Practising medicine... Literally

I suppose the best thing about being out here is that you get to give everything a try - this is also the worst thing. Patients don't seem to care when you explain that you're a student and that you're going to do so and so procedure on them (probably because at least it's getting done!).

So I left off with our last day of ATLS, which was good fun. We got to play Sister Hope Less, in which we offered absolutely no help, and made ridiculous mistakes so that they got stressed (and then we were nice in their exam scenario)
One of the boys from Newcastle was being the "patient" who had a GCS of 8 and I learnt a new way to test response to pain - NIPPLE CRIPPLE, not once but twice, I thought I was going to die of laughter.
Anyway, we finished at lunch time and we had made plans to have a braii at ours, so we went home and I fell asleep on the sofa. When I woke up the boys had foraged for a mountain of drink and food. Excellent hunter-gathering. We got a good crew going, had a barbecue and then hit the town! We went to downtown Joberg, to a bar called Kitchener's and boogied the night away. Amazeballs. I was home by 2am because I was super super tired, shortly followed by one of my housemates and a girl we'd said could crash on the spare bed in my room (do she could come out after the BBQ) and then the last 2 warriors finally strolled in at 4am.
One of our party did not even make it out the front door though: after chugging a bottle of red wine, and a beer for a ring of fire violation he painted the downstairs toilet red (and broke one of the decorative wall plates) whoops!
Saturday evening I went in for what should have been a 24h call, but I was in no fit state! It was a bit of a slow night, with the classic stabbings, beatings, shootings etc. nothing new for the books!
Monday was the start at Bara for the two Newcastle boys who were at Joberg general - the man running the ATLS course is the consultant in charge at the moment, so we asked if they could jump over to Bara (especially as we were short on students!).
It was very nice not having to get a cab in, or be late because I was riding in with the dr who owns this house. It was also very nice being able to go home after ward work was finished at 11!!
Unfortunately I've got a lurgie, so Tuesday morning was spent foraging for lemsips and throat sweets before heading into the hospital for a 24h on call shift. I arrived about 3 after spending an 1h15m in a cab driving there because of traffic!
Luckily the night call was trickle-y... There weren't enough patients to rush us off our feet, and we did spend a while twiddling our thumbs, but there was enough to keep us going! Everyone took a nap but moi (as I have learnt my lesson about sleeping in those chairs) and we were lucky enough to be out the door by 8.30am! Winner!
Tomorrow is my last shift at Bara. I'm doing a 24h call, rushing home and then getting my flight at 12 to cape town. It's going to add probably another 500rand (£50) to my already £400 cab bill unless I get a lift back from the hospital (which hopefully I will!) but there is really no other way to get to the airport!
I really hadn't prepared (or budgeted) for having to pay £30 each way to the hospital every day and I'm pretty glad that I won't be doing it anymore!
Next post will be from cape town!

LOVAGE xox

Driving is an essential life skill...

It's been a week, and in order to not receive hate mail from my younger sister I bring you another scintillating update!
After my amazingly long night shift on Monday, I slept for most of Wednesday aswell, and then we headed out on a big adventure in town. We went to an area called Greenside and drank ourselves stupid in a bar called Mama's. DRINK IS SO CHEAP HERE! Thursday was then of course a COMPLETE write off, but when a round fo 8 beers and 8 sambuca shots is £12 why wouldn't it be?!?!?
Alan (the doctor who I'm living with) left for Kruger national park early on Saturday morning. Leaving us with a "free house" (not that we're really going to do anything with it) and an afternoon of (disappointing) rugby. After that we then hit (yet another) bar and made friends with loads of people and played a lot of pool (well I didn't play because I'm an absolute liability!)
Because I was doing a 24h shift on Sunday I toddled off home at about 11pm, or would've if the taxi driver hadn't said he couldn't drive me back so I waited AN HOUR (with our new housemate Gio from Cambridge) for a cab to take us back.

Sunday morning was a painful wakeup. Luckily I was hangover free, but after finally getting to bed at about 1am I was super duper tired. We arrived at the hospital for about 7.45 (technically an hour late for the ward round) and got stuck in! There were jillions of people left over from Saturday night, and the pit was SO full! The nice thing about having been there for a while (and having done a victory dance in the Drs room after finding out I made it into 5th year) is that everyone trusts you to just get on with it, and is more than willing to just countersign without too much history. Because it was so crazy, I was only getting countersigned when I wanted to discharge someone, or decide definitive treatment... Everything else I was just sending for investigation etc. on my own!
So the run down is pretty much the same as last time I did a long long shift including but not limited to:

• A woman who thought she may have been pregnant and was stomped and jumped on by her (now ex, good for her) boyfriend - luckily she wasn't pregnant, and suffered no serious damage on FAST, but was sent for further Ix by gynae just in case
• A man who had 2 cuts put through his lower lip, which was the only case plastics were willing to take
• A man who was hit with a bottle that sliced through his nose TO HIS SINUS but neither maxfac or plastic would take him
• Several other facial stabs/slices that we were left to deal with
• Several gunshot wounds
• A man with severe burns, who needed an escharotomy - his chest looked like a chess board afterwards! But he's alive, unlike lots of the burn patients here who are just left to die! 
• A woman who'd fought with another woman and had been scratched in the eye, after forcing her eye open there was no light reflex, and she couldn't see the light... Silly me, I thought that opthalmology on call might take a referral at 9pm BUT NO it's Sunday so she'll have to wait until they can see her at St John's Monday morning! 

