Responsibility

Should we not expect our patients to take some personal responsibility for their health? Along with apartheid paternalistic medicine was swept out the door in 1994. Treatment cannot be forced upon a patient who doesn't wish to take part. Our constitution very clearly reflects this principle by ever lowering the age at which consent to medical and surgical procedures may be granted. A 12 year old may now either consent to or opt out of an operation. Even if a doctor knows that the patient is choosing to walk a road which will surely be strewn with nettles, if the patient is of sound mind and has been adequately informed, she can choose not to have life-saving treatment.

Eight months ago I saw a middle aged woman at the clinic with what was clinically quite obviously a cancerous growth in the breast, threatening to break through the skin. The fact that, before presenting to me, she had already waited what must have been several months since she should have realised something unusual was growing in her, made me suspect that she was too scared to face a doctor and for her worst fears to be confirmed. Such a response is quite predictable and, of course understandable. I am not blunted to the human feelings of trepidation and doubt which we all experience. I, thus, obviously counselled the patient and explained, in simple terms, the different options available to her for obtaining local control of the tumour if not to save her life. I ran a set of tests to confirm the diagnosis and prepare the patient for a radical mastectomy within the following two weeks.

Yesterday, the same patient presented to me again at the clinic. She'd never had the mastectomy. She presented on the correct day for her scheduled surgery. An open biopsy was done and she was given another follow up date at the clinic. This is were things got hazy: the next we saw of her was earlier this week. She says admin never gave her a follow up date. Our notes clearly request a follow up date. What I'm getting at is that this patient should have made sure she got to see a doctor again. Whether or not admin booked her into the system, she should have made sure to see us again, to ask for a date. In the subsequent six months she carried that growing tumour with her every day. Surely she should have questioned what was happening to her, thought it strange that after the last surgery she never got to see the doctors again. The constitutional court of law entrusts a 12 year old to consent to an abortion which may complicate and result in a septic uterus, emergency hysterectomy and loss of the ability to ever bare children. Yet, a grown woman, fully counselled, of sound mind, could not ensure that she had a follow up date to see her surgeon.

During the six months since her last visit, the mass in her breast ulcerated through the skin forming a massive crater. It invaded her chest wall and matted her axilla. By now it would have spread to numerous other organs. In a word, it now is irresectable. The smell from that tumour is so pungent, it makes your nose sting. Local surgical control six months ago would probably not have saved her life. It would have saved her dignity.

Putting on the green

My current neck of the woods is somewhat well known for its spectacular golf courses. Acres of manicured green lawns attract some of the great names in the golfing world. With that, of course, comes the inevitable golf estate lifestyle. White gabled villas connected by neat cobbled pathways dot these urban oases. Where previously, wild birds chirped in tree tops, neat ponds have been dug to house the ever popular Egyptian goose. Men in white pants and pink shirts toddle about with silent entourages a respectful distance behind. (Whether silent out of respect or bordom, I'm never quite sure.)

As an ironic comment on societal inequality in South Africa, an informal settlement of 'previously disadvantaged' citizens (though when exactly 'previously' stopped and currently began, I can't say, as things certainly have not improved for them since the days they were 'disadvantaged' ), is located just across the road and around the corner from the fanciest golf course / urban estate of the lot: Fancourt. The ruffians patients who keep me up on a Saterday night treating their post drunken brawl head injuries, suturing their faces back together, inserting intercostal drain after intercostal drain for stabbed chests largely come from that exact informal settlement.

So, when last wednesday afternoon I drove past a group of youngsters from the informal settlement wielding sticks on a patch of grass by the roadside, my first thought was that I should probably call the police because skulls would be cracking soon. Imagine my bittersweet surprise when five more young guys rounded the corner each carrying a single golf club. They were all just meeting up for an innocent round of golf! Some were barefoot, none had any golfing equipment except for the single club but they looked excited to join in the fun of a sport well played and shared amongst like-minded fans. In a town of fancy golf courses and million rand championships, these guys were not going to miss out. Their putting green was jagged, littered with the occasional broken bottle top but that wasn't going to dim their eagerness. They had an appointment with the guys for a wednesday afternoon round of golf.

