tag:blogger.com,1999:blog-68918825468326445542024-03-13T08:32:44.297+02:00Eishmadiskakhi1001 examples why, in the giant footsteps of Chris Barnard, the first brain transplant will be in South Africa.Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.comBlogger17125tag:blogger.com,1999:blog-6891882546832644554.post-3265931840402328222009-04-02T17:46:00.003+02:002009-04-02T17:46:00.676+02:00The Big 5Since 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.<br /><br /><div style="text-align: center;">I present to you - the BIG 5 à L'Afrique du Sud State Theatre...<br /></div><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIgGuU1pCsxDW3zctad7-8aL9DcpBrW3_07MenpNiXkHB5jq2xDd4SfeL8fyhH-0pF8NNiBIhAxPua6gy2k4zuwD8CUl4PFO4NUa4pwpdk3v427qezngc6a7Lk7-kC4kuJNuBDJL6ir2qN/s1600-h/Cockroach.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIgGuU1pCsxDW3zctad7-8aL9DcpBrW3_07MenpNiXkHB5jq2xDd4SfeL8fyhH-0pF8NNiBIhAxPua6gy2k4zuwD8CUl4PFO4NUa4pwpdk3v427qezngc6a7Lk7-kC4kuJNuBDJL6ir2qN/s320/Cockroach.jpg" alt="" id="BLOGGER_PHOTO_ID_5320075738918771970" border="0" /></a><span style="font-weight: bold; color: rgb(102, 51, 102);font-size:130%;" >1. Blattodea</span><br />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.<br />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.<br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkIxNlfklzabooZTXNj5xQkLxUimnYKaiwchK8SY8OrC91LPP4cI20ZCZZQxOSEzVyl4KSuvGVR_8beYcCpJLvIUpvI2bsjG5EAF-FZdw-uBb1vml-mKeZ0BZ403fAZAdXO5M0KfGA6LOi/s1600-h/Fly.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkIxNlfklzabooZTXNj5xQkLxUimnYKaiwchK8SY8OrC91LPP4cI20ZCZZQxOSEzVyl4KSuvGVR_8beYcCpJLvIUpvI2bsjG5EAF-FZdw-uBb1vml-mKeZ0BZ403fAZAdXO5M0KfGA6LOi/s320/Fly.jpg" alt="" id="BLOGGER_PHOTO_ID_5320079363883870562" border="0" /></a><br /><span style="font-weight: bold;font-size:130%;" ><span style="color: rgb(102, 51, 102);">2. Diptera</span></span><br />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.<br />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).<br />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.<br /><br /><br /><br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-MQ4oxD3M1SKgg4fDKfuEqr-ag9RM9Fy6fkOiGCVLnpIXt366ZgiQX5V9qkj1cLXPyn-Q9obw9JRiJ9ZEHWb9AMQZAGg0nrPKNdsiGzPKuyMxlMQe9QY4-jg6dsqGuAeGR6jw8HYBKCFa/s1600-h/HIV+%26+Hepatitis.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-MQ4oxD3M1SKgg4fDKfuEqr-ag9RM9Fy6fkOiGCVLnpIXt366ZgiQX5V9qkj1cLXPyn-Q9obw9JRiJ9ZEHWb9AMQZAGg0nrPKNdsiGzPKuyMxlMQe9QY4-jg6dsqGuAeGR6jw8HYBKCFa/s320/HIV+%26+Hepatitis.jpg" alt="" id="BLOGGER_PHOTO_ID_5320086378824848882" border="0" /></a><br /><span style="font-weight: bold;font-size:130%;" ><span style="color: rgb(102, 51, 102);"><br />3. HIV/AIDS</span></span><br />You probably can't see these little suckers with the naked eye, but given our statistics I can assure you they are there.<br />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.<br />I arrived on call with the biohazardous sharps bin looking like this. Although, I must say that I have seen worse!<br /><br /><br /><br /><br /><br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcvby9UTnfo0C80ORBVzegXz0HDLyP2vRM6r_bED_n0RoFuhNecPvVv2Dg934ci4sB2mayUqIQE-yHx7BQk8jHDoWG7ulb1BmDkdO84HAuedUuXirXX2cFxiSGehCTrxGNM5XWi_410qIT/s1600-h/Ascaris.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcvby9UTnfo0C80ORBVzegXz0HDLyP2vRM6r_bED_n0RoFuhNecPvVv2Dg934ci4sB2mayUqIQE-yHx7BQk8jHDoWG7ulb1BmDkdO84HAuedUuXirXX2cFxiSGehCTrxGNM5XWi_410qIT/s320/Ascaris.jpg" alt="" id="BLOGGER_PHOTO_ID_5320099119601859010" border="0" /></a><span style="color: rgb(102, 51, 102);font-size:130%;" ><span style="font-weight: bold;"><br />4. Ascaris Lumbricoides</span></span><br />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.<br />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!<br /><br />(btw Willy told me to send you his regards, Bongi)<br /><br /><br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQCD2KFmBNG2vySmrnNDlZHU0bhqguuPRk8FRoSh7Q-Cdjg5kpgmoyVZksQ8ue_e803_pLILImchynI_B8d8hWUmP_c-2OklPwmznaTFgXpwlPv_IvADY_6f8iLeof2TApUazFaZRYmZ_q/s1600-h/Mozzie.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQCD2KFmBNG2vySmrnNDlZHU0bhqguuPRk8FRoSh7Q-Cdjg5kpgmoyVZksQ8ue_e803_pLILImchynI_B8d8hWUmP_c-2OklPwmznaTFgXpwlPv_IvADY_6f8iLeof2TApUazFaZRYmZ_q/s320/Mozzie.jpg" alt="" id="BLOGGER_PHOTO_ID_5320101966278102034" border="0" /></a><br /><span style="font-size:130%;"><span style="color: rgb(102, 51, 102);">5. Anopheles</span></span><br />Mildred the mozzie is sitting (quite ironically) in the caution area - around 610 mmHg of this pressure bag.<br />I still question that HIV cannot be transmitted by mosquitoes. How do you know that this specific mozzie doesn't suffer from oesophageal reflux?<br />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.<br /><br /><br /><br />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?<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDu1s6wu9YC6x0J_6qRBZgROkZaZXW2By0ZPqDIlrbvS0V4yilLDdpv6Jpi96hjb2-rok3_ByNKiVTqZbKrDmiq3JJ-sDEk5Tf1wl8cogJhVu-Vg5mZDV5k7GhqA-6lziyq7oX1SbUv75R/s1600-h/Tabard.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDu1s6wu9YC6x0J_6qRBZgROkZaZXW2By0ZPqDIlrbvS0V4yilLDdpv6Jpi96hjb2-rok3_ByNKiVTqZbKrDmiq3JJ-sDEk5Tf1wl8cogJhVu-Vg5mZDV5k7GhqA-6lziyq7oX1SbUv75R/s320/Tabard.jpg" alt="" id="BLOGGER_PHOTO_ID_5320107028709769234" border="0" /></a>P.S. Anybody interested in being a co-author in my trial - "Tabard Nebs - an Accidental Cure for Malaria".Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com8tag:blogger.com,1999:blog-6891882546832644554.post-78823028167866978912009-02-19T17:55:00.002+02:002009-02-19T17:55:00.471+02:00Five Surgeons...<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1idButuK8rXWn9aXgcaB7eO4kCDMbABlqQov_FkKzYoihqkgEMcyZ1yt0s3YZ8NDw1xO09HiED-h2Mjx1WP5lwy1pTmDwCoNmKkJViyhMZU8u3kulnhB1iLdEJ8-A38nZzmW0YeQD_u8T/s1600-h/Operation+Game.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1idButuK8rXWn9aXgcaB7eO4kCDMbABlqQov_FkKzYoihqkgEMcyZ1yt0s3YZ8NDw1xO09HiED-h2Mjx1WP5lwy1pTmDwCoNmKkJViyhMZU8u3kulnhB1iLdEJ8-A38nZzmW0YeQD_u8T/s400/Operation+Game.jpg" alt="" id="BLOGGER_PHOTO_ID_5304514175883312562" border="0" /></a><br /><span style="font-size:11;">from big cities were discussing who are the easiest patients to operate on :<br /><br />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." <br /><br />The second, from Johannesburg responds, "Yeah, but you should try electricians! Everything inside them is colour-coded."<br /><br />The third surgeon, from Durban says, "No, I actually think librarians are the best, everything inside them is in alphabetical order."<br /><br />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."<br /><br />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."</span>Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com7tag:blogger.com,1999:blog-6891882546832644554.post-77320964655412913502009-02-13T15:27:00.002+02:002009-02-13T15:32:37.996+02:00Responsibility & Telephones & Lazyness, Oh My!<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcRSEGPyjQtbukeL_Pabk2dYkMGWZlgSbzgj6azsK6BiZocXKGWJMdjdHFYoOLs_iyK4tMHDJjR3bMQxE-YY6CKnzIhpv4jqaex5pyyh8zMqU8LvbdyqunJxKJ7nzz2k5ArYHdSvF4DrQ5/s1600-h/Furious+Phone.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 250px; height: 281px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcRSEGPyjQtbukeL_Pabk2dYkMGWZlgSbzgj6azsK6BiZocXKGWJMdjdHFYoOLs_iyK4tMHDJjR3bMQxE-YY6CKnzIhpv4jqaex5pyyh8zMqU8LvbdyqunJxKJ7nzz2k5ArYHdSvF4DrQ5/s400/Furious+Phone.jpg" alt="" id="BLOGGER_PHOTO_ID_5302268468384197250" border="0" /></a>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.<br /><br />Here ensues three stories to illustrate my point.<br /><span style="color: rgb(204, 102, 204);font-size:130%;" ><br />Switchboard Operator & Nurses</span><br />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.<br />"Not a problem", I reassure her. "Just sit tight, I'll get this sorted out from my side"<br /><br />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.<br /><br />4121 - engaged<br />4122 - rings, rings, rings<br />4123 - engaged<br />4122 again - engaged<br />(the nurses are making private phone calls)<br /><br />9 - rings, rings, rings<br />(switchboard operator still sleeping/on tea/away)<br /><br />After retrying for 10 minutes or so I finally get through to ICU.<br />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.<br /><br />4137 - rings, rings, rings<br /><br />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!<br />"Ask one of the others, please"<br />"We don't know, we are the new shift." (so much for handover rounds, which was 2 hours ago mind you)<br />"Please could you look on the roster for me, Sister."<br />"Where is the roster?"<br />"I don't know, I don't work there - you do"<br />"Find out from switchboard" and she puts the phone down in my ear again before I can tell her nobody is answering at switchboard.<br /><br />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.<br /><br />We eventually solved the problem by phoning a random ICU doctor & asked who was on call. All was sorted out in 2 minutes.<br /><br />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.<br /><span style="color: rgb(204, 102, 204);font-size:130%;" ><br />Laboratory Technicians</span><br />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".<br />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").<br />Problems :<br /><ol><li>nobody answers the phone at the laboratory - it just rings & rings & rings</li><li>when it rings too much, it is irritating to the lab tech's, so they take it off the hook</li><li>then the phone stays engaged<br /></li><li>there is no computer system for us to personally check results<br /></li><li>it is far to run to the laboratory each time<br /></li><li>smoke signals would contravene certain laws (besides, they would be too stupid to understand it, or be too busy sleeping to notice)<br /></li></ol>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.<br /><br />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.<br /><br />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.<br /><br /><span style="color: rgb(204, 102, 204);font-size:130%;" >Blood Bank Technician</span><br />I'll spare you the details. We called for 4 packed cells, 6 fresh frozen plasmas & 1 mega unit of platelets.<br />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.<br />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.<br />I KNOW she would have made it, but we missed the window of opportunity.<br />And the struggle continues because blood bank doesn't have to break the news to families, therefore no culture of responsibility.<br /><br />I wish I could enlighten those who hide behind the telephone :<br /><blockquote>You may enjoy the anonymity and use it as a scapegoat for sloth and ducking responsibility....<br />You may enjoy ignoring the phone because you know it brings more work...<br />You may enjoy removing the phone off the hook because your sleep is then uninterrupted...<br />How corny, but what if that phone call is your life hanging in the balance?<br /></blockquote>People die everyday because of phones, lack of responsibility & lazyness.<br />Shameful!Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com8tag:blogger.com,1999:blog-6891882546832644554.post-59460088638477252222009-02-01T22:17:00.012+02:002009-02-02T17:07:59.938+02:00Kodak Moments<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuTltd4x37zB-Yr5oBiMJp4jh6tiatqwoLw8haL0GRrf0Qdq09PsmzX9rEU068z7IlnuV07sAB3MpKdwigoMEH16VUDyu09_IuP8d16x77i8SG-23X3FUyOhQ_p_1-NN22LxvukyixIMM0/s1600-h/151371_35mm_film_1.jpg"><img id="BLOGGER_PHOTO_ID_5297956553689459922" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 300px; CURSOR: hand; HEIGHT: 224px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuTltd4x37zB-Yr5oBiMJp4jh6tiatqwoLw8haL0GRrf0Qdq09PsmzX9rEU068z7IlnuV07sAB3MpKdwigoMEH16VUDyu09_IuP8d16x77i8SG-23X3FUyOhQ_p_1-NN22LxvukyixIMM0/s400/151371_35mm_film_1.jpg" border="0" /></a><br /><div align="center"><span style="font-family:arial;font-size:85%;">It has been suggested to me, by several people on numerous occasions, to keep a<br />diary of the frustrations we as South African doctors in state hospitals have to<br />endure. So here begins a series of "Kodak Moments" I wish outsiders could<br />witness. Oh, and these recounts apply to every State Hospital I have worked in<br /><span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">thus far</span>.</span></div><br />It has happened once again. The damned electricity is down. There have been serious problems with the <span class="blsp-spelling-error" id="SPELLING_ERROR_1">airconditioning</span> for months. Working in a sauna is already a debilitating circumstance.<br /><br />Impeccable timing too as I had just started slipping drugs into the next patient on the <span class="blsp-spelling-error" id="SPELLING_ERROR_2">maxillofacial</span> list, sending Queen Mab in her <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">chariot</span> riding over the <span class="blsp-spelling-error" id="SPELLING_ERROR_4">patient's</span>, in this case, badly marred face. The generators did kick in. Is it me, or is that <span class="blsp-spelling-error" id="SPELLING_ERROR_5">lagtime</span> before backup power resumption increasing at a exponential rate? Well, my "<span class="blsp-spelling-error" id="SPELLING_ERROR_6">Chillin</span>' on <span class="blsp-spelling-error" id="SPELLING_ERROR_7">da</span> Beech" cocktail of <span class="blsp-spelling-error" id="SPELLING_ERROR_8">Sublimaze</span>, <span class="blsp-spelling-error" id="SPELLING_ERROR_9">Robinul</span>, Morphine & <span class="blsp-spelling-error" id="SPELLING_ERROR_10">Decasone</span> 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-<span class="blsp-spelling-error" id="SPELLING_ERROR_11">hooved</span> creature on my left shoulder.<br />"Go on, do it. You've started already! Things will be fine."<br />I picked up the <span class="blsp-spelling-error" id="SPELLING_ERROR_12">Propofol</span> syringe and connected it to the injection port when the theatre doors gave way to Matron (our <span class="blsp-spelling-error" id="SPELLING_ERROR_13">villiage</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_14">crier</span>) 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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_15">improvement</span>.<br /><br />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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_16">Olympics</span> open.<br />"we can't even boil the kettle"<br />"the milk is going sour in the fridge, and my coke is tepid"<br />"wonder what's happening with the cricket"<br />"it won't help to phone the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_17">superintendent </span>- it's a waste of time"<br />"Ray phoned the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_18">superintendent</span> the other day when there were no porters & we had came to a standstill. Do you <em>know </em>what he said?"<br />"<em>So, what's wrong with the doctors? Are they crippled</em>?"<br /><br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_19">guerney</span>. 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.<br /><br />Some of the surgeons mop the blood & mess off the floors themselves. I am sorry, I draw the line right there!<br /><br />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.<br /><br />"<span class="blsp-spelling-error" id="SPELLING_ERROR_20">Eish</span>, I've explained to our patient that she will be cancelled & postponed until next week. She is totally happy and accepting." my M<span class="blsp-spelling-error" id="SPELLING_ERROR_21">axfax</span> tells me.<br />I think to myself, with <span class="blsp-spelling-error" id="SPELLING_ERROR_22">Fentanyl</span> & Morphine on board, I <span class="blsp-spelling-corrected" id="SPELLING_ERROR_23">would</span> also be <strong>totally</strong> happy & accept <strong>anything</strong>.Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com1tag:blogger.com,1999:blog-6891882546832644554.post-48799309001858853472009-01-23T18:02:00.003+02:002009-01-29T00:30:59.691+02:00Pressures & Pulsations<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlknY6klL5lTjII3_Hf_gyIGKDJEOnoskpTQTNi5MHR-s2459UpA_mufU1_unX6GKWx2lpHNcXHzCYhOIZd-KlMYlmPRzXL4AbRHKFjMLSKHJCusi4K9bfKKFadlEuRIs3N0xWqQ2u1lqA/s1600-h/Mummy.jpg"><img id="BLOGGER_PHOTO_ID_5293398203287770722" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 300px; CURSOR: pointer; HEIGHT: 225px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlknY6klL5lTjII3_Hf_gyIGKDJEOnoskpTQTNi5MHR-s2459UpA_mufU1_unX6GKWx2lpHNcXHzCYhOIZd-KlMYlmPRzXL4AbRHKFjMLSKHJCusi4K9bfKKFadlEuRIs3N0xWqQ2u1lqA/s400/Mummy.jpg" border="0" /></a><br />It all transpired on a burns list. Dr Esmeralda<span style="COLOR: rgb(255,0,0)">*</span> sought her consultant's advice on a patient who had extensive injuries. She was unsure as to how she would record the <span class="blsp-spelling-error" id="SPELLING_ERROR_0">patient's</span> blood pressure during the procedure, since both arms & both legs were <span class="blsp-spelling-error" id="SPELLING_ERROR_1">unspared</span> 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.<br /><br />Glancing at the extent of the <span class="blsp-spelling-error" id="SPELLING_ERROR_2">patient's</span> burns, the Consultant said, "Don't bother with an A-line, just use a <span class="blsp-spelling-error" id="SPELLING_ERROR_3">BP</span> cuff & put it over the <span class="blsp-spelling-error" id="SPELLING_ERROR_4">dorsalis</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_5">pedis</span> artery".<br />Esmeralda exclaimed, "Oh, can one take a <span class="blsp-spelling-error" id="SPELLING_ERROR_6">BP</span> there? Amazing, I didn't know."<br />Consultant, "Of course, one can take a <span class="blsp-spelling-error" id="SPELLING_ERROR_7">BP</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_8">cannulate</span> the artery."<br /><br />A while later, a <span class="blsp-spelling-error" id="SPELLING_ERROR_9">mexican</span> 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!<br /><br />Hanging in the <span class="blsp-spelling-error" id="SPELLING_ERROR_10">doorframe</span>, Consultant asked if everything was OK.<br />Esmeralda replied, "I am absolutely amazed! It is working like a charm. It took a while to find the right sized <span class="blsp-spelling-error" id="SPELLING_ERROR_11">BP</span> 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..."<br /><br />The Consultant was a little confused. "What size <span class="blsp-spelling-error" id="SPELLING_ERROR_12">BP</span> cuff did you use? Why a neonatal <span class="blsp-spelling-error" id="SPELLING_ERROR_13">BP</span> cuff?" when the penny dropped, "Not the <span class="blsp-spelling-error" id="SPELLING_ERROR_14">dorsalis</span> penis artery, you idiot, <span class="blsp-spelling-error" id="SPELLING_ERROR_15">dorsalis</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_16">pedis</span>".<br /><br />I shudder to think, had there been no systolic reading, how & what she would have done to that poor patient in order to "<span class="blsp-spelling-error" id="SPELLING_ERROR_17">cannulate</span> the artery".<br /><br />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.<br /><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(255,0,0)">*</span>apt pseudonym (if you knew her history)Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com4tag:blogger.com,1999:blog-6891882546832644554.post-37395992626436846392009-01-20T17:35:00.001+02:002009-02-02T12:10:47.458+02:00Favourite Things<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6-vCtnLk8OeTCsQ0Zh8fhfrtzYNwQf8wLlHX0uUWA-ngzFydpaWuMRYmCv-u7CnAy237LNiMQXQprk_WWQXEAHA5qmXx2olx_Zuc6ysAiSoaiiUISSG8E2oluInNYoEg6_Vg_8w77Cau1/s1600-h/Favourite+Things+2.jpg"><img id="BLOGGER_PHOTO_ID_5293357216750977730" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: pointer; HEIGHT: 194px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6-vCtnLk8OeTCsQ0Zh8fhfrtzYNwQf8wLlHX0uUWA-ngzFydpaWuMRYmCv-u7CnAy237LNiMQXQprk_WWQXEAHA5qmXx2olx_Zuc6ysAiSoaiiUISSG8E2oluInNYoEg6_Vg_8w77Cau1/s400/Favourite+Things+2.jpg" border="0" /></a><span style="font-size:100%;">
<br /></span><div style="TEXT-ALIGN: center"><meta content="text/html; charset=utf-8" equiv="Content-Type"><meta content="Word.Document" name="ProgId"><meta content="Microsoft Word 12" name="Generator"><meta content="Microsoft Word 12" name="Originator"><link href="file:///C:%5CDOCUME%7E1%5CQuinton%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"><link href="file:///C:%5CDOCUME%7E1%5CQuinton%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_editdata.mso" rel="Edit-Time-Data"><style> v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} </style><link href="file:///C:%5CDOCUME%7E1%5CQuinton%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"><link href="file:///C:%5CDOCUME%7E1%5CQuinton%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"><style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:1; mso-generic-font-family:roman; mso-font-format:other; mso-font-pitch:variable; mso-font-signature:0 0 0 0 0 0;} @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-1610611985 1073750139 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin-top:0cm; margin-right:0cm; margin-bottom:10.0pt; margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi; mso-fareast-language:EN-US;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi; mso-fareast-language:EN-US;} .MsoPapDefault {mso-style-type:export-only; margin-bottom:10.0pt; line-height:115%;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 72.0pt 72.0pt 72.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;"><v:stroke joinstyle="miter"><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"><v:path connecttype="rect" gradientshapeok="t" extrusionok="f"><o:lock aspectratio="t" ext="edit"><v:imagedata title="" src="file:///C:\DOCUME~1\Quinton\LOCALS~1\Temp\msohtmlclip1\01\clip_image001.png"></span><span style="font-family:';font-size:100%;"><?xml:namespace prefix = o /><o:p></o:p></span> </p></v:imagedata></o:lock></v:path></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:stroke><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;"><o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">Feigning an illness for sicknotes I've written,<o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">By ladies in labour, my arms have been bitten,<o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">Brown faecal packages, by god it mings!<o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">These are a few of my favourite things.
