chicken feet

i hate kalafong (hell). there are many reasons for this (here, here, here, here, here), most emotional, i confess. but if i am honest there is one incident that stands head and shoulders above the myriad of traumas that i experienced there.

one of the strange idiosyncrasies of kalafong (hell) is that some time during each night shift, all the sisters of each ward get together in the duty room and eat chicken feet. i have no explanation for this. maybe there is an abundance of chicken feet in the area. maybe the sisters are paid in part with chicken feet that absolutely must be eaten before they leave for home after their shift. maybe it is part of some bizarre ritual that initiates all kalafong sisters into some secret evil cult. i simply do not know.

i was a mere fourth year medical student which meant i was at the absolute bottom of the rung that night on call for internal medicine. i knew nothing and was of almost no help to anyone. the only thing that i could do was to put up drips, so the senior medical students would send me to the wards whenever they got a call that a drip needed inserting. for some reason kalafong sisters never put up drips. maybe there was a fear that the patients were allergic to chicken feet and the residue of the no doubt scrumptious delicacy on the fingers of the sisters could potentially cause the patients harm. they were clearly not about to take that chance, so there was plenty of opportunity for me to hone my already very well honed drip inserting skills.

i had just left the female medical ward after inserting a whole host of drips and was quite keen to see what was going on in casualties. i walked in.

"drip to be inserted in female medical." the sixth year student smiled. i don't think it was really meant to be malicious although it felt that way at the time. i think it was more a relief that he had done his years of continuous drip insertion honing and was glad that he honed no more. it was the natural cycle of things and he had passed the batton to the next group. it was simply my turn.

"i was just there!" i protested at no one in particular, turning to leave with my shoulders sagging just enough to be noticable to the discerning eye.

i entered the ward through the back door. the main door had been locked by the sisters. this was another thing one got used to there. it was just something the sisters did at night.  the reason for this behaviour elluded me, especially when they had just called for someone to insert a drip. you would think that they would unlock the door in anticipation of that person actually arriving to insert the drip. maybe they needed their privacy while performing strange initiation rites with chicken feet.

as i entered the ward, a patient looked at me.

"doctor, help me! i'm dying!" i froze. it was dark. i could only make out the patient's shape, silhouetted against the dirty cream coloured wall. yet her eyes were so wide with fear that i could see her white sclera. i felt a shiver go down my spine. what was i to do? i was only a fourth year. i didn't know this patient and even if i did, i had no knowledge to actually help her. in my naivety i hadn't yet learned the rule that more often than not, if a patient tells you they are dying, it is because they are in fact dying. the one thing i knew is that i couldn't ignore her.

i walked up to her. she lifted her arm weakly. then suddenly her fingers encircled my arm and all her remaining strenght seemed to go into her grip. her nails bit into my flesh as she pulled me close to her face.

"help me doctor, i'm dying!" she repeated. she scared me, so i pried myself loose and checked her file. she had been admitted the previous day with the diagnosis of meningitis. antibiotics had been prescribed but only one dose had been signed for since admission. probably the drip had been out when the other doses were due and once some poor fourth year had reinserted it, the sisters hadn't bothered to put up the dose that had been missed. at least there was something i could do, i thought. i could check to make sure the drip was working and get the sisters to give the last dose of missed antibiotics. somehow i allowed this thought to make me feel better. i would help this lady and all would be well.

i checked the drip. it was working well.

"don't worry, mamma, i'll send someone to help right away." i said as i turned to leave. she lunged for my arm again when she saw that i was going, but there was no strengh left and she missed. as i walked away a knot developed in my stomach. i felt that i had failed this old lady. i had done the little bit my knowledge had permitted me to but i had also allowed my fear of her and of what she was facing to intimidate me to such an extent that i hadn't really stayed to comfort her. i was determined to be a change in her circumstances and her life. i would speak to the sisters.

i walked to the duty room. the door was closed but there was an almighty din emanating from inside. the sisters seemed to all be shouting and laughing in unison. i knocked and opened the door. for a moment the bright light from their happy little room blinded my eyes that had become accustomed to the darkness of the ward. the light seemed to pour out into the gloomy ward behind me. all the sisters were sitting around the table eating chicken feet. when they saw me they all went silent, but continued eating.

