Saturday, November 22, 2008


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.


Unknown said...

This reminds me of rule number six of The Rules: Each unit of blood involves at least four telephone conversations with the blood bank.

Anonymous said...

Heh. If one is going to curse at someone, they ought to be angry enough to back it up and not change their mind. I'm still laughing at this line:
"Yes i did. of the stupid f#@king variety."
Is there any other kind?

anne said...

The language was entirely appropriate. In fact, I am getting quite a chuckle out of it.
My mother worked with a surgeon in the 1990s who, it seems, every other word out of his mouth (as soon as the patient was asleep) was F#&k. When I spoke with her on the telephone, and she would indiscriminantly use that word with me. This annoyed me, because had I used that word with that frequency and intensity as a teenager, the consequences would have been dreadful. Just when I was ready to send her off to swearing rehab, the surgeon passed away (EtOH abu/liver cirrhosis) and the problem resolved itself. In his defense, she claims that he was the best surgeon she ever worked with, and was a great guy.
Sometimes nothing works quite as effectively as a well-timed and heart-felt 'F#&k you, you f#&king moron'. Great story Bongi!
p.s please note that there is another Anne who occasionally posts here. I noticed that the other day--she might object to this posting. I am the anne with all little letters.

Dragonfly said...

Oh how frustrating.
And re "Yes i did. of the stupid f#@king variety", ROFL.

Greg P said...

There are no doubt several varieties of bastard, roughly based on how hard the person is working at it.

Jade said...

lol,when students go AWOL its always on purpose!! My personal fav hiding spots:
The Caf (my reg did not eat much)
Peads ward
computer labs - facebook
once i made the mistake of calling the reg on her cellphone. she took this opportunity to add me to her contacts so everytime we went AWOL she would send me an sms asking me and my partner to do stuff. the smses always began with a please and ended with a smiley face. How could i say no.
lesson: we(students) respond very well to manipulation and promises of cool procedures
By the way, thanks for ruining my 'animals I've seen list'. whats the difference anyway?

Devorrah said...

I'm proud to say I've never sworn in front of my students, but it's every young teacher's nightmare that she'll stub her toe and say, "Shit!"

Bongi said...

what i hoped would come out in the comments is the relative gravity that the two protagonists attributed to the same situation. let us not forget that in the night in question a fellow human being lost his life (ok he demised the next day but the actual losing of his life happened that night). yet the debate between myself and the fool behind his protective bars was about him trying to assert himself and use what little power he had for some macho psycho display. aren't there a few psychiatrists or psychologists out there willing to give us a few morsels down these lines?

anne said...

Bongi it's a funny post. Please don't take it too badly that we all gloss over the severity of the situation. The situation was catastrophic for that patient (and you too), but you won't get the guy behind the bars to do anything any different. If you'd asked him nicely and explained the severity of the situation, I bet he wouldn't have moved any faster. It's not possible to reason with someone like that. Sometimes it's easier to laugh at these stories to deflect the tragedy of it. If you think for too long about your patient's fate being influenced--or even decided-- by some egotistical bureaucrat with the IQ of a fruit fly, you will go crazy. I am not saying that you should accept a bad situation, I am just saying that the post, or at least your language, was funny. The story was very sad, but many of your stories are. Nonetheless, I am happy to read them.

Bongi said...

anne that is a very good point;. and in fact i do try to mix the grave with the sublime in my posts, so read on and enjoy. thanks.

JC Jones said...

I had to leave an ER in North Philly at about the same point - when I started screaming & cursing at people who worked there, I knew I was on the verge of a psychotic break.. ;-0

Anonymous said...

What's really hard is that you care so deeply about every life that you try to save... and so many of them don't seem to make it, despite your best efforts (and road blocks from every direction). I worry about burn out... How can you go on like this? As "bad" as we think it is in the US, it's nothing like SA...

DeeJay said...

I work in Kalafong bloodbank for two months now, and I have to say that I love this place. I have a wonderful relation with both doctors and students there. But unfortunately not everyone working for this company is friendly or open minded, I know, I know.... Some just don't give a shit about what happens, so I am quite sad to read this story, as I can imagine the frustrations of the doctor!
Personally my only irritation is when I phone the wards to send a "sister"....they just don't pick up the phone, or, if they do, it's in such an uninterested and rude manner, that I wish I could leave the "jail-like" bloodbank and do the things the doctor in this story wanted to do with my predecessor! Anyhow, working together to achieve best interest for the patient...that's a goal on itself.

Bongi said...

deejay, thanks for the comment. it is good to hear there new blood there.

i agree, the aim should be to work together for the good of the patient.

truth be told there was one guy there i got on very well with. he was not the one i wrote about. the guy i wrote about i only ever had bad experiences with.

the sister thing in can't be changed. try not to let it get you down. and above all don't let the kalafong apathy that spreads like a fungus infect you and dampen your present enthusiasm and work ethic.