And just like that here we are...
Well.
Total disaster. To cut a long story short I managed to lock myself out of the blog for 6 months. Classic Hannah. I guess I didn't put too much effort into unlocking it as it felt weird to write about life on here when the novelty wore off. When I say novelty wore off, I mean in a good way. South Africa sucked me in and made me feel like I had been there my whole life. Writing all of our adventures on here seemed like an invasion of privacy. That's not meant to sound as melodramatic as it does, I promise.
I'm back in the UK now and despite pre-empting a complete nervous breakdown on touching down in Dublin, I'm holding myself together quite nicely. Probably has something to do with the fact I've already got plans to go back.
The latter six months of my stay in SA completely overtook any of my expectations. I was moved into the Casualty department and as the only doctor for the last 4 months. I was responsible for managing the unit with the help of my exceptional nursing colleagues - so basically they told me what to say and do, and I did it.
Our Casualty has 2 consultation rooms, a triage area with room for 3 patients in chairs and one couch. Then we have a resus room, POP room and short stay unit with space for 4 beds and sometimes 3 or 4 walking wounded. (Mostly thanks to the lack of health and safety in the workplace these were generally patients that a Plastics registrar in the hand clinic would be heavily invested in).
In my six months of essentially being the emergency physician for a whole district I saw inconceivable numbers of trauma patients. The vast majority being stab wounds, peppered with a few gunshots if there was a big football match on. We had more than 15 children with acute malnutrition, several of whom died in the department. I had a grand total of 13 dead on arrival patients in my time there, sprockling into the back of bakkies (pick up trucks) alongside livestock to confirm the death of a grandmother. I counselled innumerable relatives about the imminent death of their relatives to HIV and its complications. We had 3 patients die waiting to be seen by the nurses at triage. The burden of sexual assault continued to seep into the fabric of South African society and we had one nursing colleague return from higher training to take over that role entirely. Witnessing her expertise and confident, calm approach to these broken people is one of the most inspiring experiences I had in South Africa.
For a full month we functioned without XR after electricity ravaged the building during a storm and I was promptly informed that obviously it was witchcraft. I can assure you my reaction to leaving open fractures without x rays for 3 days turned me into quite the witch myself. In these parts it is believed that you can purchase lightening and throw it at your enemies. I considered launching a few bolts in the direction of the provincial department of health headquarters a few times myself.
My frustrated relationship with the ambulance service continued. One particularly sour note was when an 66yo came in in status epilepticus and needed to be intubated. I managed his fits, placed an OP airway and spent 14 minutes arguing with the medical doctors to have him transferred for a CT Brain. We then set about to organise kit to intubate the patient. I built a T tube out of an old oxygen mask - equipment to help the man breathe out carbon dioxide. It took 6 hours for the appropriate ambulance crew to arrive, so much so that the patient had recovered enough of his neurology to breathe without the need of a tube. I was then told that I had wasted resources asking for an advanced crew. At the time of the request the patient needed ICU level care - the fact that he had improved during the wait was a miracle - and certainly not something to be 'blamed'. My record for trying to get an ambulance technician on the phone to book was 4 hours. This patient had been woken in the night to the sound of his wife being raped by armed intruders and then they buried a machete in the man's head as he tried to free her. He was 84 years old. He then sat shaking in short stay waiting on ambulance headquarters to pick up the phone. I was spitting fire by the time the ambulance came.
Let's talk about some successes! We had 4 patients diagnosed as ectopic pregnancy and transferred for surgery and I watched each one walk off the patient transport bus and back to their families. Scanning for ectopic pregnancy will haunt me for the rest of my life. Someone told me that in the UK there is one death from ectopic pregnancy per year, but I'm not sure in what population. I had a death from ruptured ectopic pregnancy during one busy Saturday shift. The absolute worst afternoon of my career to date and every time I had a ?ectopic referred to me after that I had to dig deep and keep it together. We had about 8 ruptured appendixes in 6 months and 7 of them made it home, albeit with dodgy looking scars. For some reason due to the workload at the referral hospital perhaps, basic surgical skills go out the window and I had lots of children with lower midline lap wounds closed with subcuticular sutures only to have dreadful wound sepsis after. I began requesting closure with clips on my referral letters. How rude of me. (clips can be taken out easily if suspicion of sepsis and don't leave huge gaping crevices in 7 year old girls).