"good evening sisters." no answer, unless silence is an answer. "sorry to bother you but the patient in bed 5 in cubicle d is in a bit of distress."

"we'll check on her now now." i knew what now now meant in our strange south african english. now now was not as soon as now and implied no urgency. now now was not as now as i wanted it to be.

"ok," i said, knowing that if i antagonised them they would purposely postpone checking on her just to teach me a lesson. "also i see that she hasn't yet received her last dose of antibiotics. her drip is working, i checked, so please give it to her when you go to her." the sister looked up from the chicken foot she was now toying with between her fingers. i saw in her eyes that she despised me, although i had never laid eyes on her before in my life. some things in kalafong one learned to accept.

"i said we would see to it now now!" she repeated. then her head dropped back down to give the chicken feet the full attention they seemed to deserve. i stood still for a minute. then i quietly closed the door.

as i walked away to do the drip i had actually come to the ward to do, raucous laughter errupted from that small brightly lit room. it brought me to a stop in the middle of the floor in the dark ward. i felt tears well up. i didn't know if i wanted to cry because the sisters were clearly enjoying a joke at my expense or at the futility of an old woman who lay in bed 5 in cubicle d all alone with the fear of death over her. i just knew there was something horribly wrong with the whole picture.

i got the drip up and running in double quick time. i then rushed off back to casualties, but not before quickly checking on the patient again. when i approached her she still had the same stare. this time her arms lay still on the bed beside her.

"don't worry, mamma," i said, "i have asked someone to come and help you. it is all going to be ok." she didn't react. "i promise i'll also come back myself tonight to check on you." a little of the fear went out of her eyes. only a little.

on the way back to casualties i made sure i composed myself. it wouldn't be good to show the senior students that i had been so affected by something they no doubt had seen quite a lot of. anyway everyone always said not to let kalafong get to you, otherwise it could change you forever. at that moment forever seemed like such a long time. the sixth years were busy doing a lumbar puncture behind one of the flimsy curtains in the casualty unit that seemed designed to give the impression of privacy without actually delivering any real privacy. one of them looked up.

"sorry dude, but they just called for another drip in male medical." i turned and walked out without saying a word. the quiet of the open air kalafong corridors could possibly afford my soul a bit more peace than the overwhelming noise of human suffering of casualties. usually i could handle it, but then i felt a despondency and futility that was too much to bare.

in the end there were three drips in male medical so it took me longer than expected to get them all up and running. this time it didn't bother me. i was in no rush to get back to casualties. also i knew i had told the old lady in female madical i would check on her and i was afraid. i was afraid of what i could not do for her. i was afraid i would be inadequate. i was afraid of the face of fear that i had seen in her eyes. somehow her reality at that moment was too real and i didn't want to face it. i wanted to be at home in my warm bed, ignorant of how terrible life could be. but i knew i had to go to her. if for nothing else, i had to just be with her so that she was not alone. i walked slowly to female medical.

i walked past the duty station. this time the door was open, but besides that there was no discernible difference. all the sisters still sat exactly where they had been. some of them were still eating the last of the chicken feet. the light from their room lit up half the ward, but did not reach all the way to cubicle d. they didn't see me slip past them so their laughter must have been aimed either at someone else or just part of the normal merriment associated with people sharing a meal together. still, just like the light, it seemed to me to be out of place.

