Wednesday, August 27, 2008


like most surgeons i can't overemphasize the importance of mobilization after an operation. it is good on so many levels. the lungs enjoy it. the vascular system enjoys it. the bowels sure do enjoy it.

ironically smokers mobilize quickly. it seems after an operation the only thing on their mind is that first drag. unfortunately you must make it to the balcony to get that payoff. no amount of pain will get in the way of a fully fledged nicotine addiction. there are less common motivations to mobilize in south africa.

it was a normal call. then very late that evening my pager went off. it was mamelodi hospital. as usual they were phoning about a gunshot would. actually there were two but they were exactly the same. both were through the right iliac fossa area and both turned out to be caecum injuries. the only difference was that one was in a 25 year old male and the other was in a 23 year old female. fortunately both patients were stable so i decided to operate the female first. the male just had to wait for his turn. both operations were identical and both went without any problems and the call proceeded as calls tend to do.

the next morning on my early morning rounds, as could be expected, both patients were still groggy from the previous night's anaesthetic. i was groggy for different reasons. other than that both seemed as well as could be expected.

however, about an hour later, on the academic round with the prof, both patients were missing from their beds. i remember thinking that the cases were truly identical in all respects. i also remember the prof's questioning eyes looking at me, wondering if my story was indeed true seeing that both patients were nowhere to be found and therefore could not substantiate what i said.

after the rounds my curiosity got the better of me. i went looking for my missing patients. they weren't smokers so they weren't on the balcony where i looked first. but i soon found them tucked away in a corner together holding hands and whispering sweet nothings to each other. it was about then that i decided to ask how they got shot. being amazingly astute as i am i had already figured out that they knew each other. there story went like this.

they were a young couple deeply in love. for some reason that i can only attribute to the madness that seems to overtake the lovestruck they decided to go for a stroll together in mamelodi that evening. during this stroll they got stopped by a gun toting thug that seemed to be in need of a cell phone. the male, trying to avoid confrontation, gave his cell phone up without any arguement. apparently he also threw his wallet into the deal. the thug took both and then with precision aiming, just for good measure, he put a bullet through both of them, exactly in the same place.

so it seems that is not just smoking that motivates patients to mobilize early after major surgery. two lovers getting shot together seems to have the same effect.


rlbates said...

It's nice when patient's have something to get them moving. You couldn't get away with it now, but when I was an intern we would occasionally on rounds get the patient into the bedside chair and then literally roll-up the mattress so they couldn't get back into bed. This was only used on the extreme cases, but it worked.

Karen Little said...

aw, sweet...

Anonymous said...

How do you do it?

Knowing that you're the little girl in the starfish story-- the one that can only help those which happen to lie closest at her feet-- how do you get by?

It's overwhelming. It crushes me. Everyday, knowing that the best I can do is so small.

I went into medicine believing that I could change the world and I let my ideals guide me. Today, I'm just tired and exhausted of everything.

Bongi said...

karen, i suppose you could say that the couple that gets shot together stays together?

anonymous, make a difference for that one. it is good enough. my previous post also deals with how i manage to deal with collateral damage.

Devorrah said...

Sweet story, but have no idea where the actually got shot. Head, tummy, foot?

Also, I agree with just trying to make a difference day by day, one person at a time. It's much more rewarding to teach one child to read than to sue a corporation. I've taught about 400 students by now, and I bet most of them remember me.