Quote by Steve Jobs

“You’ve got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle.”

Hear hear!

RIP

Amandla!

I have a patient in my ward; shall we call him Mr T; a sweet young man who has been an inpatient in the ward for many weeks. He has full thickness burn wounds to his leg and foot. Obviously such an injury is accompanied by excruciating pain particularly during the dressing changes which are done every second day. Patients who call hospital wards their homes for extended periods of time become accustomed to the routine of the ward and even adopt some of the medical jargon they pick up when communicating with the ward staff. This particular gentleman has become adept at doing his own dressing changes and is quite an expert at describing wounds in medical terms (using words such as granulation tissue, although he calls it ‘graduation tissue’).

I recall another patient who was a long term resident of a medical ward, mainly because he suffered from brain damage and could not remember his own address or any next of kin contact details. This guy quietly observed the nurses going about their daily duties. One morning he joined them in making the beds, perfectly copying their particular way of folding the corners and rolling the blanket into a tight sausage at the base of the bed. Needless to say, as soon as the patient revealed his very useful bed-making talent he quickly received an invitation to stay as long as he wanted to.

But I digress, back to Mr T: we took him to theatre today to cover his burn wounds with skin grafts. This we perform under cover of spinal anaesthesia, numbing the patient’s legs while his consciousness remains intact. Mr T was acutely scared of the procedure and especially concerned that the spinal might stop working at any moment during the procedure, flooding his nerve ends with unbearable pain. We needed to constantly reassure him that everything was okay. We guided him through every step of the procedure. The operative site is hidden from the patient by a green fabric shield so he could not visually follow what we were doing. (And thank goodness for that as I cannot think of anyone who’s stomach could stand seeing an operation being performed on themselves).

At one point we needed to take a split skin graft with a machine called a dermatome. Unfortunately this contraption makes a terrifying noise, just like a grinder splitting through bone. In reality it very smoothly and effectively removes a super thin top section of skin (epidermis) from the dermis. Mr T was understandably completely freaked out by the hair-raising screech of the dermatome. He quickly realised though, that the spinal was indeed working perfectly because he had no sensation of pain at all! I think it was the whole stress of the situation and his extreme fear combined with the sweet realisation that he was not going to feel any pain after all, that made him burst out in, first giggles and then, deep tummy guffaws. He kept saying how he felt no pain from the grinder! The atmosphere in the theatre, previously sombre and a bit stressed by the patient’s panic, changed so drastically that we all started laughing along with him. Then he started singing the praises of all the doctors in the theatre saying how wonderful we are to give him new skin and save his leg.

At the completion of the surgery, still on the theatre table but nicely wrapped in bandages, the patient punched his fist in the air and bellowed “Amandla!” Now, this cry was used during the Apartheid years as a cry of togetherness by the ANC party members. It means power. One person, usually at a political rally would call out, “Amandla!” and the crowd would answer, “Awethu!” meaning, “Power to the people!” Most white South Africans, including myself, not really understanding the beautiful meaning behind the words, experience debilitating fear when we hear those words called out in great crowds. Or, at least, we would have during those dark ages of Apartheid. When exclaimed by the voice of a thousand people at a political rally it sounds like a proclamation of civil war.

The most amazing thing is that today when my patient, Mr T, cried, “Amandla!” I really HEARD him. He was celebrating that he had power in his court again: he was strong enough to survive the fear of surgery; strong enough to survive the burn wound and strong enough to take on life after months of being incapacitated in hospital. But he wasn’t doing all this alone. He invited us to join him in jubilation. We had walked the path with him, daily. We gave his legs the power to carry him. He gave us power to serve our other patients and to do it with an abundance of energy.

And we answered, “Awethu!”!

the inner room

Each of us has a space deep in our person where we retreat to when we need to be with just ourselves. Some of our inner rooms are neglected, dusty spaces like forgotten attics. We keep boxes of past experiences beneath layers of dust. We clearly do not enjoy ruffling through those past experiences, though some may bring recollections of beautiful times. Our outer lives may simply be so busy that we don’t have the time to retreat to our inner rooms. As that space gathers more and more dust and spider webs, it becomes exceedingly unwelcoming. We stop going there. We would certainly not invite anyone else there.

Then there are the inner rooms that are often visited. Some look like well-lived-in family homes. I imagine scatter cushions haphazardly thrown onto deep, soft couches, flattened in the centre from wear. Dirty coffee mugs stand around from previous visits. A room like this is certainly a regular haunt. Perhaps the visits aren’t always treasured,happy times, but they are real. The owner of such a room may not appreciate his own wondrousness but he is comfortable with who he is and happy to chill with his private self.