A doctor's very best friend

Stilettos

Only a woman would wear a pair of stilettos that will inevitably leave her feet two painful blistered wrecks, simply because they are pretty and feminine and make her legs look svelte. (For that reason and of course for the wonderful foot massage her man will give her in the evening!) I worked with an Obs and Gynae reg who insisted that wearing high heels on her overnight calls was more comfortable than the very unflattering flat crocs the rest of us shuffled around in. 

Women are good at ignoring pain or just setting it aside, if there is a worthwhile reason for doing so. It may be the lovely way that your new heels compliment your outfit. Or a more selfless reason: encouraging your kids to spread their wings and leave the nest so they may grow and develop while you cry your heart out because your babies are gone.

I've always been under the impression that if one indulges in emotional pain you give it more power. I thought the best way to deal with hurt and disappointment is to try not to recognise its existance. Pain and sadness is part of life but there's no point wallowing in it. Instead of allowing sadness to affect my person, I would concentrate on getting on with life. My masterplan was not to ever get hurt by simply not allowing myself to FEEL the hurt. I thought that a person who breaks down in a flood of tears over something non-earth-shattering was just being self-destructive by indulging in the bad emotions.

Then I heard about a study conducted by a group of psychologist that unequivocally proved suppressing negative emotions is dramatically more damaging to the body, in a physical sense, than feeling the hurt and crying is. Participants in the study were hooked up to a number of monitors, measuring pulse rate, blood pressure etc. Couples were asked to discuss topics that both parties felt strongly about. These topics evoked strongly negative emotions in both. One of the parties would be asked to suppress all feelings about the topic and remain calm. The other party was instructed to react in accordance with their feelings on the topic. Then they would alternate roles.

The heart rate monitor beeped like crazy and the BP went through the roof every time a participant was suppressing his negative emotions. The cardiovascular derangements lasted longer in the outwardly controlled person that in his "emotional" counterpart who experienced only a brief surge in stress markers with a quick return to normal levels as his emotions were allowed a release.

It appears that the human body is equipped to deal with negative feelings by expressing them. Getting "worked-up", sad or angry over something and really FEELING and expressing the emotions is the healthiest, most natural way of dealing with stress. I was quite shocked, to be honest, to learn that my survival strategy was causing me more long-term hurt than protection from pain, as I'd thought.

So, since I learned of this remarkable study that disproved one of my core principles, I am no longer avoiding my stilettos. I now wear them with the full knowledge that my feet may be blistered by lunch time. If my feet should hurt I'll admit to it and I might even cry about it. Does this strategy seem a little pointless to you? The point is that I'd get to enjoy my legs looking lovely and svelte which wouldn't have been the case if I'd hidden my feet in the protective recesses of my old crocs.

Words

A few of my favourite things... So much meaning lies in a single word. As you read these lovely words allow them to carry you away to a treasured memory or a sweet dream.

Felicity ~ pleasantness                                                  

Ebullience ~ bubbling enthusiasm

Gambol ~ to skip or leap about joyfully

Mellifluous ~ sweet sounding     

Ethereal ~ invisible but detectable          

Halcyon ~ happy, sunny, care-free

Dalliance ~ a brief love affair       

Inglenook ~ a cozy nook by the heath    

Buoyant ~ hopeful               

Luxuriant ~ opulent, lush     

Petrichor ~ the smell of earth after the rain

Serendipity ~ finding something nice while looking for something else

(Picture down-loaded from the blog fanciful-fanciful.blogspot.com)

