Finding the Joy
Greetings from Sweet Matat, where things are all change!
I took one for the team last week. We've been arguing back and forth for a few weeks trying to solve the problem with OPD. The outpatient department is staffed by one of our clinical associates and the plan is that doctors head there after finishing their rounds on the ward. There has been a bit of friction between colleagues at work over who gets to OPD and at what time. So the long and short of the story is that someone had to volunteer to leave their spot and be assigned primarily to OPD.
Thanks to my crippling British inability to bear awkwardness, I found myself landed in OPD. Miles away from my beloved pregnant ladies and even further away from the operating theatre. OPD is basically GP land. The antithesis to my preferred work environment. Anyway, I have plowed through and definitely got my money's worth out of my poker face. I find myself making a conscious effort to 'find the joy' here. That is, instead of letting the burden of the failing system here get on top of you, you have to try and find the positive in your day. We have been speaking about this a lot recently with some of the other doctors in the cape who have been here longer. I find that they are all a bit burnt out - the overwhelming need and lack of resources has taken it's toll. I feel very naive when I say that I hope I don't get burn out here - I have a fear that it is inevitable.
OPD is a crash course in diagnostics. First in the door - 'Doc, I am feeling cold pains in my left body' that was dealt with swiftly, and next was a patient who had Stage 4 HIV with concurrent TB and died the next day. The variety in approaches to health here never ceases to amaze me. Every day brings at least one or two emaciated patients with terminal conditions, normally TB or HIV and its complications, or occasionally disseminated malignancy. this week I had a 24 year old with end stage lymphoma, a 75yo whose spine collapsed from bony metastasis and another five who had to be sent to the referral hospital for tests, but had fairly convincing evidence of cancer. The current waitlist to see a urologist - so thats anything from having an enlarged prostate to kidney cancer is three months. A reasonable number of patients waiting to see a specialist will die before the appointment comes round. I feel a sense of irritation at those patients complaining in the UK that the GP doesn't have a same day appointment.
Being in OPD does have it's benefits - when I get through the patients quickly I can jump ship into casualty and help out there. This week I've managed to scrape together a few surgical cases too. A 5 year old who had his finger amputated in a door - I terminalised it and was rather chuffed with myself too. Then more gruesomely, its the start of the circumcision season. 1n 18 year old came in with a penis the size and shape of a grapefruit after having a circumcision in the bush veld. I took him to theatre with one of the other docs for 'exploration' - theatre speak for 'I've not a baldy notion what this is but we'll make it numb and get a good look at it' - it looked as though he had bled quite heavily after the circumcision and developed a huge haematoma in the shaft. We milked it out, washed it and reconstructed his manhood. A high-five post op tells me my help was appreciated. I told him to spread the word among his friends that they could come here for a safe clean circumcision. I very much doubt he shall make his traumatic journey into manhood public knowledge.
We have managed to cram in lots of exploring in the past few weeks as well. Last weekend a few of us headed to the Wild Coast for another doctors birthday. It had been claimed that a 4x4 wouldn't be necessary for the dirt track down to the hostel. I can confirm that after our third mud slide/stuck in the mud situation, in a HIRED Volkswagen Polo, I repaid my self quite heavily in white wine from an enamel mug when we finally arrived safe.
The weekend passed in a blur of debauchery and hill walking. All thoughts of OPD were very much washed away by Monday morning.
This week I was covering the male surgical ward as the other doctor was off on holidays. Much to my delight, it's basically filled with peripheral vascular disease. My prayers were then answered when the visiting surgeon who apparently comes once a month - yet not since I have been in SA, came for a visit. Thanks to my professional experience as 'Teacher's Pet', I did the whole list by myself and have booked two amputations for his next visit which are for me as well. Smug. Don't hate the player, hate the game.
This weekend was again a particular delight. I'm just home after three days at the coast. I was picking up my new steed - Winnie - a 2005 Toyota Rav4. I managed to squeeze in a beach lodge, a Tequila Fest, two hangovers and 24 hours in a game lodge with a night in a tent in the bush.
At the game reserve I managed to see zebra, ostrich, white lion, wildebeest, impala, nyala and a tortoise. Anyone know why they call the animals by their singular term? Anyway it makes me sound more legit so we shall carry on. The 'lion' - though there were at least six, were incredible. We plodded in, rifle in hand in an open land rover. My heart was in my mouth. The lion in this reserve have a recessive gene which makes them white. Absolutely beautiful creatures.
I want to tell you that the night in the wild was amazing and so peaceful, however, that would be a lie. I never slept a wink as every time I would doze off there would be a rustle in the bushes and something would rub up against the side of the tent. Things came to a head with the visit of a huge ostrich to the bathroom at 0630. I heard a 'tap tap tap' on the glass and prayed it was just the maid calling me, but to my ?horror/surprise it was a huge ostrich - the same one who had hissed at another guest the previous day. Awkwardly for both of us, the bush shower meant that anyone outside could see the specimen showering. Thankfully the ostrich cleared off before I had to expose myself to her - for this I am eternally grateful.
We managed to squeeze in some quad biking before check out which was awesome. I got some very disgusted looks from the zebra as I zoomed round the valley like a halfwit.
I shall leave things there for tonight - I've got to bug proof the flat before bed. I was greeted by six cockroaches when I arrived home and I'm just about at my limit of nature exposure (literally) for this week.