The most beautiful rooms are spaces of candle light. The glow is soft and warm and forgiving. Our most valuable treasures are placed on gilded pedestals. Owners of such rooms retreat there often: it takes a high level of maintenance to keep the space sparkling and clean and golden. The most outwardly flawed people may own lovely sanctums like these. They have gained perhaps the most valuable asset in this world: the knowledge that God loves us despite our weaknesses and human inadequacies just because we are His children. What arrogance we have to impose stricter judgements upon ourselves than He does on us!

Owners of lovely inner rooms make mistakes like the rest of us. They sin like we all do; they even have grave embarrassments to hide. These self-esteem ravishers burrow their way into inner rooms. They make their homes in corners. They throw scary shadows among the candle light. For the light to survive, we need to face these dark demons. Almost daily spring clean may be needed. The human nature is such that we err on a daily basis despite our best intentions. Shadows cannot survive where there is light yet many of us create our own barriers against the light. We seem to think that we need to wallow in shame and self-pity when we’ve acted in a way that darkens our inner rooms. God offers us candles of forgiveness in abundance. In His Great Book He has forgiven us a long time ago while we still hold onto the shame that comes with the self-imposed darkness. A candle lit in a dark corner drives out the scary shadows and restores the golden glow of our inner rooms.

For some people, inner rooms are so private that they hardly invite themselves inside. Certain inner rooms are sealed with re-enforced steel walls, pin codes and laser eye alarm systems. What would happen if we were to invite an outsider in? Could they steal our treasures? Would they sell our shames to gossip papers? I don’t know... Is there truly anyone in this world that could be asked to be a safe keeper of our private selves? Is it not sufficient that each inner room has one supreme owner with God reigning over them all?

Were we to share all of ourselves with our families, friends and partners except that which we keep in our inner rooms would that mean depriving them of our true selves? Surely our inner rooms are just the treasured essence of the rest of us, of the outside bits. I think that the problem lies in the fact that we are primarily so harsh and unappreciative towards ourselves. If we loved who God created us to be with our very human imperfections and the influence of sin in tow, we would remain comfortable with who we are in our private thoughts whether other people also see us there or not.

What would happen if we were to the world who we are to our private selves in quiet moments?

The Girl is a Surgeon

Women are surely perfectly suited to the field of surgery. We are lauded for our ability to handle numerous tasks simultaneously. Women generally express care especially towards the vulnerable members of society: babies, the elderly and the sick. A woman on a mission will persevere in the achievement of her goal until she has spent all her resources. If a cause close to her heart is neglected, a woman will take up a cross and protect the weaker party as a lioness protects her young.

The fairer sex is known for single-mindedly persevering in spite of their own needs. Women display great aptitude in the hands-on management of disasters without getting side-tracked by ego-sparring as their male counterparts often do (which prevents finding a speedy resolution to a problem). Attention to detail and multi-tasking comes naturally to a woman.

Han Suyin (1917-____), a Chinese physician and writer, accurately noted “There is nothing stronger in the world than gentleness.” A gentle woman can achieve so much more; can break down many more barriers than a forceful man.

Perfecting the art and science of surgery is a passionate business. The practice of surgery holds drama, suspense, commitment and love. We all thrive on these, don’t we, girls? We can turn even the most mundane work into passionate artistry.

You ask: but what of the difficult hours, emergency cases inevitably come in at 3am. Babies have been waking women at ungodly hours for thousands of years. You say: but its hard work.  How many families are not reliant on a single mom to keep the pot boiling, the kids clean and healthy and a hospitable roof over their heads? Now THAT’S hard work. A woman’s ability to multi-task combined with the extra will to prove her worth in a male-dominated field more than compensate for lack of brawn. Surgery is a craft, it’s just glorified needlework. Are women not the ultimate seamstresses?

The Human Sciences Research Council (HSRC) of South Africa declared that feminisation of medical schools in this country is progressing rapidly. At undergraduate level, female enrolment in medical school in 2003 had increased to nearly 55% nationwide and 63% at the University of Cape Town (UCT).