"mamma, i'm here" i whispered as i approached her bed, just in case she was asleep. she lay with her head to one side. she didn't stir. i walked closer and took her hand. it was cold and clammy. i leaned towards her face. even in the darkness i could see her eyes were open, but they were fixed in the stare of death. she had died alone and i had failed her completely.

i have hated the sight of chicken feet ever since.

la mancha

the man was an enigma. those who knew him soon realised he was the only person in kalafong (hell) that cared anymore. somehow that terrible place hadn't eroded his soul to such an extent that he no longer gave a damn about his patients. yet to those who only had a fleeting acquaintance with him, he seemed course and even harsh. he didn't fit into kalafong (hell), yet he would not have fitted into any other place quite as well as he fitted into kalafong (hell). yes, he was an enigma.

my consultant in kalafong (hell), the enigma, had a certain way of bringing his point across (here and here). on the face of it it was never pretty but it was always funny in some twisted sort of way, despite that never being his intention. he also had a knack of going off on some wild tangent for seemingly no reason. what we may have thought was normal would more often than not set our own don quixote off on some wild quest chasing what seemed to us to be little more than windmills. but who were we to argue? he was after all the consultant.

so on that particular morning, when the house doctor showed the don the official consultation form from the internal department requesting us to drain an abscess on one of their patients there really was no way for him to know that this would cause the old man to fly into a frenzy and charge off towards the wards of the unsuspecting internal medicine department, his entire entourage, myself included, in tow. i was a very junior medical officer so i kept to the back and just observed.

"where are the doctors?" he bellowed at no one in particular as he stormed through the doors. "are you all deaf? i said where are your doctors? i want them here right now!" from behind a few curtains here and there the house doctors of that department peered, eyes wide, like frightened rabbits. still they froze and moved no closer.

"i said come here!" he shouted pointing directly at the closest one. "you! are you a doctor?" it seemed like a silly question. of course he was a doctor. but our master continued, "i said are you a doctor?"

"yes sir." wrong choice of words.

"don't call me sir!! do i look like i've been smacked on the shoulder by some foreign queen?"

"no, professor."

"don't call me professor!" his face went red with rage and despite it seeming impossible, the volume of his rantings increased. "i am not one of those academic professors in that ivory tower on the other side of town who operate by remote control from the comfort of their large chairs in their studies! i am a real surgeon!"

"sorry doctor."

"that's better." his voice dropped down back to jet plane decibels. "i asked you a question. are you a doctor?" the poor guy's lip quivered as he carefully and deliberately chose his words.

"yes doctor."

"what degree do you have?" we all cowered out of the direct line of sight of the man just in case he asked us the same seemingly easy question. at least we now knew not to call him sir or professor. but the poor internal house doctor had no such privilege.

"i have an mbchb, doctor." he almost whispered.

"yes you do. and do you know what that means?" before the confused victim could answer this next seemingly easy question our consultant blundered forth. "bring me a blade and show me where this patient is with the abscess.

a few moments later we were all standing around the patient wondering what was going to happen next. the house doctor was visibly shaking.

"i asked you a question?" continued our mentor, toying with the knife in his hand that the doctor had fetched for him "what does mbchb mean? or what does the chb part mean? the mb part is easy. that means you can give pills out. any old monkey can give pills out, but now i want you to tell me what the chb means"

"i'm not sure sir, i mean doctor!"

"if you call me sir again i will have you thrown up against the wall and i will bring a firing squad in here and have you summarily shot!" our consultant believed a firing squad covered a multitude of sins. "well let me tell you what it means. you see this sharp shiny thing in my hand? this is a blade. chb means you are trained to use one of these. it means you have a bachelors degree in surgery and it means you can lance an abscess. now watch me." he turned towards the unsuspecting patient. "you see now. this is the blade and this is the abscess. and this is the blade draining the abscess." with that he sunk the blade deep into the abscess. the patient winced, but, surprisingly made no other objection. i assumed he felt the threat of the firing squad may have been a general threat and that it was not limited to the poor house doctor. also once the thick stream of puss came out, there even seemed to be relief on the patient's face.