My personal battle against peripheral vascular disease continued whilst in Casualty. I had my little band of amputees and smokers who wound turn up for review. Quite often I would smell them before I could see them. Perhaps an article in the Christmas BMJ about the improvement in smell in casualty from the start of my reign to the end would make interesting reading. When I left, not one of my 6 or 7 vasculopaths had gangrene, and none of my nurses had to deal with maggots. For now. I'm hyper-anxious about returning home to train having been rogue in the jungle doing amputations with faulty equipment and the wrong sutures. Perhaps I'll just say I haven't done any operating before...
There's some cheesy quote from a movie about not knowing which morning on earth is going to be your last - this always made me laugh when doing caesarean sections. It's true, I can't remember which one was my last, but every time I made that pfannenstiel incision I'd pray it was the last time. I was lucky to avoid obstetrics quite a lot in the last 6 months due to the fact that my colleague Jon went from post FY2 to independent obstetrician overnight. His natural skill with obstetrics was a welcome relief and the poor man quite regularly gave up a post work beer if I was on call in case I needed him to come tearing in at 0200 and help me with an anterior placenta or a head that was stuck in a fully dilated cervix. Thankfully, my unwanted obstetrics fellowship passed without too much drama, even if I was drenched in a cold sweat every time I opened a uterus.
I suspect I'll continue to debrief a bit here as the weeks go on - thanks for the support in the early days on here - it was a bumpy start for sure. You are welcome to stay subscribed but I suspect most of you will have your fill of my adventures when we catch up over the next few weeks. BRB I'm off to become a Vascular Surgeon!
Much love,
Hannah
Total disaster. To cut a long story short I managed to lock myself out of the blog for 6 months. Classic Hannah. I guess I didn't put too much effort into unlocking it as it felt weird to write about life on here when the novelty wore off. When I say novelty wore off, I mean in a good way. South Africa sucked me in and made me feel like I had been there my whole life. Writing all of our adventures on here seemed like an invasion of privacy. That's not meant to sound as melodramatic as it does, I promise.
I'm back in the UK now and despite pre-empting a complete nervous breakdown on touching down in Dublin, I'm holding myself together quite nicely. Probably has something to do with the fact I've already got plans to go back.
The latter six months of my stay in SA completely overtook any of my expectations. I was moved into the Casualty department and as the only doctor for the last 4 months. I was responsible for managing the unit with the help of my exceptional nursing colleagues - so basically they told me what to say and do, and I did it.
Our Casualty has 2 consultation rooms, a triage area with room for 3 patients in chairs and one couch. Then we have a resus room, POP room and short stay unit with space for 4 beds and sometimes 3 or 4 walking wounded. (Mostly thanks to the lack of health and safety in the workplace these were generally patients that a Plastics registrar in the hand clinic would be heavily invested in).
In my six months of essentially being the emergency physician for a whole district I saw inconceivable numbers of trauma patients. The vast majority being stab wounds, peppered with a few gunshots if there was a big football match on. We had more than 15 children with acute malnutrition, several of whom died in the department. I had a grand total of 13 dead on arrival patients in my time there, sprockling into the back of bakkies (pick up trucks) alongside livestock to confirm the death of a grandmother. I counselled innumerable relatives about the imminent death of their relatives to HIV and its complications. We had 3 patients die waiting to be seen by the nurses at triage. The burden of sexual assault continued to seep into the fabric of South African society and we had one nursing colleague return from higher training to take over that role entirely. Witnessing her expertise and confident, calm approach to these broken people is one of the most inspiring experiences I had in South Africa.