<br /></span></p><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center">
<br /><span style="font-family:';font-size:100%;"><o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;"><o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">Cream coloured pustules & crisp panga slices,<o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">Breath smells & foot smells and species of lices,<o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">Wild taxi drivers cause crashes & dings,<o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">These are a few of my favourite things.<o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;"><o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">
<br /></span></p><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">Sr Pleses in green dresses that phone about rashes,<o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">AIDS blood that squirts on my nose and eyelashes,<o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:100%;">Clinic referrals & the crap that it brings,<o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="TEXT-ALIGN: center"><span style="LINE-HEIGHT: 115%;font-family:';font-size:100%;" >These are a few of my favourite things.<o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-size:100%;"><b><i><span style="font-family:';">REFREIN :</span></i></b></span><span style="font-family:';font-size:100%;"><o:p></o:p></span></p><div style="TEXT-ALIGN: center"></div><p class="MsoNormal" style="MARGIN-BOTTOM: 0pt; LINE-HEIGHT: normal; TEXT-ALIGN: center"><span style="font-family:';font-size:12;"><span style="font-size:100%;">When my salary bites,
<br />When the bullets sting,
<br />When crime waits at my gate,
<br />I simply remember my favourite things
<br />And I want to emigrate.</span><o:p></o:p></span></p>
<br /><?xml:namespace prefix = v /><v:stroke joinstyle="miter"><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:f eqn="sum @10 21600 0"><v:path connecttype="rect" gradientshapeok="t" extrusionok="f"><o:lock aspectratio="t" ext="edit"><v:imagedata title="" src="file:///C:\DOCUME~1\Quinton\LOCALS~1\Temp\msohtmlclip1\01\clip_image001.png"></v:imagedata></o:lock></v:path></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:stroke>Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com1tag:blogger.com,1999:blog-6891882546832644554.post-80591721331092868612009-01-16T16:40:00.004+02:002009-02-01T21:35:10.869+02:00Dr Zhivodka<div style="TEXT-ALIGN: center"><span style="font-family:courier new;">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, </span><a style="FONT-FAMILY: courier new" href="http://other-things-amanzi.blogspot.com/2008/12/doctors-for-africa.html">doctors for africa</a><span style="font-family:courier new;"> I have decided to lift the ban on a post I wrote on Spring Day last year (oh, the joys of spring!).</span><br /></div><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8eo1GOlO55yJO5ZQB-5fN9XjeadAcOr-_76q-dMinM9FogQkGLqneEe3AnN1SP1XSHMz2mdLIMgUbgRNRri7S4OIm8LRBRUoMhv1Pk9YY6VNytkhOxz7fYrBLappqG-UwLMffuJx2VYht/s1600-h/Doctor+Zhivago.jpg"><img id="BLOGGER_PHOTO_ID_5241162271489658626" style="FLOAT: left; MARGIN: 0pt 10px 10px 0pt; CURSOR: pointer" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8eo1GOlO55yJO5ZQB-5fN9XjeadAcOr-_76q-dMinM9FogQkGLqneEe3AnN1SP1XSHMz2mdLIMgUbgRNRri7S4OIm8LRBRUoMhv1Pk9YY6VNytkhOxz7fYrBLappqG-UwLMffuJx2VYht/s400/Doctor+Zhivago.jpg" border="0" /></a><br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_0">SOB's</span> alive!<br /><br />It feels like yesterday. My first day at work as an Intern. Triple whammy! I found out :<br /><ol><li>first rotation is Internal Medicine (my fave, right up there with root canal treatment)<br /></li><li>my Registrar is one newly appointed, Dr <span class="blsp-spelling-error" id="SPELLING_ERROR_1">Zhivodka</span></li><li>I'm on call (<span class="blsp-spelling-error" id="SPELLING_ERROR_2">aargh</span>, Monday Firm - the worst. Weekend-wreck dumping ground.)<br /></li></ol>Typical! I'm not surprised! As an irritating, <a href="http://www.youtube.com/watch?v=jHPOzQzk9Qo"><span class="blsp-spelling-error" id="SPELLING_ERROR_3">whistly</span> tune</a> from Monty Python repeats in my head, I try to take advice from the lyrics. Let's not judge Dr <span class="blsp-spelling-error" id="SPELLING_ERROR_4">Zhivodka</span> by his cover (something like <span style="FONT-STYLE: italic">Fargo</span> meets <span style="FONT-STYLE: italic">Deliverance</span>, set in <span class="blsp-spelling-error" id="SPELLING_ERROR_5">Khayalitsha</span>) and give the guy a chance.<br /><br />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?"<br />"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 <span class="blsp-spelling-error" id="SPELLING_ERROR_6">dubiosity</span> & my scepticism is back with "too much of" vengeance. Houston, we have a problem!<br /><br />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.<br /><br />Right, rounds out of the way - let the call begin.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOBZqy6WwXrmnrGNrNj3zELPn5OxQz2CKzHz1nI2brWNhzgyi-U6y3h8hbQZKIoIE5uTs-uM4XJAmRQH8cCZhKAagCARMa4FAUhfnW3n4uxc-Kp8tc9OEAUZb8vZfuZycv62slBckxWY0c/s1600-h/Vodka.jpg"><img id="BLOGGER_PHOTO_ID_5241838741749908594" style="FLOAT: right; MARGIN: 0pt 0pt 10px 10px; CURSOR: pointer" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOBZqy6WwXrmnrGNrNj3zELPn5OxQz2CKzHz1nI2brWNhzgyi-U6y3h8hbQZKIoIE5uTs-uM4XJAmRQH8cCZhKAagCARMa4FAUhfnW3n4uxc-Kp8tc9OEAUZb8vZfuZycv62slBckxWY0c/s200/Vodka.jpg" border="0" /></a>Dr <span class="blsp-spelling-error" id="SPELLING_ERROR_7">Zhivodka</span> is very, very slow. For each patient he is seeing, I am seeing three. Dr <span class="blsp-spelling-error" id="SPELLING_ERROR_8">Zhivodka</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_9">Endocarditis</span> and he admits the patient with Infective <span class="blsp-spelling-error" id="SPELLING_ERROR_10">Endocarditis</span> . Can you guess what the patient with ?<span class="blsp-spelling-error" id="SPELLING_ERROR_11">Guillain</span>-<span class="blsp-spelling-error" id="SPELLING_ERROR_12">Barré</span> gets admitted with? I, on the boring hand, was striking one PCP or HIV or <span class="blsp-spelling-error" id="SPELLING_ERROR_13">PTB</span> after the other (in various permutations, some even hitting the South African <span class="blsp-spelling-error" id="SPELLING_ERROR_14">Trifecta</span>).<br /><br />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 9<span class="blsp-spelling-error" id="SPELLING_ERROR_15">mmol</span>/l. I phone the lab just to ease my mind and confirm the specimen was <span class="blsp-spelling-error" id="SPELLING_ERROR_16">haemolysed</span>, only to be told NO <span class="blsp-spelling-error" id="SPELLING_ERROR_17">HAEMOLYSIS</span>! Shit, I remember this is an emergency - something about the heart & fatal <span class="blsp-spelling-error" id="SPELLING_ERROR_18">dysrhythmias</span>. I phone Dr <span class="blsp-spelling-error" id="SPELLING_ERROR_19">Zhivodka</span>, 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_20">gluconate</span> 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.<br /><br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_21">Gatiep</span> on spirits :<br />"Dr <span class="blsp-spelling-error" id="SPELLING_ERROR_22">Zhivodka</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_23">Zhivodka</span> from now on, shall we? So take your pick. Intern or Retard?"<br /><br />I got the patient turfed to safety, only too pleased searching for the cause of the <span class="blsp-spelling-error" id="SPELLING_ERROR_24">hyperkalaemia</span> 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.<br /><br />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 <a href="http://www.youtube.com/watch?v=grbSQ6O6kbs">Monty Python</a>.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiudPRonyeVDlfxjrRXr72Gu-wEPjyISqdcDYYjZpvENy49eyLU0WY0SdGSgOkAf9VWmBHHjfYiLBT2ZrdwTXFhbdQcYqEkBkM7l3VGB2UdWB1dZBA2GNqNqWeqA2wvLX7q8S2ivCy7oEfe/s1600-h/Cigars.jpg"><img id="BLOGGER_PHOTO_ID_5241838994734306978" style="FLOAT: left; MARGIN: 0pt 10px 10px 0pt; CURSOR: pointer" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiudPRonyeVDlfxjrRXr72Gu-wEPjyISqdcDYYjZpvENy49eyLU0WY0SdGSgOkAf9VWmBHHjfYiLBT2ZrdwTXFhbdQcYqEkBkM7l3VGB2UdWB1dZBA2GNqNqWeqA2wvLX7q8S2ivCy7oEfe/s200/Cigars.jpg" border="0" /></a>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 <span class="blsp-spelling-error" id="SPELLING_ERROR_25">dyspnoeic</span> & with a massive pleural effusion of the entire right <span class="blsp-spelling-error" id="SPELLING_ERROR_26">hemithorax</span>, I proudly presented how well she improved once I inserted an <span class="blsp-spelling-error" id="SPELLING_ERROR_27">intercostal</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_28">Zhivodka</span>. The smile returned.<br /><br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_29">ludicrousy</span> for a post-graduate. I clearly remember some of the interchange :<br /><ul><li><span style="COLOR: rgb(51,51,153)">"What is the cause of meningitis?"</span></li></ul><span style="COLOR: rgb(0,102,0)">"Protozoa"</span><br /><span style="COLOR: rgb(51,51,153)">"I say meningitis & your first thought is protozoa!"</span><br /><span style="COLOR: rgb(0,102,0)">"Fungus?"</span><br /><ul><li><span style="COLOR: rgb(51,51,153)">"How do we treat infective <span class="blsp-spelling-error" id="SPELLING_ERROR_30">endocarditis</span></span><span style="COLOR: rgb(51,51,153)">?"</span></li></ul><span style="COLOR: rgb(0,102,0)">"<span class="blsp-spelling-error" id="SPELLING_ERROR_31">Warfarin</span>"</span><br /><span style="COLOR: rgb(51,51,153)">"You have just killed the patient."</span><br /><span style="COLOR: rgb(0,102,0)">"Heparin?"</span><br /><ul><li><span style="COLOR: rgb(51,51,153)">"Do you even know what <span class="blsp-spelling-error" id="SPELLING_ERROR_32">Guillain</span></span><span style="COLOR: rgb(51,51,153)">-Barr</span><span style="COLOR: rgb(51,51,153)">é</span><span style="COLOR: rgb(51,51,153)"> is?"</span></li></ul><span style="COLOR: rgb(0,102,0)">(Fifth Amendment)</span><br /><span style="COLOR: rgb(51,51,153)">"But you have just told me you diagnosed <span class="blsp-spelling-error" id="SPELLING_ERROR_33">Guillain</span></span><span style="COLOR: rgb(51,51,153)">-Barr</span><span style="COLOR: rgb(51,51,153)">é</span><span style="COLOR: rgb(51,51,153)">. How can you diagnose something if you don't know what it is?"</span><br /><br />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).<br /><br />I was amazed at <span class="blsp-spelling-error" id="SPELLING_ERROR_34">Zhivodka's</span> 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, <span class="blsp-spelling-error" id="SPELLING_ERROR_35">Zhivodka</span> shared with me how the HOD told him that perhaps Internal Medicine was not his forte & he should think of pursuing other avenues of <span class="blsp-spelling-error" id="SPELLING_ERROR_36">healthcare</span>. How typically diplomatic of the HOD! I would have told him that perhaps his forte is NOT <span class="blsp-spelling-error" id="SPELLING_ERROR_37">healthcare</span>.