Female doctors often practice in the public service, in primary care and among the poor. Women favour certain disciplines such as public health (80% - 93% of doctors in this sector are female), psychiatry, internal medicine, obstetrics and gynaecology and paediatrics. Those disciplines are considered to be more ‘family friendly’. Only a small percentage of female doctors even consider general surgery, and a tiny amount of them enter the field. At UCT women made up only 11% of enrolments in general surgery in a seven years enrolment period studied. Some surgical disciplines had no female students at all. The trend at UCT has been confirmed at national level by the Association of Surgeons in South Africa (ASSA), which found that across the country female doctors amounted to only one-tenth of the number of male doctors specialising in general surgery.  International surveys reflect trends shown in South Africa. US studies showed that only 6% of young female doctors even allowed surgery to cross their minds.

The feminisation of medical schools combined with so few females going into surgical disciplines implies that before long there will be a shortage of surgeons to fulfil the work load. International studies note that such high proportions of female medical graduates can lead to problems in health-system provision.  Dr Sharona Ross, director of surgical endoscopy and assistant professor at the University of South Florida (USF),  said, "if half of all graduates are women and so few are going into surgery, we are eventually going to have a shortage of surgeons.’ Dr Ross launched the USF Women in Surgery initiative. They organised a national symposium for women who are or hope to become surgeons. The aim is for experts from across America to share their experiences of life as surgeons and provide support and advice through a mentorship program to upcoming female surgeons. Dr Ross aims to attract more women to general surgery and support those who are already there through the USF Women in Surgery initiative. "We want to explore what steers women to or away from surgery,'' she said, "and promote mentoring to advance or enrich their careers."

Mignonne Brier and Angelique Wildschut, researchers for the HSRC Review of November 2006 very eloquently noted, ‘The debate has highlighted some difficult underlying issues about the gender division of labour in the home and traditional expectations of medical work. The medical profession traditionally demands that doctors should work inordinately long hours. Men have managed to do this because they have been supported in the background by women. But many women doctors do not have that support because society still expects them to bear the brunt of child and home care. Because they cannot work these long hours, they choose part-time appointments. However, it is not only women who would prefer more time for family and leisure. Male doctors would like this too. The answer to the problem lies in the sharing of the ‘invisible’, unpaid labour in the home and society and in humane working conditions for all.’ Actually, more men than women said the lifestyle and workload would keep them from choosing a career in general surgery.  

An article in the journal Archives of Surgery (2006) concluded that the real deterrent to women is the ‘chauvinistic image’ of the profession. Female medical students and registrars view surgery as an "old boys club.’ There are numerous shocking tales of sexual discrimination directed at female medical students, registrars and qualified surgeons by other male surgeons.

The Association of Women Surgeons (AWS), an international organization with members in 15 countries, is another organisation committed to supporting the professional and personal needs of female surgeons at various stages in their careers. They wish to break down barriers that remain for women in surgery.

The age of the chauvinistic, all male surgical team is over! A softer, feminine touch is spreading over the world like a Mexican wave. And I’m cheering all the way!

"It is not easy to be a pioneer -- but oh, it is fascinating! I would not trade one moment, even the worst moment, for all the riches in the world." – Elizabeth Blackwell, the first woman to receive a medical degree in modern times. She founded the London School of Medicine for Women in 1875.

References:

1. HSRC Review - Volume 4 - No. 4 - November 2006

2. Female Surgeon in Tampa Encourages other Women to go into the Field by Irene Maher. Published in the St Petersburg Times in    February 2010.

3. www.womensurgeons.org

Viva Africa, Viva!

‘Eish, Docta, I have a pain.’

‘Where does it hurt, Morena?’

‘No, Docta, it doesn’t hurt, it just pains.’

‘Sista, please give the patient some Panado for his pain.’

‘Eish, Docta, the Panado is OS (Out of Stock – read: in the hall cupboard thus too far to walk).

Anaesthetist to surgeon, ‘The patient’s blood pressure has dropped.  Can you pinch him, or cut him, or something?’

Private GP referring to surgeon, ‘Docta, I think this patient has rectoschisis.’

Surgeon, ‘She has what?’

‘She is bleeding from the rectum.’

‘Oh, have you examined her for a cause of bleeding?’

‘No, the patient told me she is bleeding. I have not examined her.’

‘Sista, will you put a dressing on this patient’s wound when you have a minute?’

‘Eish, Docta, no. We have now weked for two hours. We are going on tea.’

Sister to a friend, ‘I would never wek in a private hospital because then I’d have to smile at the patients.’

Patient having a circumscision done, ‘ Docta, can you, you know, make it longa while you’re at it?’

‘Docta, we would rather give the antibiotics twice a day. It is inconvenient to give it four times a day like you wanted.’

Referral letter from a peripheral hospital, ‘Thank you for accepting this patient. She did not receive any medication or dressings in our hospital for a hitherto unknown reason.’