I took one for the team last week. We've been arguing back and forth for a few weeks trying to solve the problem with OPD. The outpatient department is staffed by one of our clinical associates and the plan is that doctors head there after finishing their rounds on the ward. There has been a bit of friction between colleagues at work over who gets to OPD and at what time. So the long and short of the story is that someone had to volunteer to leave their spot and be assigned primarily to OPD.
Thanks to my crippling British inability to bear awkwardness, I found myself landed in OPD. Miles away from my beloved pregnant ladies and even further away from the operating theatre. OPD is basically GP land. The antithesis to my preferred work environment. Anyway, I have plowed through and definitely got my money's worth out of my poker face. I find myself making a conscious effort to 'find the joy' here. That is, instead of letting the burden of the failing system here get on top of you, you have to try and find the positive in your day. We have been speaking about this a lot recently with some of the other doctors in the cape who have been here longer. I find that they are all a bit burnt out - the overwhelming need and lack of resources has taken it's toll. I feel very naive when I say that I hope I don't get burn out here - I have a fear that it is inevitable.
OPD is a crash course in diagnostics. First in the door - 'Doc, I am feeling cold pains in my left body' that was dealt with swiftly, and next was a patient who had Stage 4 HIV with concurrent TB and died the next day. The variety in approaches to health here never ceases to amaze me. Every day brings at least one or two emaciated patients with terminal conditions, normally TB or HIV and its complications, or occasionally disseminated malignancy. this week I had a 24 year old with end stage lymphoma, a 75yo whose spine collapsed from bony metastasis and another five who had to be sent to the referral hospital for tests, but had fairly convincing evidence of cancer. The current waitlist to see a urologist - so thats anything from having an enlarged prostate to kidney cancer is three months. A reasonable number of patients waiting to see a specialist will die before the appointment comes round. I feel a sense of irritation at those patients complaining in the UK that the GP doesn't have a same day appointment.
Being in OPD does have it's benefits - when I get through the patients quickly I can jump ship into casualty and help out there. This week I've managed to scrape together a few surgical cases too. A 5 year old who had his finger amputated in a door - I terminalised it and was rather chuffed with myself too. Then more gruesomely, its the start of the circumcision season. 1n 18 year old came in with a penis the size and shape of a grapefruit after having a circumcision in the bush veld. I took him to theatre with one of the other docs for 'exploration' - theatre speak for 'I've not a baldy notion what this is but we'll make it numb and get a good look at it' - it looked as though he had bled quite heavily after the circumcision and developed a huge haematoma in the shaft. We milked it out, washed it and reconstructed his manhood. A high-five post op tells me my help was appreciated. I told him to spread the word among his friends that they could come here for a safe clean circumcision. I very much doubt he shall make his traumatic journey into manhood public knowledge.
We have managed to cram in lots of exploring in the past few weeks as well. Last weekend a few of us headed to the Wild Coast for another doctors birthday. It had been claimed that a 4x4 wouldn't be necessary for the dirt track down to the hostel. I can confirm that after our third mud slide/stuck in the mud situation, in a HIRED Volkswagen Polo, I repaid my self quite heavily in white wine from an enamel mug when we finally arrived safe.
The weekend passed in a blur of debauchery and hill walking. All thoughts of OPD were very much washed away by Monday morning.
This week I was covering the male surgical ward as the other doctor was off on holidays. Much to my delight, it's basically filled with peripheral vascular disease. My prayers were then answered when the visiting surgeon who apparently comes once a month - yet not since I have been in SA, came for a visit. Thanks to my professional experience as 'Teacher's Pet', I did the whole list by myself and have booked two amputations for his next visit which are for me as well. Smug. Don't hate the player, hate the game.
This weekend was again a particular delight. I'm just home after three days at the coast. I was picking up my new steed - Winnie - a 2005 Toyota Rav4. I managed to squeeze in a beach lodge, a Tequila Fest, two hangovers and 24 hours in a game lodge with a night in a tent in the bush.
 |
| Pimp my ride |
At the game reserve I managed to see zebra, ostrich, white lion, wildebeest, impala, nyala and a tortoise. Anyone know why they call the animals by their singular term? Anyway it makes me sound more legit so we shall carry on. The 'lion' - though there were at least six, were incredible. We plodded in, rifle in hand in an open land rover. My heart was in my mouth. The lion in this reserve have a recessive gene which makes them white. Absolutely beautiful creatures.
I want to tell you that the night in the wild was amazing and so peaceful, however, that would be a lie. I never slept a wink as every time I would doze off there would be a rustle in the bushes and something would rub up against the side of the tent. Things came to a head with the visit of a huge ostrich to the bathroom at 0630. I heard a 'tap tap tap' on the glass and prayed it was just the maid calling me, but to my ?horror/surprise it was a huge ostrich - the same one who had hissed at another guest the previous day. Awkwardly for both of us, the bush shower meant that anyone outside could see the specimen showering. Thankfully the ostrich cleared off before I had to expose myself to her - for this I am eternally grateful.
We managed to squeeze in some quad biking before check out which was awesome. I got some very disgusted looks from the zebra as I zoomed round the valley like a halfwit.
I shall leave things there for tonight - I've got to bug proof the flat before bed. I was greeted by six cockroaches when I arrived home and I'm just about at my limit of nature exposure (literally) for this week.
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