"there you go, mb and chb. now never consult us to drain an abscess again!" he turned and strode out. we had to follow. i was right at the back so i think i was the only one who heard the quiet and slightly bewildered voice of the house doctor as he said;

"i didn't consult you. that isn't even my patient."

gatekeeper

i am somewhat known for not knowing when to keep my mouth shut. but, fortunately for me i once managed to put a watch in front of my mouth, but only just in time.

i was on rotation just before intermediate exams. this was a difficult time when generally you had to make sure you didn't make enemies in other departments. you always ran the risk that the guys you irritated would be in the exam or write a scathing report to your own prof. then, no matter how well you knew your work, you would not get through. it's just the way things were.

interestingly enough the obstetric and gynaecology department stood apart from all other surgical disciplines. for many years they had not done the rotation and therefore did not write the intermediate exams common to all the rest of us. other than the fact that this meant that they didn't share with us the burden of running the icu department (which they did use, however) it also meant that they could be very narrow minded. they didn't have an overall knowledge of physiology and the management of acutely sick patients. to them a patient was simply a vagina and a uterus of varying size, with or without a bun in the oven. in short, the rest of us thought of them as lazy and stupid.

i was on call in the icu at kalafong (hell). the way things worked there is we all knew all the patients in the finest detail. on a call day that knowledge was absolute. we could recite the finest details of any patient under our care in an instant. so late that afternoon when i walked into icu and saw the prof of obstetrics standing at the bed of one of my patients who we were treating with severe pre-eclampsia and hellp syndrome with his entire entourage i immediately walked towards them to answer any questions they might have.

as i approached i remembered that prof from my pre-grad days. we used to call him red beard which was some sort of a reference to a scary pirate, but more a comment on his interesting choice of facial hair. he always seemed to try to intimidate and to be honest i think we were all scared of him. looking at him now i couldn't understand that anyone could be scared of an obstetric prof. thinking back it seemed to me that his so called intimidation tactics were no more than posturing. he must have been trying to hide something. i walked up the the group of gynaecologists milling around my patient.

"hello prof." i greeted.

"oh, are you in charge here?" he asked looking up at me. i could see his underlings shifting uneasily. maybe he still had the power to intimidate them.

"yes prof, i am." i smiled in what i thought was a friendly, disarming way. i readied myself to help them with any and all questions they might have. after all there was absolutely nothing about the patient that was not at the tip of my fingers.

"good, because we are trying to make head or tail of what is going on here." simultaneously a few things happened. firstly i realized he was not going to lower himself to the point of actually asking me anything in front of his hordes. secondly, right there i decided that i would not be intimidated by what i now saw as the posturings of an old sad man. i stepped, back and folded my arms. secretly i enjoyed watching him struggle and flounder as he went through the patient notes. lastly the perfect sentence popped into my mind. by some miracle i actually kept my mouth shut and did not actually say.

"of course you are prof. after all the only thing more stupid than a gynaecologist is an obstetrician."

experience

different places deliver different opportunities for experience. it is just a fact. a surgeon working in hollywood is going to see a different spectrum of patients than what one in, say, delhi would. it doesn't mean one is better than the other but it does mean one would feel more at home treating certain conditions than the other. therefore when the belgians rotated with us it stood to reason that they would feel a little unsure on their feet in our environment, initially at least.

when i started in surgery there was already a belgian there. our department had an arrangement with a university in belgium which meant there was at least one belgian registrar with us for one whole year at a time. each year the belgian would go back and another would come to our shores to replace him. so i got to know quite a few belgians in my time. chatting to them i realised the vast difference between the approach to training in their country and in our humble department.

when i first joined the department, in an effort to make small talk i engaged the belgian. i didn't really know what to talk about so i decided to ask him about the differences in the sorts of things they saw there and the sorts of things we saw in south africa. i started with things that were common to us.

"so have you ever seen a gunshot wound in belgium?" i asked.

"of course! i saw one that went in the thigh anterior midline and exited on the lateral aspect just before i came out to south africa." i decided to rather ask him about the weather. it would bore me less.

a year later when the new belgian had joined us i decided to strike up a conversation so that he at least felt there was someone he could speak to in this new strange country. at that stage we were so consumed by surgery there was little else we were capable of talking about.

"so have you ever seen a gunshot wound in belgium?"