True stories. No, I kid you not.

Add your own funny hospital experiences.

Ode to a Dog

It is said, “(Love is) to know the pain of too much tenderness; to be wounded by your own understanding of love; and to bleed willingly and joyfully.” And, “Even as love crowns you so shall he crucify you.”(Kahlil Gibran)

But I tell you, what a load of bull! Why would one want to “bleed willingly”? I recognise that romantic love can lead to exactly that. Refer to dear Romeo and Juliet. I say seek a kind love, a love which forgives, which adores, which comforts.

My best mate in this world, is a little ball of fluff with a black button nose and the kindest eyes which worship me day and night. The old adage of dog being man’s best friend cannot be disproved. My little Mackie will wake up from a snooze to follow me wherever I go. He senses when I’m sad or stressed. He’ll never nag me to tell him about my day but will rather nuzzle me till I’m comforted. I need only pick him up in my arms and squeeze him tight to feel my blood pressure settling down and myself becoming calm. From him, I have learned the joy and comfort of true friendship.

This love I have for my dog takes no maintenance; no long declarations of my commitment. I can return home after a thirty hour call and he’ll just know that I missed him while I was gone as I know he waited in vigil for my return. He’ll not remember my tardiness but will praise the hour I’m back with him. Even if I leave him for the twenty minutes it takes to visit the corner shop; he’ll twirl circles round me when I’m back. A wet kiss will be slapped on any part of me within his reach.

All Mackie asks in return for his free-flowing and unmeasured adoration are his daily meals and a tummy tickle every now and then. If I spoil him with a snack or a run on the beach, his little heart blossoms.

Mackie trusts me fully. When I call him to me, he knows all bodes well for him. I’ll never hurt him; I’ll save him from attacking dogs; I’ll remove a stinging thorn from his foot. Mackie will risk his life for me and he has, in fact, jumped into a turbulent stream when he believed I was in trouble.

May I always be true to my dog, as he is to me. May he always know my love and never want for anything. And one day when he passes through the Pearly Gates before me, let me remember my best friend and smile and not be sad.

“Hear our humble prayer, O God

For our friends, the animals

Especially for animals who are suffering

For any that are hunted or lost or deserted or frightened or hungry.

For all that must be put to death,

We entreat for them all

Thy mercy and Thy pity.

And for those who deal with them

We ask a heart of compassion,

Gentle hands and kindly words.”

-Albert Schweitzer’s Prayer for the Animals

Feminism Rules!

A successful adult man is going places in life – personally and professionally. A successful adult woman stays home to mother her husband – as nature intended. This, in a nutshell, is the paraphrased secret to healthy relationships of a lovely man I recently encountered who earnestly believes that God’s intended place for the woman is barefoot and in the kitchen.

I find this view so preposterous, it isn’t even necessary to provide a counter argument. What I shall do is remind us all of some of the highly influential women shaping society today. The world has been ruled by men for thousands of years and it hasn’t always done so great. I leave it to you to decide whether the following women should rather stay home to cook and clean or whether they should continue to work their magic in their particular spheres.

Sonia Gandhi is the President of the Indian National Congress and leader of the United Progressive Alliance. A Roman Catholic, Gandhi is tremendously popular amongst the people of India and exerts a tremendous amount of political power in the world’s largest democracy.

Michelle Bachelet is a qualified medical doctor and President of Chile. She is credited with promoting free trade agreements and effectively revolutionizing trade in the Latin American world. Her administration has improved women’s equality and Chile’s political and economic climate.

Yoani Sanchez defies the oppressive Cuban regime by covertly blogging on her personal observations about the struggles of the people of Cuba. She publishes from internet cafes to avoid detection and prosecution by the Cuban authorities. She won the Ortega and Gasset Journalism Award in Spain.

Mary McAleese is currently the longest-serving woman president in the world. She has worked to improve relations between Catholics and Protestants in the once-war-torn Ireland. Under her rule, Ireland now has the second highest income per capita in the European Union.

Aung San Suu Kyi is the world’s only Nobel Peace Prize winner (awarded to her in 1991) currently imprisoned. She is the leader of the National League for Democracy in Burma. As Mohandas Gandhi and Dr. Martin Luther King Jr before her, Suu Kyi believes in leading through non-violent resistance. Suu Kyi was elected Prime Minister of Burma in 1990.The military leadership refused to acknowledge the election. She remains under house arrest today.