Perennial rookie

I was still a student when a school friend of mine banked her first adult salary as an actuarial assistant. When I finally graduated and reached the dubiously honourable rank of intern, she was already an actuarial consultant, in charge of large contracts.
In medicine you're never certain of whether you've actually made it. When I was adressed as "doctor" on my first call as intern and I had to make potentially life and death decisions as is expected of a real doctor, I assumed the nurse had addressed someone standing behind me. The community and one's family think you've really achieved something great if you're a doctor. There is still much respect for the profession.
Amongst other doctors though, an uncompromising ranking system is strictly observed.
As a meagre little intern, you might just feel a bit chuffed with yourself for making a good diagnosis or performing a procedure well. Your students might gather around you, eager to see the signs you've picked up in your wisdom. Be assured though when you present the case to the registrar, it will transpire that you missed the most important sign and the patient is sick from something completely different than what you had just been describing to the students. A good thing the sister knows best than to trust your diagnoses: she waited for the reg to see the patient before administering the meds. Your prescription would have been completely inappropriate.
But soon the house of cards come down again. The registrar who appeared so knowledgeable and accomplished the night before, is brought to his knees by the consultant on the next morning's ward round. As it turns out, the reg himself had failed to address a vital aspect of the patient's management. What's more, and a seemingly and infinitely graver mistake is that the reg cannot quote the specific study which proves that the patient should have been managed differently from the way the reg elected to manage him. This entire exchange between the registrar and consultant occurs on the grand ward round, in front of the patient (!), the students, interns and other registrars. The reg feels so stupid and wonders whether he shouldn't just go straight back to med school, or possibly quit medicine all together because he obviously knows nothing at all. Now he has to return to the patient and keep treating him. The patient, having heard the entire exchange, believes his doctor is useless and doesn't trust him anymore.
Don't make the mistake of thinking you've finally made it once you yourself are the consultant. Your colleagues are bound to raise their eye brows at some ofthe diagnoses you make, and some of your treatment plans. As you become more specialised in your field your focus narrows and as a consequence you become less adept at treating diseases you don't deal with daily. You might not be able to answer a general medical question posed to you at a dinner party. Your friends don't understand the subtle nuances of your speciality. They just think its great that you're a doctor and as such must know everything.
While my non-medical friends are settled in their careers, safe in the knowledge that they know what they're doing and can, with relative certainty, expect the same results from similar situations on a daily basis, I keep riding the rollercoaster of knowledge. Each day brings the chance of feeling completely out of my depth, too junior and unsure. The only certainty is that one doesn't outgrow that feeling.

Getting back my mojo

The Urban Dictionary defines one's mojo as your sense of purpose and meaning in life. Your mojo is your personal energy and charisma, your cool or style essence. Mojo is that little bit of majic that sets you apart from everyone else. Its that sparkle, the passion that makes each person totally awesome in their own unique way.
Sounds just epic to me! Wonder where I could buy me a bit of that stuff. I never knew I had me a little mojo until there was a void where my mojo used to be. I had regressed to a place where I hated my job. It had become monotonous and frustrating and didn't stimulate me as it used to do. Despite that, my personal life was being neglected as I was spending all my time at work. I was stuck in a rut.
Now, I refer you back to my very first post on this blog. Its all about a stab heart. I just LOVE stab heart cases! I don't mean that in the figurative sense but actual knife-through-the-heart surgical cases. I do say this with the utmost respect to the patient involved. To be so close to the physical life force keeping a body pulsing, and to really see the fragility of life in such a dramatic way, can only jolt one's mojo back into your own personhood.
The specific patient I refer to was rushed into casualties by highly charged ambulance men, very aware of the urgency of the situation. A jagged 10cm long wound cut across his left precordium. Blood bubbled out in gusts with every gasp he took. I explored the wound with my finger. Under the sharp edge of his fractured rib, I could clearly feel his, already weak heart beating. After rapid resus efforts we rushed him to theater; sawed open his chest; stopped the bleeding; and with God 's grace, granted him another chance at life.
The adrenaline and, I guess, the sense of achievement jolted life back into me too.
As we pushed the patient into theater, he stopped me. With effort, he whispered, "Doctor, do your best." I was truelly moved. I don't only have the responsibility towards myself to be connected to my job and my life but other people depend on me to pour my energy and passion into being the best doctor and surgeon I can be.