"of course! about a year ago there was one that went in the thigh anterior midline and exited on the lateral aspect."

"and what's the weather like there?"

my third year there when the third belgian came out i decided to test what was becoming a theory of mine.

"have you ever seen a gunshot wound in belgium?"

"of course!"

"let me guess. it went in the thigh anterior midline and exited on the lateral aspect?" he assured me the weather in belgium could be quite pleasant in the summer.

so the first three belgians had seen the exact same gunshot case. gunshots were so rare in their hospital that when one came in the entire surgery department was called to casualties to see it. i was amazed. they also didn't quite have the same sink or swim way of training that we had. they pretty much didn't operate at all without a consultant being present. in our way of thinking it was madness, but in reality it was just a different road to the same destination.

so imagine the culture shock when one particular belgian registrar started in our department. he was shuffled off to kalafong and put on call alone his very first night. now as i have mentioned before, getting a consultant out to kalafong at night was only fractionally easier than turning lead into gold. the senior south african registrars informed him of this fact and availed themselves to be called if he needed advice. they quickly added that they would help him telephonically but they would not actually come in. he would have to sort everything out on his lonesome.

the next day he was a wreak. he was talking about packing it all up and going back to belgium (where the weather was pleasant in the summer). to his credit he stayed.

you see, that night, not only did he see his first gunshot abdomen, but he was required to operate it. after that he did his second one and after that his third. on his very first night on call in this glorious country of ours this poor first worlder really got a taste of what it can be like. i really felt for him. but then again at least we no longer had to discuss the weather.

spindoctors

i suppose politics of sorts pervades all aspects of life, medicine included. often the way you spin a story would either land you in it or get you out of it. sometimes the consultants didn't need to know the whole truth. variations on this theme often played themselves out. this is just one example.

the boy was only 15 years old. he had been admitted the previous night by a junior registrar. apparently he had developed abdominal pain after a rugby tackle during a school game. the x-ray hadn't been too spectacular and the junior registrar felt that his abdomen was tender enough to admit him but not tender enough to operate him. this essentially meant he was not willing to take the decision to operate or not himself and wanted to get the consultant's opinion the next morning. the consultant was an interesting eccentric man who tended to be a bit conservative in his approach to cutting people open. he could also be somewhat intimidating.

i met the patient for the first time on the morning rounds when the junior presented him to the consultant. i quickly examined him while they spoke immediately decided what i though. something was wrong, i felt and it was not the sort of something that was about to sort itself out all on its own. then the consultant examined him. the patient winced but tried to be brave. the consultant also made his decision.

"he probably just has a bit of bruising. he doesn't need to be operated. a rugby tackle can't cause too much damage" he pronounced. "bongi, you're on call tonight. i'm telling you now, you must not operate this patient. he'll be fine in the morning."

"yes sir." i replied, but i had plans. all sorts of things can happen once the sun has set. i knew i could spin it tomorrow, providing i ended up being right. however if i turned out to be wrong it would be a bit tricky.

when the day ended i took a walk past the parking lot to confirm the consultant's car was gone. i then booked the patient on the emergency list for a laparotomy. i remember my house doctor looking at me with an expression of shock and horror on his face. i smiled, but i remember thinking that i'd better be right. otherwise i'd be the one with shock and horror on my face the next morning (not to mention egg).

soon we were in theater and shortly thereafter the abdomen lay open before us. the intestines were floating around in a pool of bowel content and there was a neat little tear on a section of small bowel. already the peritoneum was looking pretty darn inflamed. the mood lightened. i even felt a joke or two may be in order.