Through her work in the “Race for the Cure” and the Susan G. Komen Foundation (named for her sister who died of breast cancer), Nancy Brinker has dramatically improved the outlook for breast cancer patients today. Recognised for her amazing abilities in running a successful charity organization, she was appointed Chief of Protocol of the United States in 2007 She is closely involved in dictating diplomatic procedure.

Lisa Randal studies particle physics and cosmology as the first women ever appointed in the physics departments of Princeton, MIT, and Harvard. In 2004 she was recognised for being the most cited theoretical physicist of the preceding five years.

The only woman currently serving in the US Supreme Court is Justice Ruth Ginsburg. During her confirmation hearings, her refusal to answer questions regarding her personal opinions on issues such as abortion, civil rights, separation of church and state and gun control, became known as the “Ginsburg Precedent”. The concept behind the precedent is that a Supreme Court Justice should be impartial and rule according to the stipulations of the law and the Constitution, not their personal opinions. Two other judges sat before the same committee for their own confirmation hearings years later. They each cited the Ginsburg Precedent as justification for not answering similar questions.

Fortune magazine ranked Maria Ramos as one of the most powerful women in international business for four consecutive years (2004–07) and one of its top ten female global leaders for 2009. As CEO of Transnet, South Africa’s largest transport company, Ramos transformed South Africa’s economy by reorganizing Transnet from an inefficient and indebted company to a profit earning establishment.

Mamphela Ramphele is a South African academic, businesswoman and medical doctor. She is a current trustee on the board of the Rockefeller Foundation in New York. Ramphele is the first South African to serve as a Managing Director of the World Bank.

Dr Susan Vosloo saves the lives of paediatric cardiac patients by performing highly complicated operations. She became the first female cardiothoracic surgeon in South Africa in a field dominated by oppressive male forces.

Ellen Johnson-Sirleaf of Liberia waited tables to pay for three college degrees, including her Master's at Harvard University. She was imprisoned twice for speaking out against Liberia’s ruling military regime. In 2006 she became Africa’s first elected female president.

Queen Rania of Jordan, the world’s youngest living queen, actively campaigns to improve education and women’s rights in the Middle East.

My advice for the archaic male: get with the times, and pick up your game. Support the successful women around you. Be proud of them. They are the ones who will change the world for the better.

References:  

1.     The Top 20 Influential Women in the World Today – The Feminist eZine.url

2.     Maria Ramos – Wikipedia, the free encyclopedia.url

3.     Mamphela Ramphele Biography form Answers.com.url

4.     Women Changing the World – Oprah.com.url

Spring Time

Spring is in the air. All around me the earth is brightening. The folks in my little out post are more rambunctious than I’ve ever seen them. It’s as if there reins a certain freedom to speak louder than the whispers winter’s oppression allowed; to wear brighter colours.  Folks have a hop in their step. The new season brings with it the promise that excitement lies just around the next corner.

In celebration of this felicitous feeling I shall wear bright garbs myself. In my line of work, one doesn’t often have the chance to dress up as office workers do daily. It’s usually scrubs with tackies and if you’re not on call, you might go for jeans, comfy tops and reasonable shoes. It takes one long day on your feet to cure you of the desire to wear heals or pointy tips ever again. Scarves and necklaces inevitably dangle in open wounds. Bracelets and rings have to be removed when donning gloves. Those gloves are covered in a flour-like powder that will leave white blotches all over your clothing.

The most hilarious apparel available to the medical profession is theatre scrubs. These are not the tailored light blue ones modelled in Grey’s Anatomy. Ours are a foul-shade of dark green. They are specially created to be the most unflattering garments on the market.

In order to enter the aseptic theatre environment one has to first scavenge for the most suitable green linen top and bottoms from a jumbled mass of newly laundered scrubs. On occasion I have found scrub tops where the entrance to the sleeves had been sewn closed. I’ve found a pair of pants with one leg a foot long whilst the other was three feet long. My favourite treasure was a pair of pants broader in cross-section (round the middle) than the legs were long. If the doctors in Grey’s Anatomy were to be dressed in these green clown’s gowns they wouldn't possibly be tempted to do a spot of frolicking in the store cupboard.

Staying Alive

I was recently introduced to the term NAFI by one of my friends and fellow bloggers.  A NAFI refers to a patient with No Ambition and F-all Interest. Before you log off in disgust at me being so judgemental, let me just explain how the concept manifests in practice.