<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjffF2r_EmqBrBP6kziyutOoFUsNe7JZ2qS8HXCJ7iXxBoAj0VTnXpIOY8U5VXUwBBymMZ82v-kDUJC0bx0wd0vKeKXQI9H7Qct6Bs2dpVoEk-0GLVKiuOswFFgtlhhJ8oK3BwPns6mTrfr/s1600-h/Quack.jpg"><img id="BLOGGER_PHOTO_ID_5241846698569697618" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: pointer; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjffF2r_EmqBrBP6kziyutOoFUsNe7JZ2qS8HXCJ7iXxBoAj0VTnXpIOY8U5VXUwBBymMZ82v-kDUJC0bx0wd0vKeKXQI9H7Qct6Bs2dpVoEk-0GLVKiuOswFFgtlhhJ8oK3BwPns6mTrfr/s200/Quack.jpg" border="0" /></a>P.S.<br />As a matter of interest and in stark contrast to my <span class="blsp-spelling-error" id="SPELLING_ERROR_38">hyperkalaemia</span> patient, <span class="blsp-spelling-error" id="SPELLING_ERROR_39">Zhivodka's</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_40">Guillain</span>-<span class="blsp-spelling-error" id="SPELLING_ERROR_41">Barré</span> had a potassium of 1.8mmol/l (hypertensive on diuretics). Hallelujah, he got up and walked after a few bags of <span class="blsp-spelling-error" id="SPELLING_ERROR_42">PotChlor</span>.<br />Even more interesting/shocking, a quick search (or should I say, quack search) on e-Register & <span class="blsp-spelling-error" id="SPELLING_ERROR_43">Zhivodka's</span> still on the roll!Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com4tag:blogger.com,1999:blog-6891882546832644554.post-17671748525608960972009-01-09T15:28:00.002+02:002009-01-29T00:27:58.746+02:00I'll Take the Stairs<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1i9c2InKdgtWlUcbQOJOuA5fI1hnII1JH3ujDlnal7bnsiRieFinOvx1trWKTnwKiz6xfGEgWH3kq9mWsY49otqjn9cjBRNS0MJK5ulr2U3FOg-6DFDm5a3SUOg4jxSg__QX_FgM8KYYe/s1600-h/Lifts.jpg"><img id="BLOGGER_PHOTO_ID_5252931110137865250" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: pointer; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1i9c2InKdgtWlUcbQOJOuA5fI1hnII1JH3ujDlnal7bnsiRieFinOvx1trWKTnwKiz6xfGEgWH3kq9mWsY49otqjn9cjBRNS0MJK5ulr2U3FOg-6DFDm5a3SUOg4jxSg__QX_FgM8KYYe/s400/Lifts.jpg" border="0" /></a>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.<br /><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(204,102,204)font-size:130%;" >Elevator Etiquette (or lack thereof)</span><br />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.<br />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... <span class="blsp-spelling-error" id="SPELLING_ERROR_0">ehem</span>... well not here. Instead one is greeted with a sea of eyes wielding a "screw you, we were here first" expression.<br />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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">possession</span> of the <span class="blsp-spelling-error" id="SPELLING_ERROR_2">ambubag</span>.<br /><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(204,102,204)font-size:130%;" >Streamlining</span><br />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 7<span class="blsp-spelling-error" id="SPELLING_ERROR_3">th</span> floor down to ground & back again would <span style="FONT-WEIGHT: bold">not</span> be via the stairs. This theory and assumption was first disproved during my student rotation through vascular surgery.<br />Professor Atherosclerosis<span style="FONT-WEIGHT: bold; COLOR: rgb(255,0,0)">*</span> was notoriously vicious, but in a very creepily calm way. He <strike>asked</strike> told me on our first academic rounds, to fetch a <span class="blsp-spelling-error" id="SPELLING_ERROR_4">patient's</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_5">angio</span> from radiology "on the double!"<br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_6">Ath</span> could dish up, should I keep him waiting.<br />I arrived back at rounds both with the <span class="blsp-spelling-error" id="SPELLING_ERROR_7">angio</span> & living proof that a person can be both a pink-puffer & blue-bloater simultaneously.<br /><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(204,102,204)font-size:130%;" >Elevator Mentality</span><br />OK, so I have a few observations...<br />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.<br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_8">waypoints</span> to your journey, which starts by heading in the opposite direction.<br />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.<br />Fact : The one hospital I currently work at, has an up & down button on the ground floor!<br /><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(204,102,204)font-size:130%;" >Murphy's Law</span><br />When you need the lift most, it will always be one floor away heading for the extreme <span class="blsp-spelling-error" id="SPELLING_ERROR_9">altitudinal</span> opposite.<br />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.<br />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.<br /><span style="font-size:130%;"><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(204,102,204)">Did You Ever Think?</span></span><br />...The people who can least afford to, use the lifts.<br />...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.<br />...If the lift cable were to snap, you would jump up on the spot one second before impact.<br />...Look at the weight restriction plaque, glance around you & give a nervous giggle?<br /><br /><span style="font-size:130%;"><span style="FONT-WEIGHT: bold; COLOR: rgb(204,102,204)">Elevator Storeys (pun intended)</span></span><br />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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">Alma</span> 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.<br /><br />Dr Sanitary Pad<span style="FONT-WEIGHT: bold; COLOR: rgb(255,0,0)">*</span>, <span class="blsp-spelling-corrected" id="SPELLING_ERROR_11">superintendent</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_12">humourous</span> to most gravid indeed.<br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_13">dialysed</span> now, we'll throw in one <span class="blsp-spelling-error" id="SPELLING_ERROR_14">Powerplate</span> Session absolutely FREE).<br />More serious though was getting emergency patients to theatre on stretchers up the stairs.<br />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.<br />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!<br />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.<br /><span style="font-size:130%;"><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(204,102,204)">Conclusion</span></span><br />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!".<br /><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(255,0,0)">*</span>not his real name.Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com5tag:blogger.com,1999:blog-6891882546832644554.post-27375601284287734712008-09-19T18:53:00.004+02:002009-01-29T00:28:24.096+02:00You Are Not a Real Saffa Doctor Until You Have :<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCqJO5jraHLe9bm25FglBmAwnGzEl4O8uDblTEO1rgK2OrbxP3X07nSpTTT8GTxlX9WIIrf3r_t6eaqP6cvztHvVv5YazSCZ791awQvRm_u9sTtcECS-cEEsZ1WdcC4rS-_e3R6JAlR9zO/s1600-h/Smokin+Doctor.jpg"><img id="BLOGGER_PHOTO_ID_5246172424474727890" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: pointer; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCqJO5jraHLe9bm25FglBmAwnGzEl4O8uDblTEO1rgK2OrbxP3X07nSpTTT8GTxlX9WIIrf3r_t6eaqP6cvztHvVv5YazSCZ791awQvRm_u9sTtcECS-cEEsZ1WdcC4rS-_e3R6JAlR9zO/s400/Smokin+Doctor.jpg" border="0" /></a><br /><ul><li>filled out a thousand J88's</li><li>filled out two thousand disability grants</li><li>seen worms exiting the human body via anus, nose, mouth & laparotomy</li><li>cauterised warts the size of cauliflowers</li><li>done a caesar because of warts</li><li>stopped wearing a mask around TB patients (pregrad)</li><li>inserted 3 ICD's in 10 minutes (on family members who had an argument)</li><li>treated hysteria with ethyl chloride</li><li>been handed a Checkers packet containing the fruits of the TOP clinic</li><li>done a caesar in under 15 minutes</li><li>had your fingers in a stab neck whilst rushing to theatre</li><li>given a BCo & Voltaren injections in a cash practice locum</li><li>earned more abroad in 2 months, than a year in SA</li><li>been shocked to see a negative HIV result</li><li>diagnosed marasmic kwashiorkor</li><li>had a prescription for paracetamol, amoxycillin & insulin returned as "Out of Stock" x3</li><li>wiped & wiped & wiped with an alcohol swab, but the skin won't come clean</li><li>been referred a patient with "multiple electrolyte derangements"</li><li>heard : "the patient is having a change in condition"</li><li>survived two 24 hour trauma calls on a pay-day weekend</li><li>had your first (second & third) needlestick injury and/not completed the ensuing course of ARV's</li><li>been convinced you are seroconverting</li><li>washed vaseline and/or zambuk off your hands after an examination</li><li>gotten a laryngoscope blade stuck in a passion gap</li><li>medschool friends living in 5 continents</li><li>witnessed the spoils of initiation school</li><li>been in the 3rd round of allocations for internship/community service</li><li>seen sangoma cuts & scratches</li><li>cut off abdominal, wrist, ankle & neck sangoma strings</li><li>retrieved a matchstick head from a middle ear</li><li>been 4th in the queue on the line to the HPCSA - for the past 2 hours</li><li>recognised the winter aroma of Yardleys <span style="FONT-STYLE: italic">You're the Khaya</span>*</li><li>waited for months for your first pay cheque</li><li>taken your own toilet paper on call with you</li><li>heard a patient presented as FUBAR BUNDY</li><li>scanned through the files waiting in casualties & left the wishy-washy ones for a colleague</li><li>marveled at what the ID photo looks like when filling out a death certificate for an AIDS victim</li><li>met a 16yr Grav 3 Para 2</li><li>achieved the most amazing feats in casualties with the help of pethidine & valium</li><li>been laughed at by an entire clinic after trying to pronounce the name of the next patient</li><li>had the phone amicably put down in your ear before you are finished talking with a sister</li><li>been blamed for poor assisting when the scissors won't cut or suction doesn't suction</li><li>watched patients picking their nose (+/- eating it)/scratching their privates/hocking lurgies on grand ward rounds</li><li>been amazed when a 2 minute conversation between patient & translator comes back as a monosyllabic "No"</li><li>cried with a patient because there is no state funded treatment for a potentially manageable condition</li><li>cried because a patient has received such poor care</li><li>cried after seeing what a violent society is capable of doing to people</li><li>cried whilst treating a child who has been raped</li><li>cried to see human neglect</li></ul><br />*a delicate blend of matured perspiration, with a hint of paraffin and a mystical swirl of wood-fire smokeEishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com42tag:blogger.com,1999:blog-6891882546832644554.post-67874775161726853362008-09-13T08:31:00.013+02:002009-01-29T00:28:57.077+02:00Mojo<p><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe_nMeis_X0Ty6QoLoE8edvNIeHe6Gda_UNgF2AR84Dh29JATBpzcQeHyb7DMbYYoUIotWIduSpdbLzAgo_uDgz4U5_0EuENY_D0gDZLbcf8uxlL0XTbGbPZneM7I9sv5vsntc-mRkZHoI/s1600-h/Free+Throw.jpg"><img id="BLOGGER_PHOTO_ID_5245389862925916962" style="FLOAT: left; MARGIN: 0pt 10px 10px 0pt; CURSOR: pointer" height="335" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe_nMeis_X0Ty6QoLoE8edvNIeHe6Gda_UNgF2AR84Dh29JATBpzcQeHyb7DMbYYoUIotWIduSpdbLzAgo_uDgz4U5_0EuENY_D0gDZLbcf8uxlL0XTbGbPZneM7I9sv5vsntc-mRkZHoI/s400/Free+Throw.jpg" width="300" border="0" name="BLOGGER_PHOTO_ID_5245389862925916962" /></a>Fueled by the lack of astute assistance by Sister Ples & her Horde of Hobbits, an anaesthetist in state practice develops a notable skill in projectile accuracy. To adapt to the situation, one is forced to throw things around in theatre (only have two hands, can't be in two places at once, often have finger in the proverbial hole in the dyke & can't move etc.)