And so so much more. I ran my first resus on a guy who I thought has an exacerbation of COPD, but actually had that and a haemothorax after having the crap kicked out of him. Got to do my first chest drain, ON A FLAIL CHEST it was awesome. And made all the more awesome buy the fact that I had done the diagnosing!

Tuesday was a cheeky day off (or happy fun day) as I was shattered, but Gio (the new guy staying here working at Bara) took a cab in. It was a guy who we knew and does us all "special deals" but it was stil 450rand! (That's about £40) SO MANY MONIES it's ridiculous!

For the past two days I've been "observing" on an ATLS (Advanced Trauma Life Support) course, and by observing I mean they're letting us take part in everything - yes we don't get the certificate at the end, but they're going to give us a letter saying we took part!
The Wednesday night we went out for a course meal (paid for by them) in a lovely hotel with a ridiculous buffet. I skipped all the mains in favour of a whole plateful of delicious smoked salmon and asparagus (all chased down with a couple of glasses of delicious sauvignon blanc of course).
Tomorrow is the last day, which is exams for the people getting the qualification, and we're being the actors! They've got a makeup artist coming in to make the "patients" look realistic, so it looks set to be a really fun day!

I got a call from one of the interns at Bara while I was on the course, which I obviously couldn't take, and I had no idea what it was about until I talked to one of the other students there, and apparently the unit is really thin on the ground, and just can't function with 4 of its students on a course. The bad thing is only two of us are coming back! I guess that I'm going to have to work at some point over the weekend, which of course means at least £45 on cab fare (hopefully I'll get a lift back)
AS SOON AS I GET BACK TO THE UK I AM LEARNING TO DRIVE.

Loves xox

Don't worry, I'm not dead yet!

As Tegan kindly reminded me. I've not posted since Friday. This isn't because I've been kidnapped or killed but because I've been busy!
I had the weekend off (or rather took it off as trauma was covered by the French students!)
On Sunday I was rudely awoken to the security system complaining. Unfortunately Alan was doing a locum shift, and I didn't know the code to turn it off. After a frantic few phone call ingot through and got the code, BUT THIS THING WOULDN'T GIVE UP. It went off three times. With about a two minute break between them! a perimeter sweep (in my bare feet - not recommended when it's 2degrees) revealed nothing touching the fence, but did mean that the security guards (guns out) turned up just as I was doing a very poor impression of a lookout in my pyjamas. Luckily they were convinced that I was just a mentalist who didn't know what was going on.
In between my checks to make sure a burglar wasn't breaking in, the two new med students arrived. They are from Newcastle and are based at the General not Bara, but are also doing trauma.
To get them settled in we had a big BBQ Sunday night (and ate a hideous amount of food - including clove sausages) luscious!
Monday was back at the hospital. I spent the day in the pit again seeing a variety of weird and wonderful things including but not limited to:

• A woman who "ran into a tv" splitting her forehead from hairline to eyebrows down to the bone (for "ran into tv" tea "boyfriend hit her with the handle of a machete after throwing her across the room)
• A 5 year old kid who got hit by a car pulling away at a stop sign, who looked to have just a few cuts and scrapes but actually had a massive frontal bone fracture on (head CTs are rationed here) and further investigation revealed a small epidural haematoma and a fractured c1 (although we are really hoping that it's just not fused yet!)
• A man who fell asleep drunk in front of his paraffin heater and gave himself a massive partial thickness burn a month and a half ago and then paid a "specialist" to heal it... It's now slouchy and infected and manky
• 2 dog bites
• 2 sets of stab wounds (one arm, one chest)
• A septic spider bite (see spiders are dangerous)
• A man who was mugged, ran away and cut his foot open. Left it a day before coming in so it was swollen open and manky. Here their suture window is a little bigger, but my oh my that was difficult to suture
• A woman who was beaten with a pipe all over her body - sent it because a clinic was worried she had a crush injury.
• A man who was shot in the legs 6 times by the police
• A man who almost sliced off all 5 digits on his right hand with an angle grinder whilst "trimming a tree" (apparently there's an attachment for it) and LUCKILY just sheared off all the flesh.