A mother recently brought her six year old child to me after she’d sustained burn wounds for the second time in her life. On both occasions, she’d been sitting too close to the fire, so much so that her clothes caught alight. The mother elected to bring her to hospital an entire month after the burns had occurred with the result that the wounds were septic. The mom showed no sign of being concerned about the child, worried that the same accident had happened again or at least upset that the girl would have to be admitted to hospital for a number of weeks and receive skin grafts. On my probing, she admitted that the girl likes sitting close to the fire, so she allows her to do just that. The child caught alight twice while under adult supervision!

Compare this to the case of the eight month old left alone on a bed with a bucket of boiling water or that of two four year olds allowed to play with matches. You may think these are isolated cases of child neglect but I promise you, one sees these things on a daily basis. Accidents happen, sure, but the difference here is that these people take disasters in their stride. They either expect nothing better of life, having been dealt a rotten lot before. Or they just don’t have a sense of being worth more; being able to work towards a better life. What shocks me every time is that the parents of these children are relaxed when they bring their kids in. If my child had been in such a horrific accident, I would be in a frenzy of concern. I’d cry with my child. I’d ask the doctor a million questions on whether the wounds would heal; if it’ll leave scars; if there would be permanent sequelae. I would just seek to know whether my child was going to be okay.

A mom brought her two year old to casualties after a near drowning. She was so lackadaisical about the whole event, I couldn’t believe my eyes. Surely anyone would realise that drowning kills. This particular mom was not concerned enough to have answers to my basic questions: when had it occurred; how long was the child underwater; was the child unconscious when she was retrieved from the water?

These parents have as little hope for their children as they have for themselves. Even if they are poor, even if they are uneducated the basic human wish of wanting better for your children than you yourself has had should prevail. Ambition needn’t be big and awesome: we don’t all have to be real estate magnates, talk show hosts or beauty queens. What about just trying to stay alive and stay healthy. HIV prevention campaigns might actually be successful if people expected that they might stay HIV negative even though everyone around them is dying from AIDS and if they believed that they were worth fighting for, even if the only warrior were themselves.

Plump, Rosy-Cheeked Babies

My grandmother, who is a very level-headed, dignified elderly lady, recently suggested I look into sperm donation instead of the dating game to find the father of my future children. Needless to say, I have not had a very successful run with relationships. My experience is that South African guys' interest is tweaked when they hear that the girl is a doctor. They immediately think (and some say aloud), “Wow, you must be so clever!” This is inevitably followed by, “Ooh, you must make big bucks…”

The guy quickly catches on that being a doctor does not mean you’re loaded but rather that you often have to work late; get up at night to go to work and cancel dinner dates because you’re caught up in theatre. Their natural instinct of wanting a nurturing figure to adore them 24/7 takes over and things aren’t so rose-coloured anymore. Add to that, that the girl doctor is often more independent, ambitious and sometimes higher earning than the guy and he almost certainly develops an inferiority complex.

One could suggest that a straight forward solution would be to marry a fellow doctor. Many girls do precisely that.  Imagine though the dinner time conversation one would have for the rest of your life: just medical jargon. No wonder so many doctors' kids go into the same field as their parents: they’re never exposed to any other life. Most male doctors would still prefer to marry a nurse than a fellow doctor. It appears that such a partnership suites the male ego better than the doctor-doctor alliance.

My gran herself was married to a doctor and raised three children.  She taught Afrikaans and Geography for a number of years before settling down with my grandfather and running his medical practice. She is well-educated and enlightened especially so for the times in which she grew up. Even so, she followed a fairly traditional course in love and marriage. For her to have considered sperm donation as a way of furthering her own gene pool via her only granddaughter is rather revolutionary.

I recently read an article in a popular magazine about this exact topic. The magazine featured the three most sought-after sperm donors in Europe. All three were of Scandinavian origin; all three boffins of some sort; ambitious and not too bad looking (though rather nerdy). Women from all over the globe, including some South Africans, requested these guys’ genes to mix and mingle with their own and form hundreds of new little earth walkers. It seems that women are drawing on sperm banks much more frequently than I had ever imagined.

The question is: why are we not finding suitable mates? There are more females on earth than there are males and therefore not every girl will find a partner. Besides that, it seems that all the good-looking guys turn out to be gay. Then there are the cry-babies, the mommy’s boys, the a-romantics and the plain villains. Neither a good option. One of my theories is that all the chemicals and hormones in our tap water nowadays, a major one being Oestrogen, interfere with the development of a proper man. In my grandmother’s dating years, the men were strong; their greatest aim was to protect their family against any form of predator. They went to the army where they had to carry about heavy poles and survive in pouring rain storms for weeks on end. They came home with emotional scars but also biceps. A man would retire at the end of a working day to a cigar, the evening paper and pensiveness. Today’s male needs elicit steroids to develop muscles. The ones who don’t bother are called metro sexuals. They write poems and discuss their feelings without being prompted.  If you seek the rougher sort you end up with the type that dangle their pants under the bum line, reek and smoke ciggies. They're bound to disappear as soon as you ask for child support.