"i'm right again. sometimes i get so tired of always being right." i mimicked the consultant's usual line. the house doctor shook with laughter. once he was able to assist again we finished the operation and closed up.

still there was the matter of telling the consultant the next morning that we had disobeyed his direct command. and here is where i knew i needed to put the right spin on it. he didn't need to know that i had never had any intention of obeying him. i had evaluated the patient and i was not comfortable to leave him through the night when i felt sure that he needed an urgent operation. in fact the junior that had admitted him displayed a total lack of the usual confidence associated with surgeons by not operating him the night before. i was not going to do the same. i was going to back myself and my own clinical acumen and that is why i operated. also i knew that if i had argued with the consultant on the ward rounds he would have entrenched himself in his opinion and there would be no way to spin the story the next morning. i had essentially lied to him and i knew it. he did not need to find out.

"bongi, how is that patient doing?"

"doctor, last night he suddenly got much worse. his pulse went up and his abdomen became much more tender.in fact he developed an acute abdomen so i felt obiged to operate." again the house doctor looked at me with horror. the consultant's fists clenched.

"what did you find?" i was home free. thank goodness i was right. if i had been wrong, this is where it would have all unravelled. i told him. and that was it. nothing more was said. i survived.

p.s. the patient also survived.

the baby story

the life of a medical student is somewhat left of normal. most people shy away from blood and guts and gore. as a medical student you need to embrace it. but in the beginning it is quite an adjustment. sometimes you don't know how much to adjust. what falls within the parameter of normal medical student desensitization and what is way too far?

i was a fourth year which in clinical terms meant i was at the bottom of the rung. i was doing my obstetrics rotation which meant i needed to deliver a certain quota of babies in a given time. we all tended to be goal orientated then. our registrar was the most junior obstetrics registrar in their department so she was even more goal orientated than we were. she was also a bit skittish.
so that day, when a lady came in fully dilated and then popped out a dead baby she seemed to go to ground. don't get me wrong. i do not enjoy the whole emotional roller-coaster involved in delivering a dead baby, but once it's done you need to move on, especially in kalafong where the constant stream of bursting women is never ending.

so there we were in kalafong labour ward in the middle of the night with a somewhat unstable registrar who suddenly seemed incapable of pretty much anything because she was so distraught. i had the thought that she should maybe try dermatology as a speciality. it wasn't too late to change. the house doctor spent quite a bit of time consoling her. time i thought could be better spent in consoling the mother who had just lost her child. but a fourth year's opinion was much less sought than listened to. finally the night went on.

some time later when the distraught mother was bundled off to the ward and the dead baby was bundled off to the morgue and the registrar bundled herself off to the doctor's room the call finally continued. we continued delivering babies while the registrar went through the prenatal record of the mother to try to see if there was a possible reason for the death. she discovered the mother's blood group was rhesus negative. this basically meant if the baby was rhesus positive the mother needed to get an injection of antibodies to prevent her developing her own antibodies against the rhesus factor. if this happened her chances of successfully bringing her next pregnancy to term would be greatly reduced. the registrar hadn't drawn the chord blood from the baby which is the normal method of getting blood to determine the baby's blood group. she therefore didn't know if the mother needed the injection or not. i simply thought it's not worth taking the risk and we should rather just give the mother the injection on the grounds that the baby was most probably rhesus positive. but the real reason the registrar was in a spin had to do with what the professor was going to say in a few short hours at handover about her not drawing chord blood from the baby. she settled on a plan.

"you!" she indicated my friend and i, "you are going to go down to the morgue and get that baby's blood. and you'd better move it. the sun will be up soon.

the morality of what she was asking didn't occur to me then. it was late and we were tired. also we were junior. if the registrar told us to do something then we were required to do it. so off we went.

kalafong is a scary place on a good night. the morgue was in a ditch along a deserted corridor. all was dark and foreboding. but we were on a mission and our over active imaginations weren't going to stop us. we finally found the poor baby and got to trying to get blood. then we discovered something. you actually need to be living for your blood to be drawn out of conventional veins. after a few attempts we graduated to trying to get blood through the frontal fontanelle. this also didn't work, probably because the small amount of blood there had clotted and couldn't be drawn up in a standard syringe. finally we stuck the biggest needle we had right into the heart and managed to get a small amount of blood. by this stage my own blood was curdling, the hairs on the back of my neck were standing up and i felt sick to my soul. we left.