<br /><br />Take for example, the seemingly simple and common task of ensuring reliable intravenous access - singlehandedly.<br /><br /><span style="font-size:180%;">10 Steps to IV Access</span></p><p style="TEXT-ALIGN: right"><span style="font-size:78%;">(when the patient is 5m away from the bin)</span><br /></p><ol><br /><li>Attempt to flush existing drip with saline. Infiltrated/haematoma/thrombophlebitis/never in. From a distance, throw syringe into paper bag (<span style="FONT-STYLE: italic">PB</span>), needle into sharps bin (<span style="FONT-STYLE: italic">SB</span>).<br /></li><li>Remove existing cannula. Flick ball of sticky strapping & hurl filthy infusion set into <span style="FONT-STYLE: italic">PB</span>, lob icky cannula into <span style="FONT-STYLE: italic">SB</span>.<br /></li><li>Disinfect arm. Pitch swab into <span style="FONT-STYLE: italic">PB</span>.<br /></li><li>Recannulate. Patient performs & knocks safety sheath onto floor. Discard potentially lethal (1:3 HIV) needle by tossing into <span style="FONT-STYLE: italic">SB</span>. <span style="font-size:78%;">(Like a bushman shooting his poison-tipped arrow).</span><br /></li><li>Whilst holding cannula in place, tear off piece of strapping with other hand & teeth. Roll finished - strapping too short. Fling into <span style="FONT-STYLE: italic">PB</span>. Stretch for new roll, strap cannula.<br /></li><li>Cap cannula as Sr Ples disappeared to Hobbiton whilst you thought she was preparing a new infusion set.<br /></li><li>Open new IV bag, toss wrapper & cap into <span style="FONT-STYLE: italic">PB</span>. Open new infusion line, launch wrapper & caps into <span style="FONT-STYLE: italic">PB</span>. Run fluid through.<br /></li><li>Stick down with dressing, screw up backing into a ball & shoot into <span style="FONT-STYLE: italic">PB</span>.<br /></li><li>Clean up bloody spills with gauze, fire into <span style="FONT-STYLE: italic">PB</span>. <span style="font-size:78%;">(Red splotch marks target like in a game of paintball).</span><br /></li><li>Catapult gloves into <span style="FONT-STYLE: italic">PB</span>.<br /></li></ol><p>That's 14ppm (projections per minute) with median accuracy of over 93% (p<0.05)! There is no more satisfying sound than that "thwack!", as the projectile meets its mark. Until this week, that is!<br /></p><p>Having transgressed the Draconian Constitution in one of my <a href="http://eishmadiskakhi.blogspot.com/2008/09/does-anybody-examine-their-patients.html">recent posts</a>, my retribution has been public humiliation. The big gavel in the sky has clapped down & deemed my post inappropriately critical & the punitive verdict has been passed. As attested to by the litter-strewn area around the <em>SB</em> & <em>PB</em>, my projectile accuracy has dropped out the bottom. <em>Es ist die Strafe Gottes.<br /></em></p><p>I have lost my mojo!</p>Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com1tag:blogger.com,1999:blog-6891882546832644554.post-67301735665550654012008-09-05T04:27:00.008+02:002009-01-29T00:30:07.525+02:00The GCS Chronicals<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9gz_uYM4wuanRHwbmfAuqvUlCcPpOO8hvAp2uO_X9Af2_jeFnwAcRdw4GnxdYDvwLiDVXB7FLVTkskl5XdHVVllp9bxPko7cWCrdvwG-cHB7lEVmhQYZyVic3gix-7iI8eVUmTmqZMToM/s1600-h/Coma.jpg"><img id="BLOGGER_PHOTO_ID_5239877633018331202" style="FLOAT: left; MARGIN: 0pt 10px 10px 0pt; WIDTH: 238px; CURSOR: pointer; HEIGHT: 240px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9gz_uYM4wuanRHwbmfAuqvUlCcPpOO8hvAp2uO_X9Af2_jeFnwAcRdw4GnxdYDvwLiDVXB7FLVTkskl5XdHVVllp9bxPko7cWCrdvwG-cHB7lEVmhQYZyVic3gix-7iI8eVUmTmqZMToM/s400/Coma.jpg" border="0" /></a>I don't know what it is about the <a href="http://en.wikipedia.org/wiki/Glasgow_Coma_Scale">Glasgow Coma Scale</a> that some doctors find it so difficult to master! Wow, why did I use the word master. Makes it sound like one needs to put buckets of blood, sweat & tears into studying the art of GCS application.<br /><br />Could it be that the total 15 exceeds the number of digits on a pair of human hands? I know the theatre staff can't count beyond 5 when checking there are no missing swabs. (Theory : 5 fingers on left hand, right hand occupied as index finger outstretched from clenched fist, taps the count out on the fingers of the left hand).<br /><br />Or marginally more likely, the assessor desirably needs to be GCS 15/15 himself in order to successfully evaluate the assessee.<br /><br />Perhaps, it is all part of a master plan providing comic relief in dire and sad situations. I must say, I thoroughly enjoy the multifaceted, oftentimes creative interpretation of the GCS! So much so, I have decided to devote space here to relate, from my ever growing repertoire, stories regarding the enigmatic Glasgow Coma Scale...<br /><br /><span style="font-size:180%;">Ignorance</span> (including face-saving strategies)<br />Referrals from outside often elicit amusing responses to the question - "so what is the patient's Glasgow Coma Scale?"<br /><blockquote></blockquote><blockquote></blockquote><blockquote style="FONT-FAMILY: courier new">"We are a very small, rural hospital. We don't have that scale here."<br /><br />"We had one, but it is broken."<br /><br />"Very, very severe."</blockquote>And my personal favourite, came from an old GP doing sessions in a plattelandse dorpie :<br /><blockquote></blockquote><blockquote style="font-family:courier new;"><span style="font-family:courier new;">"</span>Hoor<span style="font-family:courier new;"> </span>hier<span style="font-family:courier new;">, </span>Boetie<span style="font-family:courier new;">. Toe </span>ek<span style="font-family:courier new;"> </span>geswot<span style="font-family:courier new;"> </span>het<span style="font-family:courier new;">, </span>het<span style="font-family:courier new;"> </span>ons<span style="font-family:courier new;"> </span>nie<span style="font-family:courier new;"> </span>sulke<span style="font-family:courier new;"> fancy </span>goed<span style="font-family:courier new;"> </span>gehad<span style="font-family:courier new;"> </span>nie<span style="font-family:courier new;">. 'n </span>Pasient<span style="font-family:courier new;"> was </span>óf<span style="font-family:courier new;"> in 'n </span>koma<span style="font-family:courier new;">, </span>óf<span style="font-family:courier new;"> </span>nie<span style="font-family:courier new;">. </span>Nou<span style="font-family:courier new;"> </span>hierdie<span style="font-family:courier new;"> </span>ou<span style="font-family:courier new;"> is in 'n </span>KOMA<span style="font-family:courier new;">!"</span><span style="COLOR: rgb(255,0,0)">*</span></blockquote>Five stars, old man, plus 10/10!<br /><br /><span style="font-size:180%;">Manipulation of Score</span><br />This commonly occurs to avoid having to intubate a patient. Always entertaining when the score is around that watershed 8/15...<br /><br /><blockquote face="courier new">"His GCS is 11 at the moment, but it is steadily declining. I anticipate you may have to intubate him by the time he arrives - you know how slow the ambulance service is."<br /><br />"It is currently 9, but I suspect the patient will need to be tubed soon as her hepatorenal syndrome is likely to get worse before it gets better. Would you like to come do it down here, or would you prefer it when she arrives in the unit?"</blockquote>I was mightily peeved when a patient for an emergency c-spine fusion arrived in theatre sans tube & GCS 7. Paging through the file, I noticed the patient had been in the ward for 2 days already (just don't ask) and the GCS was dutifully charted as 7/15 by the Interns & MO on multiple occasions. When I started bogging on the MO for leaving a patient so long without a secure airway, the Consultant protectively stepped in.<br /><blockquote style="FONT-FAMILY: courier new">"I saw the patient myself and the GCS was more like an 8 than a 7."</blockquote>I couldn't think of a diplomatic way to enlighten him, so I just left it at that. I think, in this instance, it is true what they say about orthopods! So I diffused the situation by making my stale old joke :<br /><blockquote face="courier new">"What's the orthopaedic definition of the heart? The organ which circulates Cefazolin through the body."</blockquote>And we all laughed & (they thought) all was forgiven.<br />Interestingly, this was the same MO who had written "<span style="COLOR: rgb(51,51,255)">PEARL</span>"<span style="COLOR: rgb(255,0,0)">**</span> in the notes of a patient who had had an enucleation decades prior.<br /><br /><span style="font-size:180%;">Plain Stupidity</span><br />I overheard a doctor explaining to a patient's family, that she was brain dead and they should consider switching off the ventilator. I suppose he had been watching too much <span style="FONT-STYLE: italic">Bold and Beautiful</span> because the patient was GCS 7/15 and improved to 9/15 a few days later. We managed to pick up the pieces before a case of culpable homicide ensued.<br /><blockquote style="FONT-FAMILY: courier new">"His Glasgow is 15/15, but he's a bit confused."<br /><br />"It's about...*heavy, pseudointellectual pause*... 5 to 10."<br /><br />"0/15"</blockquote>When explained to above doctor that it can't possibly be zero, he retorted :<br /><blockquote style="FONT-FAMILY: courier new">"How do you know, you haven't seen the patient!"</blockquote>Who am I to argue when he did, in a way, have a point.<br /><br />I often wonder if these doctors ever think back, blushing, about the silly things they have said or done? I know I often do. I am the first to admit that nobody's perfect. However, I doubt many of the above quacks even realised their faus pax.<br />Oh well, comatose is bliss.<br /><br /><span style="font-size:85%;"><br /></span><span style="COLOR: rgb(255,0,0);font-size:85%;" >*</span><span style="font-size:85%;"> Roughly translated from Afrikaans "Listen here, kid. When I studied, we didn't have such fancy things. A patient was either in a coma or not. Now this guy is in a COMA".</span><br /><span style="COLOR: rgb(255,0,0);font-size:85%;" >**</span><span style="font-size:85%;"> </span><span style="COLOR: rgb(0,0,0);font-size:85%;" ><span style="COLOR: rgb(51,51,255)">P</span><span style="COLOR: rgb(153,153,153)">upils</span> <span style="COLOR: rgb(51,51,255)">E</span><span style="COLOR: rgb(153,153,153)">qual</span> <span style="COLOR: rgb(51,51,255)">A</span><span style="COLOR: rgb(153,153,153)">nd</span> <span style="COLOR: rgb(51,51,255)">R</span><span style="COLOR: rgb(153,153,153)">eactive</span> <span style="COLOR: rgb(153,153,153)">to</span> <span style="COLOR: rgb(51,51,255)">L</span><span style="COLOR: rgb(153,153,153)">ight.