For a full month we functioned without XR after electricity ravaged the building during a storm and I was promptly informed that obviously it was witchcraft. I can assure you my reaction to leaving open fractures without x rays for 3 days turned me into quite the witch myself. In these parts it is believed that you can purchase lightening and throw it at your enemies. I considered launching a few bolts in the direction of the provincial department of health headquarters a few times myself.
My frustrated relationship with the ambulance service continued. One particularly sour note was when an 66yo came in in status epilepticus and needed to be intubated. I managed his fits, placed an OP airway and spent 14 minutes arguing with the medical doctors to have him transferred for a CT Brain. We then set about to organise kit to intubate the patient. I built a T tube out of an old oxygen mask - equipment to help the man breathe out carbon dioxide. It took 6 hours for the appropriate ambulance crew to arrive, so much so that the patient had recovered enough of his neurology to breathe without the need of a tube. I was then told that I had wasted resources asking for an advanced crew. At the time of the request the patient needed ICU level care - the fact that he had improved during the wait was a miracle - and certainly not something to be 'blamed'. My record for trying to get an ambulance technician on the phone to book was 4 hours. This patient had been woken in the night to the sound of his wife being raped by armed intruders and then they buried a machete in the man's head as he tried to free her. He was 84 years old. He then sat shaking in short stay waiting on ambulance headquarters to pick up the phone. I was spitting fire by the time the ambulance came.
Let's talk about some successes! We had 4 patients diagnosed as ectopic pregnancy and transferred for surgery and I watched each one walk off the patient transport bus and back to their families. Scanning for ectopic pregnancy will haunt me for the rest of my life. Someone told me that in the UK there is one death from ectopic pregnancy per year, but I'm not sure in what population. I had a death from ruptured ectopic pregnancy during one busy Saturday shift. The absolute worst afternoon of my career to date and every time I had a ?ectopic referred to me after that I had to dig deep and keep it together. We had about 8 ruptured appendixes in 6 months and 7 of them made it home, albeit with dodgy looking scars. For some reason due to the workload at the referral hospital perhaps, basic surgical skills go out the window and I had lots of children with lower midline lap wounds closed with subcuticular sutures only to have dreadful wound sepsis after. I began requesting closure with clips on my referral letters. How rude of me. (clips can be taken out easily if suspicion of sepsis and don't leave huge gaping crevices in 7 year old girls).
My personal battle against peripheral vascular disease continued whilst in Casualty. I had my little band of amputees and smokers who wound turn up for review. Quite often I would smell them before I could see them. Perhaps an article in the Christmas BMJ about the improvement in smell in casualty from the start of my reign to the end would make interesting reading. When I left, not one of my 6 or 7 vasculopaths had gangrene, and none of my nurses had to deal with maggots. For now. I'm hyper-anxious about returning home to train having been rogue in the jungle doing amputations with faulty equipment and the wrong sutures. Perhaps I'll just say I haven't done any operating before...
There's some cheesy quote from a movie about not knowing which morning on earth is going to be your last - this always made me laugh when doing caesarean sections. It's true, I can't remember which one was my last, but every time I made that pfannenstiel incision I'd pray it was the last time. I was lucky to avoid obstetrics quite a lot in the last 6 months due to the fact that my colleague Jon went from post FY2 to independent obstetrician overnight. His natural skill with obstetrics was a welcome relief and the poor man quite regularly gave up a post work beer if I was on call in case I needed him to come tearing in at 0200 and help me with an anterior placenta or a head that was stuck in a fully dilated cervix. Thankfully, my unwanted obstetrics fellowship passed without too much drama, even if I was drenched in a cold sweat every time I opened a uterus.
I suspect I'll continue to debrief a bit here as the weeks go on - thanks for the support in the early days on here - it was a bumpy start for sure. You are welcome to stay subscribed but I suspect most of you will have your fill of my adventures when we catch up over the next few weeks. BRB I'm off to become a Vascular Surgeon!
Much love,
Hannah
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