Entitlement

The current economic environment and pricey private medical care has lead to many previously advantaged people now having to rely on state medical facilities. A state-employed doctor's worst nightmare patient nowadays is no longer the drunk, verbally abusive guy dumped at casualties by a police pick-up van with a couple of stab wounds in the chest and as many scars from previous drunken brawls who vomits stale papsak wine on you. Recent times have created a much more feared patient: the PANDA ( Previously Advantaged Now Disadvantaged ). This is the white lady with the manicured nails and beehive who can no longer afford her private GP's fees so has to submit to state provided medical care. She always arrives at hospital with an entourage: the highly-strung husband who feels like a utter failure for having to bring his pretty wife to a state facility where she is forced to sit in the same queues as her garden boy and domestic worker. Instead ofverbalising his feelings to his wife, he has become moody, added 20 kg to his midrif and has been banned from attending family get togethers following a certain incident concerning his brother-in-law, CEO of a successful company, and a black eye. Also in tow is the bored teen who would rather be slouched in front of his play station but couldn't be left home alone after his mother discovered a little packet containing an unidentified white powder in his sock drawer. And of course, the concerned granny, because the patient needs some form of support and the husband and son clearly don't fit the bill.

So here's the scenario: casualties is busy, as per usual. There are long queues of patients to be seen. The folders are stacked high. As per protocol patients are classified as red, orange or green. Red meaning they are seriously ill and often in mortal peril. Obviously those are seen first. Green patients have non life-threatening complaints and stable vital signs. You are rushing about trying to sort out your patients as best and as fast as you can when a very agitated PANDA husband comes up to you, "Excuse me, girly,  when will my wife be seen?" 
"I am Dr Guinevere, Mr Panda. Have you opened a folder yet?"
"We arrived before the man you've just been examining, and my wife is tired, and I have to be at work in the morning. We can't wait any longer."
You look to where the man is gesturing and quickly spot the only white patients in the waiting room. Sure, the wife looks tired, the son morose, the gran is apparently admonishing the young girl with babe in arms beside her for her teen pregnancy.
"I'm sorry you're having to wait, Sir. I had to see the gentleman who arrived after you, first because he is very seriously injured was about to die. You might have seen the paramedics bring him in on a spinal board with head blocks, noticed the endotrachial tube in his throat and the nurse giving him oxygen via a face mask. Perhaps you also saw that his leg had been severed just above the knee, was oozing blood in a steadily weakening stream as his blood pressure was falling and his heart quickly weakening, on the brink of asystole. I had to help him as a matter of emergency, you do understand, Sir."  Mr Panda goes to sit down and is placated for a full 5 minutes. Or is it perhaps queasiness with the mildest green tinge you spy round his mouth? Wife and gran give hubby a look that says so clearly they both think he's an absolute loser for not being able to afford the luxuries of the Mediclinic waiting room. Not 10 minutes later, Mrs Panda stands before you.  Mascara slightly smeared  and lips too pale but still poised on high heels, she holds on to granny's arthritic hand for support. The sullen teen has obviously been told to get up and help his mother but he drags behind, dying from embarassment behind his greasy fringe. Just as your eye catches Mrs Panda's, she starts moaning bitterly and grabs hold of  her abdomen, bending over double. 
"Dear Mrs Panda, won't you sit down before you hurt yourself. I'll ask the nurse to give you something for the pain." 
"I don't want an injection, I want the doctor to see me." She drops the charade and hands you her cellphone. "Here, speak to Mrs de Klerk, she's the dominee's wife you know, and her son-in-law is an orthopaedic surgeon in Australia. She'll be able to tell you how serious my condition is and that I am to be seen right away. And do remember that I can't have penicillin or voltaren because of my delicate constitution."
"I am sorry for the delay Mrs Panda, kindly sit down and await your turn. Everyone in this casualty is ill and will be attended to." You hand her telephone back to her and indicate the full waiting room. There is a dehydrated baby with sunken eyes you know you'll have to attend to quickly. An old man is coughing up blood. He has either TB or a lung tumour. A mom is comforting her toddler who has a rash that looks suspiciously like measles. Next to her is a man covered in bloody crusts from a wound to his scalp.