</span></span>Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com5tag:blogger.com,1999:blog-6891882546832644554.post-41205564666989217032008-09-04T18:35:00.016+02:002009-01-29T00:34:39.988+02:00Does Anybody Examine Their Patients?<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuvjTOc71E-Ty8DD3rO0daqdXL0Whyf3aYhNfVb9lYUy5vPtvTt0fn2rQWmGSbDnN0a32xFDn-DwlXumrd-Daym9zhq8ieWxaCJHYkus1Eh29jVEnRYzQehi7_1SsbK73gvFJZzk3mxzVt/s1600-h/Old+Faithful.jpg"><img id="BLOGGER_PHOTO_ID_5242371707542051330" style="FLOAT: left; MARGIN: 0pt 10px 10px 0pt; CURSOR: pointer" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuvjTOc71E-Ty8DD3rO0daqdXL0Whyf3aYhNfVb9lYUy5vPtvTt0fn2rQWmGSbDnN0a32xFDn-DwlXumrd-Daym9zhq8ieWxaCJHYkus1Eh29jVEnRYzQehi7_1SsbK73gvFJZzk3mxzVt/s320/Old+Faithful.jpg" border="0" /></a>OK, so here's a geyser moment some of you have been waiting for!<br /><br />I have just had a guts full of this week. Is <span class="blsp-spelling-error" id="SPELLING_ERROR_0">everybody's</span> clinical skills up to shit these days or am I on drugs? Perhaps I'm the one who needs therapy. I am by no means a special doctor or exceptional at my job - but for crying in a bucket. What the hell is wrong with the surgeons at Mount Doom?!?!?!<br /><br />First of all, the Spirochaetes want me to dope an ectopic from the night before. Apparently she is stable, that's why she's been left for the morning. Only problem, her potassium is 6.9mmol/l, otherwise she is "fine" & her blood workup is "fine". So I ask if that is before or after treatment. No, actually she doesn't even have a drip up. I almost shat myself! These blood results were 12 hours old. "Please do the patient a favour, put up a drip & give Insulin & Dextrose. Get back to me once the patient is properly resuscitated."<br /><br />A few hours later, I get a message. She is ready for theatre, her potassium is now 5.9. Right, that's a start. I bet the regime was given only once? Correct. I'm wearing my patience hat : "Now do it again. This time, change your fluid from Ringers (check the recipe on the bag - it contains potassium). You said the U&E was otherwise normal. I see the urea is 20 & <span class="blsp-spelling-error" id="SPELLING_ERROR_1">creatinine</span> 180. That is not normal, it seems a night of <span class="blsp-spelling-error" id="SPELLING_ERROR_2">dripless</span> dessication didn't do her any good at all."<br />I get a message 15 minutes later. "Can we please hurry, her <span class="blsp-spelling-error" id="SPELLING_ERROR_3">BP</span> is now low."<br />"How low, is low" I ask, "and what is her <span class="blsp-spelling-error" id="SPELLING_ERROR_4">Hb</span>?" I feel a sudden twinge of regret for delaying - she has probably just ruptured.<br />"47/20 and <span class="blsp-spelling-error" id="SPELLING_ERROR_5">Hb</span> is 9g/<span class="blsp-spelling-error" id="SPELLING_ERROR_6">dl</span>".<br /><br />Wait a minute. This sounds very fishy & so not like an ectopic. So I go off to visit the patient in the ward myself...<br /><br />There she was lying. <span class="blsp-spelling-error" id="SPELLING_ERROR_7">Acidotic</span> breathing, looking more dehydrated than the Sahara. Pink <span class="blsp-spelling-error" id="SPELLING_ERROR_8">jelco</span> & green <span class="blsp-spelling-error" id="SPELLING_ERROR_9">jelco</span> each in a <span class="blsp-spelling-error" id="SPELLING_ERROR_10">cubital</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_11">fossa</span> (how aggressive), but with an empty 50ml dextrose & empty 1l Ringers and a unit of blood <span class="blsp-spelling-error" id="SPELLING_ERROR_12">unneccisarily</span> trickling in. Coffee-ground <span class="blsp-spelling-error" id="SPELLING_ERROR_13">vomitus</span>, diarrhoea, massively distended and acute abdomen, <span class="blsp-spelling-error" id="SPELLING_ERROR_14">tympanic</span> on percussion & no bowel sounds.<br /><br />I put in a CVP & A-line to start a proper resuscitation. Do a blood gas, severe metabolic acidosis. So I stick my neck out against two consultants, a positive B-<span class="blsp-spelling-error" id="SPELLING_ERROR_15">hCG</span> & sonar evidence of free fluid in Pouch of Douglas. She may be coincidentally pregnant, but this is not an ectopic. Insisted she gets transferred to the Surgeons of Mount Doom for a <span class="blsp-spelling-error" id="SPELLING_ERROR_16">explorative</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_17">laparotomy</span> because I'm convinced that this is <span class="blsp-spelling-error" id="SPELLING_ERROR_18">ischaemic</span> bowel. Now 24 hours since admission - well, well, well. Guess who had a necrotic exploded colon?<br /><br />First patient up today on emergency list. "We want to drain an abscess."<br />"Where?" - "The left knee."<br />"Is she systemically septic?" - "<span class="blsp-spelling-error" id="SPELLING_ERROR_19">Hmmmm</span>?"<br />"What is her pulse & <span class="blsp-spelling-error" id="SPELLING_ERROR_20">BP</span>?"..... no idea.<br />"Why does she have an abscess? Is she diabetic? HIV? Trauma? Is it not a septic arthritis?"..... no idea.<br />Pissed off with their inability to answer a few ELEMENTAL but ESSENTIAL questions, I go ahead and slap in a femoral block & like fool didn't examine her knee properly myself.<br />When checking if the block has taken effect, I realise that granted, the knee was swollen, but the area of greatest fluctuation is actually <span class="blsp-spelling-error" id="SPELLING_ERROR_21">popliteal</span> (where a different block is needed). So I ask the surgeon where he is going to cut? Fail, fail, fail! Better get a crossmatch, I can just see that <span class="blsp-spelling-error" id="SPELLING_ERROR_22">popliteal</span> artery getting in the way of the I&D. You see, one has to think ahead for these monkeys!<br />"You should examine your patient <span class="blsp-spelling-corrected" id="SPELLING_ERROR_23">properly</span>, especially since you are about to cut into her in the wrong place!" I spit at him.<br /><br />Then a friend asks me to cover for him in his theatre. It's his last case, but has to leave urgently. The intern is about to put in a spinal & will look after the patient when all is settled. (Fine, because I've got a stable <span class="blsp-spelling-error" id="SPELLING_ERROR_24">brachial</span> plexus block on my table for <span class="blsp-spelling-error" id="SPELLING_ERROR_25">ORIF</span> etc.) The patient is apparently quite sick, renal failure, blah blah and needs a below-knee guillotine. Anaesthetic plan is unilateral spinal. So I direct the intern with the spinal, ask the surgeon (& his assistant) which side they're working. "Left", they ALL tell me, "LEFT". Somebody checks the consent - "Left". Having used heavy <span class="blsp-spelling-error" id="SPELLING_ERROR_26">bupivacaine</span>, I turn her onto the left side. The surgeons sit watching me & the patient for 5 minutes while the spinal settles. When I flip back the sheets, I see a normal left leg & rotten right foot! Can't be! I don't know who was more shocked - me or the surgeons when I called them bloody retards and stormed out of the theatre. Feeling sorry for the patient, I went back to finish the job a few minutes later. By the heavy atmosphere in the theatre, I discover that I AM THE BAD GUY! For crying in a bucket, I was going out of my way to help! This is not even my patient, but was willing to go the extra mile to help! I didn't get my sides wrong - but I'm the bad guy with the nasty temper.<br /><br />Last case of the day. Another patient with a rotten limb - foot this time. They would just like to do a bit of <span class="blsp-spelling-error" id="SPELLING_ERROR_27">debridement</span> and redressing. First to piss me off is, this adult has a paediatric 22G <span class="blsp-spelling-error" id="SPELLING_ERROR_28">jelco</span> which isn't even patent. No good should any complications (happen often at Mount Doom) ensue. I struggle for a good 15 minutes to get a 18G into an arm with none of her spidery veins left <span class="blsp-spelling-error" id="SPELLING_ERROR_29">unpunctured</span>. (All the while, surgeon just standing watching me - no help whatsoever). So I make a snide remark, "I wish patients would come to theatre with proper IV access. That way there would be more time for surgery & less anaesthetic faff time." But I have been saying this for ever and a day, so why waste my breath? Pop in a <span class="blsp-spelling-error" id="SPELLING_ERROR_30">popliteal</span> block, and off we go. Off come the dressings on the lady's foot... Well, well, well. The patient said it herself - "Oh no, you're going to have to cut off my leg now, hey?"<br /><br />How does this <span class="blsp-spelling-error" id="SPELLING_ERROR_31">nonesense</span> happen in theatre? If doctors would just examine their patients properly BEFORE theatre, the appropriate course could then be followed. I'm so sick and tired of surprises, but also refuse to do the entire workup, and especially surgical advisory, of the patient. Besides not going down well with the surgeons, it is not my domain, responsibility or area of expertise.<br /><br />Reminds me of one evening, they brought a patient for left above knee amputation. With my two-minute interview & examination - I ascertain the patient has had surgery a few months ago on the left hip. I have a quick look & see it was probably an <span class="blsp-spelling-error" id="SPELLING_ERROR_32">intramedullary</span> nail. So I tell the surgeons what they missed on their history and examination, but they ignore me and go on. I just sat back and watched with pleasure when they reached the bone & finally discovered the steel rod in the way.<br /><br />This shit can only happen in state practice. But it doesn't make it less criminal. I've had a guts full. :( Today just sucked! And sorry for the bitch & moan session, but I need the (free) therapy! I'll delete the post once I have cooled down. I miss my Alma Mater. Surgeons were cool there!<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj93D0MEFwhBUEeP7UVOYVWMF0pFh4-oEzjhiWIOyBxKJBOCuP1M-WV3bkx-EkE5CkZ1i7Kj00VyVrhZ1lRoyVeBDALCwti4oJUTmwY5PuGs-tVYhaQul4WUtJ2h28WOs-zGn-AKGhsIXFC/s1600-h/Tolerance.jpg"><img id="BLOGGER_PHOTO_ID_5242387078379297890" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: pointer; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj93D0MEFwhBUEeP7UVOYVWMF0pFh4-oEzjhiWIOyBxKJBOCuP1M-WV3bkx-EkE5CkZ1i7Kj00VyVrhZ1lRoyVeBDALCwti4oJUTmwY5PuGs-tVYhaQul4WUtJ2h28WOs-zGn-AKGhsIXFC/s400/Tolerance.jpg" border="0" /></a>Lessons learned :<br /><ul><li>I MUST follow what a wise man once told me about anaesthetics :<br /></li></ul><ol><li>Don't believe anything anybody tells you (especially a surgeon)</li><li>CHECK EVERYTHING YOURSELF</li><li>Give oxygen</li></ol><ul><li>Don't use blocks at Mount Doom. Rather do <span class="blsp-spelling-error" id="SPELLING_ERROR_33">GA's</span> - that way, when the surgical plan changes at the last minute, you are not caught with your pants down.</li><li>When you lose your temper, YOU become unpopular, whether you were right or not. Don't ever visibly lose your rag.</li><li>Snide remarks, hints & jibes don't work. People are too thick-skinned.