So, would I opt out of this hazard-strew mating game and browse the internet for a suitable sperm donor as my granny suggests? Goodness, that might be a much scarier prospect. And what would I tell the child? I don’t think I’m broody enough yet to take this suggestion seriously. If you’re reading this and have actually gone that route, please let me hear your views.

Someone once said that to love is to have your heart broken. This may be so, yet most of us plunge into the obstacle course of having our hearts broken numerous times in the hope that perfect and full-filling love awaits us round the next corner. Is that all-amazing, flying-carpet, fairy-tale in-love feeling worth sifting through the pant-hangers, the steroid poppers and the mommy’s boys for one’s perfect fit. Currently, I’d say I’m still willing to take the risk and play the game.

The Noble Masochist

I’ve worked straight through a thirty hour call more than once, not sitting down, not passing wet or dry over my lips. It is often simply too busy to take even a moment to have your supper. One may be caught up in theatre and once you leave there, go straight on to casualties where you have a backlog of six patients needing to be seen. The first chance to catch one’s breath may be at 3am, by which time you have a dehydration headache and hypoglycaemic dizziness.

Were you to ask a group of doctors whether their own stomachs take precedence over seeing a sick patient, ninety percent of them will most certainly postpone their own needs and go to sort out the patient. Surely this is what is expected of us. We signed up for a life in medicine and that means that we’ll get up on the coldest night of winter and drive through a rain storm to get to hospital if needs be.

I’m not complaining. There's a small pocket of secret pride in my heart knowing that I’ll stay in theatre until the end of the list, even though I’m post-call and can’t feel my feet anymore after traipsing about on them over the previous day and night without sitting once.

I could leave a couple of stable patients waiting to take a supper break but I expect ‘better’ of myself and would just feel guilty while not attending to them. I’ll jump on a patient’s chest to start CPR even when dressed in a designers beige coat, getting blood stains on it, because there’s an immediate task needing my particular attention.

Could it be an elevated sense of my self-worth, my worth as a doctor that makes me fore go my own basic needs? At my varsity's final graduation ceremony, one of the top dogs in management said that our families and we should stop complaining that we are sent into particularly dangerous squatter camps to visit the clinics there. Some of my classmates had reported being high jacked and suffering intimidation on those trips. The official’s view was that we have signed on to do medicine and should know that going to these dangerous areas was part of the course. Moreover, being in such testing situations would make us better doctors. Have I been brain washed to set my own health and well-being aside for my job? Do you do the same or is the better doctor the one who keeps himself mentally and physically healthy so he may draw on his own strengths when faced with taxing situations at work?

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Diplomacy

I have a patient in the ward in respiratory distress. I ask the nurse to please change the patient from nasal prong to face mask oxygen. She simply doesn't budge. When I ask her again for the mask, she replies that they don't have any. (No face mask oxygen!?!) The patient's saturation has now dropped to 73% and he is very tachypnoiec. I ask her to kindly find a mask. Then she says to me she's not going to because she doesn't think the patient needs oxygen.

This little scene has made me consider the concept of conflict resolution in the workplace. Numerous variables play a role in complicating the issue: The nursing staff are often older than the doctors in South African hospitals as junior doctors have to serve a number of years in state hospitals before being able to move to private practice. This introduces the awkward situation of giving instructions to a lady who may be your aunt or mother.

Secondly, strong cultural divides still exist in South Africa. The indigenous tribes still afford their leaders and nobility a high level of respect. If you happen to be a descendant of a rival tribe or a commoner, you can surely not be taken seriously if you aim to give instructions to a person of a higher social or cultural ranking than yourself. Unfortunately and despite more females now qualifying than males, the male doctor is much more respected than the female. Remarkably enough that divide is most severely enforced by the older female (patient and nurse alike).

There is also the unfortunate age-old conflict between nursing staff and doctors. The two professions run alongside each other and are meant to compliment each other in different and specific ways. When the one encroaches upon the other, either side has to back down and accept leadership from the other. This does not sit well with human nature. Unfortunately I have to acquiesce that doctors have in the past era of paternalistic medicine forced instructions upon the nursing staff with a certain unattractive bossiness. As a result there is a feeling amongst certain nurses, perhaps the ones previously disrespected by an egoistic doctor, to suppress the young doctors' sense of self-importance before it can impact on the nurse.