AND SO MUCH MORE. I could go on but it would get boring. I stayed to do a night shift (as there were no students) and it was a VERY quiet night. NOTHING came in after midnight. NOTHING.
I should mention that here a "night" means the day and the night. I got home at 9.30 this morning after being up for 28h. Mental.
This morning new medical students joined the trauma department. A couple are also from Newcastle and so know the boys staying here. We all had BIG plans to go and get a meal somewhere but they fell apart, so we just had a house thrown together meal of pasta kind-of-carbonara. As the boys were cooking I popped to Spar when we realised there was no cream. Unfortunately it was closed, and the nice security patrol men offered me a lift to the garage down the road but I declined "my mother taught me not to get into cars with strange men - especially not those with guns" after that comment they thought I was the bantersaurus Rex or "crazy English girl walking after dark" (as they AFFECTIONATELY called me) and curb crawled me all the way to the front door... SAFETY FIRST.
I have to go to sleep now Tegan. Sorry this was in a rush!
LOVE XOXO

I have been busy busy busy.
Having found the (very expensive) accommodation at Wits Junction somewhat lacking: in transport, locale, blissful silence (I've no idea how people can live with a fridge in their room) I have jumped ship!
Having talked to one of the Ortho regs I was with on Thursday I found out that there was a house nearby that could solve the problem of being able to drive!
I am now settled in (after a very speedy arrangement) at Swanage, a house in Sandringham, which is owned by one of the resp doctors at Bara.
There's another student who is based at Joberg General, and Monday heralds the arrival of two English students who are also at Bara!
The house is massive, and in a much safer neighbourhood, with a walkable (and safe) parade of shops, a decent kitchen and WORKING WIFI!

Hospitalwise, nothing much exciting has happened! I was only in Thursday afternoon, and saw a few ortho patients... Learnt a few new drug names (they only prescribe trade names here) and that they're very relaxed with their prescribing: for example, paracod (cocodamol) would only be prescribed "paracod 2 tabs TDS) no strength or anything!
I was supposed to be doing a night shift this evening, but the French students have spread themselves over the weekend. And I don't think it would be beneficial to have 5 of us on one shift! They leave next weekend though. So I guess that'll be pretty hectic!

xox

Day 1... TAKE 2

The 6am start was not in anyway pleasant. And it was FREEZING. Once again turned up to find out that the consultant wasn't there, but they found the one from emergency med who sorted me out!
Apart from the usual cycle of bloods, fluids, cannulas and dressings what did I do?
Well, I did most of the skin layer closure of a prisoners face that had been slashed open narrowly missing his eye. It needed four layers and 38 stitches to keep it shut. But before any of that could be started there was an arterial bleed that had to be isolated and tied off. WITHOUT ANALGESIA I have no idea how the poor man managed to stay still!!
a wound like this in UK would most certainly have merited plastics, but here apparently they don't leave their ward for hell or high water. So a senior reg and I were left to do it.

I watched the regs try to cannulate a very dehydrated baby with septic burns on her forearm. Apparently she'd been seen at a clinic a week ago and the mother had been told to change the bandages every three days - which clearly hadn't happened.
It took 11 tries to cannulate this poor kid, who didn't cry or try to move away. It's the first case of kwashiorkor that I've ever seen, and it was stereotypical, the regs talked about how in the UK if anyone saw a kid like this it'd be a case of neglect. The kid was taken off by paeds surgery for debridement under GA. But they're not sure how the skin will do as a large majority of it looks necrotic.

A bit later a woman ran in as she had a burnt man in the back of her car. It's unclear how it happened, but with both legs that alone was 36% partial and full thickness burns. The skin had peeled back off his hands which was AWFUL. But for the protection afforded by his massive boots and a thick cotton shirt he was pretty much burnt all over. He was intubated to protect his airway but that was difficult as he kept going into rigors.
Again, something like this in the UK would have warranted specialists, but here in the resus room there wasn't even a consultant! 3hours later a plastics surgeon came down to see him.
I was told that anything over 50% full thickness they don't even try to save here, they just make them comfortable.
It's been a long day, and the team here are all really nice.

I do really need to find some shops though, my supply of salad and cream cheese whipped with blue cheese (odd I know - it sounds like it belongs with lidls' cheese with mould. But it is very tasty!) has run out. So all I have in my cupboard is tea and coffee!
Maybe I'll try and order takeaway!
Toodles! Xoxo

P.S. That's sunset over soweto. I probably need to suck it up and buy a camera.

http://www.youtube.com/watch?v=aCca5mPMp9A


For those of you not following on the facebook :D

My first day...

Or what was supposed to be my first day!
At the meeting yesterday with many many frenchies (who are here for 2 weeks) it was explained we could pretty much come and go as we wished and do anything we'd been taught (either here or at home). In general that it was all pretty chill.
So it was decided that I'd have a whale of a time in trauma, and then I could dander across to medicine if there was nothing going in trauma.
Because this meeting took forever, I ha to go and get my swipe card this morning (instead of yesterday arvo) unfortunately the "regular shuttle bus" service consists of three a day 0650, 1150 and 1530... SUPER REGULAR. So I had to head in on the lunchtime bus. LUCKILY seeing as after a 45min bus journey to be told that the consultant you're supposed to be under is not there and no one else knows you're coming is SLIGHTLY annoying. Luckily, the return bus left at 13h from the hospital thinking I could get the shuttle to the mall and get some real shopping but the shuttle only runs to the mall on the weekend. Pfft. I am currently making my way back to the flat to dump all my work stuff, get my card activated to swipe me through the security at the junction and ask the lady where I can go to get food (seeing as I'm surrounded by "dodgy areas" I'm definitely not allowed in.
Only bright side of the day is saw these bad boys casually growing through a hedge!