<br /></li></ul>Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com2tag:blogger.com,1999:blog-6891882546832644554.post-47528935852670594562008-08-29T01:25:00.002+02:002009-01-29T00:36:04.324+02:00Food, Glorious Food!<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJOWvLBX1b8vnQSu1kc-wFX8haRdCjUEqLIsnMdRxdgcBQ1Hv1vVn4O3RFeWZdrl3vnOiOnPnHyGwTCUuLuMXYs-2rDdnsb-gMeHfyowPS3zjKtmawg_3_i3vh8vxQ1q-oBYmcbIN5Ie3j/s1600-h/Hospital+Food.jpg"><img id="BLOGGER_PHOTO_ID_5238163544525141730" style="FLOAT: left; MARGIN: 0pt 10px 10px 0pt; CURSOR: pointer" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJOWvLBX1b8vnQSu1kc-wFX8haRdCjUEqLIsnMdRxdgcBQ1Hv1vVn4O3RFeWZdrl3vnOiOnPnHyGwTCUuLuMXYs-2rDdnsb-gMeHfyowPS3zjKtmawg_3_i3vh8vxQ1q-oBYmcbIN5Ie3j/s400/Hospital+Food.jpg" border="0" /></a>I've always thought "portly" to be a strange word. Portly, to my (admittedly tangential) mind, has mobility-like connotations. Perhaps influenced by the Latin for door/gate? And with mobility, comes litheness & leanness - most certainly not : <blockquote>Dictionary.com - <span style="FONT-STYLE: italic">rather heavy or fat; stout; corpulent</span>.</blockquote><blockquote></blockquote>Then it hit me when I saw her. She is a porter and perhaps one of the fattest <span style="FONT-STYLE: italic">mobile</span> people I have seen. Not far off from those bed-bound blobs one only sees photo's of in the You magazine or on the Oprah show (you know - those who need the fire department's <span style="FONT-STYLE: italic">Operation Dumbo Drop</span> to get them to the hospital).<br /><br />I didn't know wrists & ankles could look like that! Her Grade IV dyspnoea is not unjustified.<span style="font-size:100%;"> She actually manages to bantam the scrub sister & floor nurse, who if you haven't guessed by now are also significantly portly. I know, I know, I shouldn't be so mean because they all suffer from a "glandular problem"<span style="FONT-WEIGHT: bold; COLOR: rgb(255,0,0)font-size:130%;" >*</span>. Somehow, this excuse doesn't hold much water with me after I found the following staff bulletin pinned to the Hobbiton notice board.</span><br /><br /><blockquote><span style="FONT-WEIGHT: bold">" <span style="font-size:85%;">MEALS ORDERED & SERVED TO PATIENTS</span><br /><br /></span><span style="font-size:85%;">Food & meals served in hospitals form an important part of the treatment of patients.<br /><br />It came to our attention and was discussed during a meeting attended by Dietetic Service Manager, Dietitians, Soft Service Supervisors & Food Service Managers that food ordered and sent for patient consumption are illegally eaten by all levels of other staff on the way to the wards and on ward level.<br /><br />This illegal practice means that patients do not receive the ration and recommended amounts of nutrients they need to fast track their hospital stay. It has been scientifically researched and reported that patients become malnourished during their hospital stay. As most of our patients already show signs of malnutrition when admitted they need amounts planned to enable them to fight disease.<br /><br />Eating of patient's food will amount to theft and according to the "Code of Conduct for the Public Service" theft is seen as a very serious transgression.<br /><br />To stay in line with the food budget is difficult if these illegal practices take place.<br /><br />Incident reporting and disciplinary steps will be taken against all staff committing any of the following :<br /></span><ol><li><span style="font-size:85%;">Reduce portions of meat, fish or chicken served to patients.</span></li><li><span style="font-size:85%;">Eating any item from the food trolley only meant for patient meals.</span></li><li><span style="font-size:85%;">Keeping back or dishing out for won use any item from the food trolley.</span></li><li><span style="font-size:85%;">Keeping back any item or items from patients receiving special diets.</span></li><li><span style="font-size:85%;">Using teabags, coffee or sugar issued to wards.</span></li><li><span style="font-size:85%;">Use or drink any milk issued to wards.</span></li><li><span style="font-size:85%;">Use or eat any bread, margarine or jam issued to wards.</span></li><li><span style="font-size:85%;">Over ordering patient numbers in wards.</span></li><li><span style="font-size:85%;">Drink patients enteral or sip feeds. <span style="COLOR: rgb(255,102,102); FONT-STYLE: italic">(OMG!!!)</span><br /></span></li><li><span style="font-size:85%;">Drink unused sip feeds issued to patients.</span></li></ol><span style="font-size:85%;">Stock control and auditing in the kitchen areas have received top priority in the past months. New appointments have been made in the Food Service Departments of all three hospitals : of Food Service Managers and Soft Services Managers : they have implemented strict stock control measures. Kitchen doors have also been locked to avoid non-personnel to enter the kitchen areas.<br /><br />Please find attached a form to be filled in when reporting any illegal incident of eating or taking patient's food.<br /><br />Please make your staff aware of the seriousness of the problem and how they with their actions jeopardize patient's recovery.</span><span style="FONT-WEIGHT: bold"><span style="font-size:78%;"> </span>"<br /></span></blockquote>So a few things synapse for me :<br /><ul><li>Where the food comes from for all those tea-breaks.</li><li>Why the staff look like they do.</li><li>The word "portly" was derived from "porter".</li><li>Why hire somebody as a porter who clearly struggles to port themselves? Ah I forgot, it's the same people who hired the porters with inter alia : scoliosis, strabismus accompanying moderate to profound mental retardation, alcoholism, narcolepsy, cleptomania & burns contractures. I am not opposed to (hiring) people with these listed challenges, but am of the opionion they would be better suited to less physical- & patient contact occupations.<br /></li></ul><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(255,0,0)font-size:130%;" >*</span><span style="font-size:85%;">Amazambanism</span>Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com3tag:blogger.com,1999:blog-6891882546832644554.post-42890006379148700752008-07-21T01:09:00.007+02:002009-01-29T00:36:54.581+02:00Hospital Security<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizzT0KIPrkEL0aLVwp44doRq2ZOHWhdLn81prjLECjqr6d0GX-rxGOZNtH5a2fCKYN5LnkcDL5PcBLPrYH3R-tqjK0UaNKiJ_LcPj5YeoaSefW1TKBeCkJJDDWcQ_N5XjXdUW5JIkRmLvR/s1600-h/Lazy+Guard.jpg"><img id="BLOGGER_PHOTO_ID_5225267250386845410" style="FLOAT: left; MARGIN: 0pt 10px 10px 0pt; CURSOR: pointer" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizzT0KIPrkEL0aLVwp44doRq2ZOHWhdLn81prjLECjqr6d0GX-rxGOZNtH5a2fCKYN5LnkcDL5PcBLPrYH3R-tqjK0UaNKiJ_LcPj5YeoaSefW1TKBeCkJJDDWcQ_N5XjXdUW5JIkRmLvR/s200/Lazy+Guard.jpg" border="0" /></a>We all know them - the primates in security uniforms posted at the entrances of our public hospitals. Very vigilant-looking characters indeed! Somewhere between REM & GCS 3, slumped over an empty box of KFC or wrapped up in a blanket on a crate outside the security booth. Their employment is to prevent theft and protect the patients & hospital employees. Aah, one feels total reassurance at the mere sight of them!<br /><br />I cast my mind back to psychology lectures in first year. Maslow's Hierarchy of Needs. This humanistic psychologist was concerned with the psychological growth and maturity of people. According to him, human action is prompted by needs which may be arranged in a hierarchy. As the more basic needs are satisfied, higher levels of needs which are characteristic of increased degrees of mental health, emerge.<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAQ8uMgqS9yI-YbziooYXeWUpilcD7IaNBAaB_Hx_56F-GQ-Qsze5bFke6ExEDVE8qrOaa1VY7iWTbUh5eVKP3TlHz8JgtXG-uMlAMIbHhpv9zEo2GXk0FGOEpmXcEq22vLXySoT1PXMqe/s1600-h/Maslow's+Hierarchy.png"><img id="BLOGGER_PHOTO_ID_5225206615030927634" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: pointer; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAQ8uMgqS9yI-YbziooYXeWUpilcD7IaNBAaB_Hx_56F-GQ-Qsze5bFke6ExEDVE8qrOaa1VY7iWTbUh5eVKP3TlHz8JgtXG-uMlAMIbHhpv9zEo2GXk0FGOEpmXcEq22vLXySoT1PXMqe/s400/Maslow's+Hierarchy.png" border="0" /></a><br />Climbing up my Jacob's Ladder towards self-actualisation, I can count on my "favourite" consultant to almost certainly thwart any attempt to rise above level 4. But that is another story to be awarded an exclusive in a future blog.<br /><br />An amoeba could fulfil level 1 - the most basic of needs. Sad to think that many South Africans cannot even fulfil this level. Does this render the underprivileged subprotozoan? Although there may not always be enough food to eat or a cholera-free water supply, our population growth proudly announces we are managing to outbreed AIDS. Hence sex (often forceful) does not seem to be in short supply. Thank goodness electricity supply doesn't fall into this category! Although when I first heard load-shedding was to be instituted, I suspected a link with excretion. I was incorrect. However, I have subsequently wanted to "shed my load" on many occasions regarding the issue.<br /><br />My concerns are with level 2 : Security. Being so low down in the hierarchy, I assume it to be rather fundamental. Well, by the astute selection of security guards we are provided with at our hospitals, I suspect management tends to differ with my assumption. We have had two moderately serious incidents (by SA standards - perhaps regarded as very serious internationally) over the past few months.<br /><br />The first incident saw an intern stabbed on the premises. Apparently the perpetrator fancied her handbag and decided to do some affirmative shopping, sinking a screwdriver into her back as a heart-felt thank you. Luckily her scapula stopped the tool short of causing injury to a few important structures known to be situated in the human thorax. The fact that she returned to work the very next day is testimony enough to the state of criminal desensitisation we live in.<br /><br />More recently, gunshots rang out one fine evening in casualties. A patient was being examined for non-fatal peripheral GSW's, when four gangsters burst into his cubicle behind a shower of bullets to finish the job. The intern examining the patient at the time, was hit. Miraculously he suffered only a soft-tissue injury whilst witnessing a murder before his very eyes. He returned to work two days later. Once again - criminally desensitised.<br /><br />The newspaper article said the criminals "<span style="FONT-WEIGHT: bold">overpowered</span> the security guards before speeding off in a white vehicle". I seriously doubt security made any attempt at stopping the gangsters, that's if they noticed anything at all.<br /><br />So who's next? Maybe we should be donning bulletproof vests in lieu of white jackets because hospital security is a farce. But then again, this passive approach is in keeping with national policy. In the wise words of our honourable Minister of Safety & Security, Charles Nqakula : <blockquote style="FONT-STYLE: italic">"They [whites] can continue to whinge [about crime] until they are blue in the face, they can continue to be as negative as they want to, or they can simply leave this country."