With that we return to the common goal of treating patients, ensuring their comfort and healing them as far as is possible within our human limits. From my training it is quite clear to me that my patient is in serious need of oxygen. This is not the time for pussy-footing or shying away from a conflict situation. The patient's well-being is the top priority. Before revealing the outcome of this little scene, I'd like to invite you, my reader, to contribute your own tested methods for dealing with workplace-related conflict and suggestions to resolving my patient's dilemma.

In Cold Blood

The South African medical fraternity lost a friend and colleague this week. A young doctor serving his community was murdered in cold blood by an allegedly mentally-ill patient. This same patient had attacked a couple of nurses some years back. This event has sparked a minor outrage amongst other doctors in the public service. We all realise that it may just as well have been ourselves ruthlessly attacked in the line of duty.

A magnitude of perils face the average doctor in South Africa. The transmission of blood- and airborne diseases is a topic quite worthy of its own discussion. Simply focusing on violence in the work place, one has to mention that convicted criminals comprise a large section of the patients seen. I have witnessed, on many an occasion, the guards accompanying prisoners, releasing their shackles and leaving them quite unattended in order that they, the guards, may have a little smoke outside under a tree. This leaves the prisoners free to act in any way they so please. A young, female medical student may, in such a situation, find herself alone with the inmate. His hands are free to grab at her or at any sharp object available in a hospital room. His legs are free to carry him out the door.

When consulting mentally ill or violent patients, we are taught to arrange the consulting room's furniture in a manner that will allow the doctor to be seated closest to the door, the escape route. I've seen this rule followed only once or twice. As a matter of course, patients arrive drunk or stoned in casualties, most often on the first weekend after pay day. In this inebriated state, they are violent and strong. Not only do they show case a vocabulary that would make any sailor proud but they often lunge at one, biting and kicking.

I gather that the Mpumalanga Department of Health is implementing a number of changes in the security systems at hospitals in the province (where the young doctor was murdered). I'd like to remind us all of the daily dangers bravely faced by health care workers in South Africa and challenge the powers that be to improve the security in hospitals countrywide.

Life Force

I hold his heart in my hand, and squeeze, squeeze, squeeze, trying to maintain a steady rhythm of 100 beats per minute. The heart has lost its own ability to maintain the circulation of blood around the young man's body. With my hand cradling the flaccid muscle, I usurp the life-maintaining contraction. At the head of the table, the anaesthetists scurry about, injecting vile after vile of adrenaline, attempting to jerk the heart back to life. The man is not dead yet but kept in a deep slumber unaware of the struggle and the stress around him.

Fifteen minutes earlier, the youngster had been fully awake to this world. He was brought to casualties slumped over the shoulder of his friend, his gangster brother. It was this 'friend' who had applied the blade, with a smooth, vicious thrust, straight into his left precordium. The blade shattered his 5th rib, plunging into the soft recess of his right ventricle. The knife handler had quickly withdrawn his weapon. Knives cost money and he doesn't have all that much to spare at present. 

My hand still cradles the heart, rhythmically squeezing the blood out. By now my hand is cramping but I cannot withdraw. Without an adequate circulation, irreparable damage will occur to the vital organs, including the brain. Then, I feel a slight twitch in my palm, very faint, quite easy to have been my imagination. Then another, stronger now. The man's heart is beating again. I let go, and all the theatre staff peer expectantly at the monitors: a normal sinus rhythm. I thank the Lord, we've been given another chance.

With the blood pressure rising, the stab wound to the right ventricle becomes very obvious again: a fountain of red spurts to the roof with every beat. My finger flies to plug the hole. Now the surgeon's skills will be put to their greatest test. While constantly moving and spurting blood, the surgeon needs to place a suture around the hole and tie it gently but firmly. If he handles the heart too much it may revert to a fibrillating rhythm, or cease beating all together yet again. The coronary artery lies just adjacent to the stab wound. Should the surgeon place his suture through this artery or tie it off, the patient will instantly have a major heart attack and a large section of his heart muscle will die off, severely decreasing his chance at life even if we do manage to close the spurting hole.

Downstairs, the young man's attacker paces the corridor. He prays that the doctors do their job, he's not ready for a murder conviction, just yet.


Miraculously, years of training and practice pay off, the surgeon places his stitches in the perfect position and the spurting stops. Again, I praise the Lord, this time with tears in my eyes.