Monday, May 05, 2008


the south african sink or swim approach to medical training tends to grow on you, but in the beginning it could be quite terrifying.

i was a house doctor. in fact i had only been a doctor for about a month and a half. i was realising that there was in fact knowledge in my head. when i saw patients it seemed to come to the fore and i actually knew what to do. it was an exciting time. all those years of study seemed less in vain.

so when i saw a young lady in casualties with severe abdominal pain, one of the conditions i considered was an ectopic pregnancy. sure enough her pregnancy test came back positive. i immediately knew what confirmatory test to do (we didn't have sonar or ct scan, scanman). shortly thereafter i stood with a syringe in my hand full of blood that didn't clot. it was all coming together so well. i had single handedly made the diagnosis of a ruptured ectopic pregnancy. i was actually using my years of study. i was being a doctor!
i quickly booked theater and called the cuban gynaecology consultant. he soon arrived. like a proud cat with a dead mouse i showed him the syringe with the unclotted blood. he obviously agreed with my diagnosis and management plan. i was the man.

then he turned to me.
"i need to go to the bank" he said. "will you be able to handle her in theater?"
"definitely not!" i replied. "you'll have to come with me."
"but i'm on my way to the bank now, so you go ahead so long. i'll join you when i get back. anyway it's just like doing a sterilization, except the tube is more bulky." at that stage in my career i had in fact done maybe three sterilizations. i started sweating.
"i don't think i can do this" i retorted.
"you'll be fine." and with that he turned and walked out. i couldn't help wondering if the patient was going to be fine though.

so i took her to theater. i was so scared i could almost not talk. but what could i do? i was the only one there. and where i did my house doctor year, we operated without an assistant. there was no one available to assist anyway. i did the operation alone. my hands were shaking so much i'm surprised i got it done.

towards the end the consultant did arrive. his banking done, he was free to observe me closing the abdomen. pity, because i still didn't have steady hands by any measure and i probably looked pretty clumsy.


Devorrah said...

It's hard to imagine that you were ever that green! Thanks for a great story.

Devorrah said...

My 19 yr old son just explained your photo, which I've been wondering about. A man fighting a wolf from the movie "300".

rlbates said...

Devorrah, I was thinking the same thing. The things about Bongi ever being that green.

Nice post!

Anonymous said...

Ah, yes...having been an OB for 25 years now, I am still apprehensive if an ectopic is on the table. Most of them are easy, run-of-the-mill cases where you can do it via the laparoscope, milk out the pregnancy and preserve the Fallopian tube - but once in a while you encounter the real thing, the intramural bleeder requiring laparotomy, O-negative blood and makes the anaesthesiologist sweat.

I particularily remember a case from the Arctic North, where the anaesthesiologist was from India, and when he started the anaesthethic he told us in a low, hushed voice: "Do it fast."

We turned to him and my boss barked out "Why?"

And the Indian gentleman answered, in the same calm, low voice: "She has no pulse."

Dragonfly said...

Wow. I can't believe that that doctor left a patient like that to go to the bank. She was lucky your were there.