collateral damage

i'm not a war doctor. well not in the truest sense of the word. but sometimes i think there are similarities between whatever it is i am and a war doctor. i'm not talking about the fact that i have operated more gunshot wounds than i can count because of the amazingly high crime rate in our country, although that is probably part of it, but i'm talking about being first hand witness to collateral damage.

when the new government came to power they decreed that no state doctor could do private work. bearing in mind almost all state hospitals were run by private doctors, in one fell swoop they got rid of almost all their senior doctors. they realized their mistake, but it was too late. those doctors did not return. the next plan was to import doctors from cuba. but having doctors from a somewhat less than free country working in an essentially free one was wrought with problems. their numbers gradually decreased as they defected. the next plan was to introduce a community service year after the intern year. they then had enough doctors but they were always junior. this is pretty much the way it has stayed up until now. then there was a change in the training of doctors. it seems that the powers that be felt that it shouldn't be so difficult. some pretty dodgey doctors were created.

the problem with having your hospitals manned by junior doctors is that they tend to be junior. junior doctors are quite often not so clued up. experience may be lacking. and this brings me to a story by way of explanation. unfortunately this is not an unusual story.

there is a physician (internist) who does a session in the state hospital in a smallish town some distance away. one day when he was there they asked him to evaluate an x-ray of a patient they said had heart failure. they had made the diagnosis largely due to laboured breathing which they attributed to pulmonary edema. they had been treating her for three days to no effect. he took one look at the x-ray and was dismayed to see free air under the diaphragm (this pretty much implied that the actual diagnosis was a perforated peptic ulcer). the physician was shocked. he told them to send the patient to some place where she could be operated.

i was doing a gunshot wound in our local state hospital as a good war doctor should when i heard the patient was on the way. i knew it would take some time, so after finishing i shot off to the private hospital to quickly do another case. after that they phoned me back to the state hospital to oversee another gunshot abdomen. while there i was informed that the patient had in fact arrived but promptly died. i suppose three days with a perforation and fluid restriction (which is part of the management of heart failure but not too good for perforation) were just too much for her to handle.

one thing i have realized is i can't change the world, much less do much about the government's policies of death and destruction. all i can do is the best where i am. just like in a war there will be people who die, people who have nothing to do with the corridors of power, because of the decisions of their leaders. it is also not really the fault of the poorly equipped (intellectually) junior doctors in these small towns. they are simply the results of political blundering. so yes in many ways i am a war doctor. sometimes that is the only way i can deal with some of the things i see.