 I wouldn't very much like to wait hours on end in this waiting room full of unpleasant smells and infectious diseases. Some of us have experienced air conditioned waiting rooms with old editions of Fair Lady and Weg to page through. Others have never had this luxury. No matter how uncomfortable a state hospital's  casualty set-up is, all the South African hospitals I've worked at have provided care of a very high and academic standard to their communities. With the advent of the NHI ( National Health Insurance ), patients from the extremes of social backgrounds will be thrown together more often. It will make for a very interesting study in social adaptation and human tolerance. Whether South Africa is ready for such a dramatic amalgamation of the classes I find doubtful. 

Mrs Panda, glances over her shoulder, in a soft voice, discreetly, she says to  you, "Ag, kom nou, Sussie, jy's mos een van ons. Sit nou die Tannie se leer bo-op die hoop dat ons volgende gesien kan word."

I will survive!

What makes a person survive stressful life events? Over the last, say two months, I have collected a crippling burden of stressful events. I share these with you not to invite pity but to illustrate humanity's caring nature and the endurance of man's will to survive. My life crises come nothing close to what we know many individuals to be faced with in war and famine and natural disaster situations. I don't claim that my lot is at all comparable, only to recognise that each person's little problem is huge to them, as it affects their daily life and future plans.

So, within the past two months I have endured the death of a close family member; the break-up of a romantic relationship; I moved towns and provinces meaning that I've had to make new friends and get to know new colleagues; moved to a new job with much more responsibility and strenuous working hours; become a student again and faced majorc career choice questions; survived a financial crisis; faced possible eviction; had a tumultuous emotion-laden Christmas and holiday season including unpleasant in-law encounters and a major change in social life and circumstances.

The Life Event Stress Scale ranks a number of stressful life events according to their likelihood of leading to stress-related illness. I tipped the scales well over the 350 mark with my recent collection of stressors. So I am well warned of having a 'high susceptibility to stress-related illness'. (You'd be glad to know I'm taking my vitamin Cs religiously.) I have included a link to the above mentioned scale at the end of this blog.

The question is thus, how do we carry on when our dreams are shattered, when our foundations are crumbling underneath us, when there seems to be no hope left in the world? Drink and drugs are always an option. Make of this what you will. Life has to go on and even though we cannot face doing much other than sticking our heads in the sand and pray for time to mend our worlds, responsibilities can be shirked only for as long as our colleagues and friends will pick up the slack. Even before we can imagine doing so, life forces us to start anew and just get on with it. I'm still waiting to catch up with my life that has seemingly continued around me, without me.

The point I want to get to is that there was love and hope to be found in the most unexpected places when I most needed it. Let me illustrate: not knowing a single soul in a new town especially during a time when I needed my friends and family around me was extremely daunting. I felt very much alone, left out in the cold to wither and wilt in my own hopeless, lightless hole of self-pity. The first ray of light strove to break through when I discovered a beautiful arrangement of wild flowers from my garden on my kitchen counter. My new maid, whom I'd met only once or twice had heard about the passing of my loved one and did something truelly thoughtful and kind for me. It touched my my heart deeply. The second blessing came in the form of a plate full of delicious, steaming, home-cooked food delivered to my front door by darling neighbours. Their timing was just right. I had nothing appetising in the fridge, it had been an especially long day at work and I was seriously considering having Kellogg's for supper. Theyd didn't know me but for having shared a coffee over the fence; I was hardly going to have a heart-to-heart with my brand new neighbours but they showed such care and support in a very practical way, it brought me to tears. I felt more part of my new community than living there for ten years would have done.

Then there is the ex-landlady left behind in Cape Town two years ago who shows me pure, unselfish support. She regularly phoned or emailed me over the past few weeks just to pray for me or share a few words of strength and guidance. When I was too overcome with grief to answer much in return, she understood and never allowed her support and kindness to wane. Her messages always arrive at the most applicable moments - when I'm on call at work and in need of divine strength or home alone and needing a pick-me-upper. I cannot neglect to mention my family, especially my mom and aunt, who despite having to face their own tremendous sorrow, have carried me through the very bleakest of moments, completely neglecting their own well-being in order to see to mine. There is no greater love than that.

Even though the road is wrought with pot holes and all sorts of miserable, nasty things, there remains a beautiful side to human nature. Love and kindness are alive in this world. Thank you to my angels for showing that you care.

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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