the registrar took the blood without so much as a small acknowledgement towards us that we had done something terrible so that she could avoid the wrath of the professor.

many times since then i have been haunted by how wrong what we had done there in the dank corridors of kalafong was, but it was a lifetime ago and maybe time does wash at least some sins away.

words

as a rule i don't swear at people (not at people) but like every rule, there are exceptions. sometimes the frustrations of old were too much to take.

i was working at 1mil (the military hospital in pretoria). because the calls were so light we were required to lessen the load of the guys at kalafong (hell). so on the day in question i found myself stalking the cold corridors of kalafong. to make it worse, my students made themselves very scarce despite numerous attempts to contact them.

late that night a gunshot wound abdomen came in. now abdominal gunshots roughly fall into two categories. the first group are hemodynamically stable. that is to say they are not trying to die at that exact moment. usually they will deliver numerous bowel perforations that can be sutured at your leisure while enjoying a casual chat with your team and theater staff. the second group are not stable. ie they are actually trying to die on you and they need fast aggressive action. in casualties they need good large bore fast intravenous access. they need fluid and they need blood. this was one of those. he was in big trouble and my students still excelled in their absence. fortunately in casualties there were previous students of mine who were rotating through internal medicine. they saw the need and stepped into the gap.

in the madness that is kalafong one of their rules to confound things is that you can't book an emergency patient telephonically. it must be done in person. i think the idea is if you leave your patient long enough to go and book the case he might die and then theater staff get to sleep rather than work. whatever the reason it can be very infuriating, especially if you don't have students. i therefore sent one of the internal students to theater to book the case. i told him to impress upon them that it was going to be fast and furious and that the patient was nearly in exitus. the other student i sent to the blood bank to organise six units of blood. i busied myself with placing a high flow central line and an intercostal drain (it was needed). soon we were ready for transport to theater.

just as we were about to push the patient to theater the student from the blood bank came back. he told me the guy at the blood bank had told him he would only issue two units of blood at a time. if we needed more thereafter we could order again. once again, just a usual kalafong ploy to try and hamstring any attempt at providing good patient care. i wondered how i would take time off from what promised to be a very tense operation to go and get more blood. i knew that the patient needed more than two units as he stood and i wasn't sure how long it would take me to get control of the bleeding once i opened. it was absolutely ridiculous.

we started pushing the patient. blood bank was on the way to theater. i peeled away from the patient as we passed it. i would have preferred to be next to my patient but blood was needed. i thought i would just take a moment to sort it out. true there was a chance the patient would crash in those few moments but what would i do without blood anyway.

i stormed in. the guy stood behind the desk with jail-like bars between us (i always assumed they were there exactly for moments like these).
"excuse me." i said as calmly as possible.
"wait. i am busy." he replied. lucky he had the bars.
"i can't wait. i have a patient in theater bleeding to death and i hear you won't give more than two units of blood."
"don't speak to me in that tone." he had taken the discussion off the point and was pretending i was being personal. i realised i could not reason with this man. he had chosen the personal route. that i could do.
"you stupid f#@king bastard!" i replied with more than just a hint of aggression.
"are you calling me a bastard?" he shouted in rage. i thought it interesting that that was the only word he linked onto. maybe he didn't hear me. i could help with that.
"yes i did. of the stupid f#@king variety." i turned to the student who was biting back a laugh.
"sorry but i don't have time for this child. i need the blood. i know it is not your job, but could you get it sorted for me? i'm going to theater for fun and games." he said it was no problem. there seemed to be a permanent broad smile tacked onto his face. i left. truth be told i prayed the blood bank guy would formally lay a complaint against me. i would have fun defending myself. there would then be no bars to protect him.

the operation went as well as could be expected. the blood did arrive, although after quite a wait. the patient got to icu where he demised the next day.

this sort of thing was fairly regular at kalafong. i knew to stay there would either make me bitter and aggressive or worse, complacent like everybody else. i needed to leave. once i qualified and was offered a consultant post there i laughed.