</blockquote>As for Maslow, it seems according to his theories, South Africans' development towards morality and lack of prejudice will remain stifled by a lack of safety.Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com7tag:blogger.com,1999:blog-6891882546832644554.post-2999221245343199202008-07-17T14:07:00.004+02:002009-01-29T00:38:16.615+02:00This is me<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrVenDPvPabsYAFkeURgeY3pCRpGygUfnOcTld4mhSIWbOpOISIXhaETEF9Hxk4zD5KXesK56n-H-xPcqbTWDTSJzQifDFgwTiGmxhyjPSPbrLxaog9UdOQ1XI6wDdkfRvSK6WUg2LBIlV/s1600-h/Pessimist.gif"><img id="BLOGGER_PHOTO_ID_5223932005925715778" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: pointer; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrVenDPvPabsYAFkeURgeY3pCRpGygUfnOcTld4mhSIWbOpOISIXhaETEF9Hxk4zD5KXesK56n-H-xPcqbTWDTSJzQifDFgwTiGmxhyjPSPbrLxaog9UdOQ1XI6wDdkfRvSK6WUg2LBIlV/s320/Pessimist.gif" border="0" /></a><br />Okay, so I have a rancid personality. Nothing I'm particularly proud of, but that is me! Problem is, it is a self-perpetuating strategy that works. It isn't anything I work on consciously, but is rather a manifestation of mankind's innate "will to survive", perhaps cracked and chipped by the very complex country I live in.<br /><br />I remember an English teacher of mine saying, "all that keeps humans clinging to life, is hope". He was a douchebag, but he was right. So in a country riddled with crime, poverty, ill-health (thanks for the gap in the market), idiocy & hypocrisy, there is not much hope for her citizens - well, at least not for those capable of logical thought and extrapolation.<br /><br />Hope : I'm still alive... therefore I must still have it? Well, the twisted sisters of hope are pessimism & cynicism. 'Tis me also! Predict a bad outcome and there are only two possible permutations. You are not surprised (and thus not disappointed - you are entitled to proudly declare "I knew it!") or you are pleasantly surprised. Win-win situation, not so? I can really recommend it. Occasionally, I am pleasantly surprised!<br /><br />It came to pass that I have started (under much duress mind you) blogging. Well done, my friends, you have managed to bring the mountain to Mohamed - thanks for creating the blogspot for me! And thanks for blowing my cover by the way. Believe it or not, I'm not being sarcastic for a change. I have found some brilliant blogs to which I have now subscribed. At first, after reading these blogs, I considered deleting my blogspot. What massive shoes to fill - they're really good! But by your persistence, I can only surmise you find my rantings amusing and "blog-worthy"...<br /><br />So...<br /><br />I will continue to sharpen my tongue and dip my fingers in bile as part of my morning grooming ritual - as combing my (rapidly dwindling) hair no longer occupies much of my time, and I will humour you with more blog instalments.<br /><br /><span style="FONT-STYLE: italic">Caveat Emptor</span> :<br /><ol><li>If you're looking to read about "shiny, happy people" you have come to the wrong place. Click on the thumbs down button & continue Stumbling.</li><li>Despite appearances, I love my job. I feel blessed having learnt the skill to help those in desperate need, being able to reassure & calm those who are faced with their own mortality.</li><li>Woe betide those (government, administration or health professionals & auxilliaries) who have a hand in the rendering of inferior service, for you are bound for mention here.</li><li>I do not suffer fools. Idiots may feature here - some may be patients too. But if intentions are good, all is forgiven & I ask for forgiveness in return. :)</li><li>This blog should be viewed as the therapeutic musings of an ever so slightly frustrated state-employed doctor trying to eke out a living in South Africa. As in life, I may come across as serious, but I am mostly taking the mickey out of a rotten situation and am chuckling inside.</li></ol>Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com3tag:blogger.com,1999:blog-6891882546832644554.post-21917032666267532082008-07-12T15:19:00.011+02:002009-01-29T00:39:03.703+02:00John Coffey<div style="TEXT-ALIGN: justify"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo3EVN5NVnVaV8l9p_yaeY5MEDeWUuc7OaZnLtUMnmi_pH6oSavrbyfpD0m5yTXoMEUR0Mi4GozwVml9A2vC_-WV1cPjqImu9_fWl-kNN8uwQXGLbrYxGKK8QqWTQ1FgDzmYQsjXNb4FiP/s1600-h/John+Coffey+3.jpg"><img id="BLOGGER_PHOTO_ID_5222119284733378866" style="FLOAT: left; MARGIN: 0pt 10px 10px 0pt; CURSOR: pointer" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo3EVN5NVnVaV8l9p_yaeY5MEDeWUuc7OaZnLtUMnmi_pH6oSavrbyfpD0m5yTXoMEUR0Mi4GozwVml9A2vC_-WV1cPjqImu9_fWl-kNN8uwQXGLbrYxGKK8QqWTQ1FgDzmYQsjXNb4FiP/s200/John+Coffey+3.jpg" border="0" /></a>The antithesis, or nemesis if you will, of John Coffey from the Green Mile is a surgeon I know. These two mutually correlated opposites ensure that balance is maintained in the cosmos.<br /></div><br /><div style="TEXT-ALIGN: center"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPaUEYupugZWRatX4YfIHXkeelYPzSEA1wu7lXveogaPULRUF8VZkGS4ZTyPcVOBO-AI6aKcoPC3wA1oS21a5x2_GQIDClHBcqTKg9_sBoyZSj1Fqz0DfZjv0vWCxD2LVR_7E1fv9HDTdv/s1600-h/Yin+Yang.png"><img id="BLOGGER_PHOTO_ID_5222120738267652882" style="FLOAT: right; MARGIN: 0pt 0pt 10px 10px; CURSOR: pointer" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPaUEYupugZWRatX4YfIHXkeelYPzSEA1wu7lXveogaPULRUF8VZkGS4ZTyPcVOBO-AI6aKcoPC3wA1oS21a5x2_GQIDClHBcqTKg9_sBoyZSj1Fqz0DfZjv0vWCxD2LVR_7E1fv9HDTdv/s200/Yin+Yang.png" border="0" /></a><span style="font-size:180%;"><span style="FONT-WEIGHT: bold">THE LAWS OF YIN-YANG</span></span></div><span style="font-size:130%;">1. Yin-Yang are Mutually Rooted</span><br /><ul><li>Both these characters hail from Central Africa.</li><li>Both dabble in healthcare.</li><li>Both are immigrants. One left to the West (which ultimately benefits) whereas the other left for the South (oh woe is me!). Why did he not go East so as to maintain the balance? Probably because no other Health Professional Council would not have him! He is our country's solution to the brain-drain. I suppose they figure, if you don't have a brain, you can't be "drained".</li><li>Physical attributes : these two are carbon copies - no pun intended, although JC South is of shorter stature.</li><li>Both talk with funny accents!<br /></li></ul><span style="font-size:130%;">2. Yin-Yang are Opposing</span><br /><ul><li>JC West is softly-spoken, JC South bellows at all theatre staff in an arrogant manner.<br /></li><li>JC West performs healing miracles whereas JC South is a finely-tuned assassin.</li><li>JC West is afraid of the dark. JC South does his best work at night when out of sight of consultants & the anaesthetists have no choice but to fall prey to his foul deeds. He is afraid of nothing & has no regrets or conscience.</li><li>JC West is honest - JC South constantly lies to save face.</li><li>JC West could probably put up a drip.<br /></li></ul><span style="font-size:130%;">3. Yin-Yang Mutually Transform</span><br /><ul><li>When JC West expels the flies of evil, they traverse across the Greenwich Meridian & fly directly into JC South's mouth, nostrils & ears which are all connected to a central vacuum chamber. <span style="font-size:78%;">(see brain-drain)</span><br /></li><li>JC West is a convicted criminal whose innocence is realised. JC South is a 007 whose criminal nature is gradually being unearthed. When he will land behind bars, though, is a mystery since the powers that be seem to turn a blind eye.<br /></li></ul><span style="font-size:130%;">4. Yin-Yang Mutually Wax and Wane<br /></span><ul><li>JC West fluxes between small & large miracles e.g. curing UTI's to brain tumours. JC South ranges from bad to worse e.g. 2 to 4.5 hour appendisectomies.<br /></li></ul>Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com0tag:blogger.com,1999:blog-6891882546832644554.post-53280210558048663232008-07-12T05:36:00.020+02:002009-01-29T00:39:27.604+02:00Mrs Ples was actually a Hobbit<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgT3FiGgkTqe72NBrsC-YR7UL_a_jVfxIrSRfchN5SK6RYiy6hcisSzXuDWpRpqKLZt0hK989lZmF3CMJ1oC6dZkah3eiGckdMjibL83sZ_x6NXgIZGEHVq4yS10Q3t1-6ELO_dyO2ofNk-/s1600-h/Mrs+Ples.jpg"><img id="BLOGGER_PHOTO_ID_5290163340849096210" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; WIDTH: 199px; CURSOR: hand; HEIGHT: 200px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgT3FiGgkTqe72NBrsC-YR7UL_a_jVfxIrSRfchN5SK6RYiy6hcisSzXuDWpRpqKLZt0hK989lZmF3CMJ1oC6dZkah3eiGckdMjibL83sZ_x6NXgIZGEHVq4yS10Q3t1-6ELO_dyO2ofNk-/s200/Mrs+Ples.jpg" border="0" /></a> I am a firm believer in evolution. How could I not be when there are real, live, walking & talking examples tormenting every moment of my working day? Eureka moment! <span style="FONT-STYLE: italic">I work in a museum where the exhibits are capable of re-animation</span>.<br /><br />Yes the missing links do have a hyoid bone and are thus able to vocalise - albeit in simple, clumsily constructed sentences. They do occasionally adopt an erect stance (when not seated - which is most of the time). Ambulation is laboured and appears to be somewhat painful, but may gather speed under certain rare circumstances.<br /><br />As cruel fate would have it, one of my regular helpers is a direct descendant of Mrs Ples. I have come to learn that there is a fine line between helping & hindering. Sr Ples (RN) is virtually a genetic duplicate of her predecessor : Mrs Ples in her purest form. In fact, this limb of hominids (ouch, it hurts to admit kinship!) remains uninfluenced by hybrid vigour or evolutionary changes. Since more intelligent branches have been unable to bring themselves to integrate, I suspect an overwhelming amount of inbreeding and as a result, we have Sr Ples (Mrs Ples to the nth power) hindering me today.<br /><br />What palaeontologists may not know by studying their artefacts, but I am privy to with my living example, is that Mrs Ples, by intuitive observational deduction, was a Hobbit. A Hobbit, yes, a Hobbit! <span style="FONT-STYLE: italic"><br /><br /><div><div><blockquote>"They enjoy at least seven meals a day, not including snacks, when they can get them - breakfast, (arguably) second breakfast, elevenses, luncheon, tea, dinner and later, supper."</blockquote></span></div></div><span style="FONT-STYLE: italic"></span>Since language is limited, all these meals are clustered together under one guise as "tea". When situations get tough - when a patient starts bleeding, or when the doctors start shouting orders, it coincides with Sr Ples having a sudden desire for a "snack". Before one gets angry, one is quickly reminded that Sr Ples suffers from Diabetes & is in urgent need of a "snack" lest her blood-sugar levels drop below 20mmol/l.<br /><br />Post-script :<br />1. What Tolkien didn't know is, there are even more meals. Another meal (main, not snack) is consumed over an hour at around 3am. This meal is strangely referred to as "lunch".<br />2. The nurses tearoom will be hereafter be referred to as "Hobbiton"<br />3. Sr Ples is rotund.<br />4. Sr Ples has painful joints.<br />5. Sr Ples sleeps a lot.<br />6. Sr Ples believes that her Diabetes improves with snacks, whereas studies have shown weightloss to be beneficial. Brilliant example of a positive feedback loop.Eishhttp://www.blogger.com/profile/01071725889453843539noreply@blogger.com4