Tuesday, June 23, 2009

bell bottoms

i recently went to prague. what a culture shock. the place is clean and beautiful and safe. i travelled quite a bit on the public transport and not once felt in danger even though i'm south african.

there is generally law and order. on the first day i went on the underground i did not stamp my day ticket because, being south african, i just assumed there would be someone to stop me and check. there was not. they rely on the people there being honest. being south african i rode the whole day essentially for free. then my conscience got the better of me and i bought another ticket so they would not lose money.

you see we south africans have no law and no order. we get away with whatever we can. we all speed and we all jay walk and we all bend all the rules as far as we won't get caught. in prague it is exactly the opposite.

but getting back to the story. one reason it was such a culture shock is because a while ago, to travel on public trains in south africa was quite risky. you see there were gangs that would throw people off moving trains for a laugh. there was also a time when certain trains would get attacked by automatic wielding thugs that would indiscriminately shoot people. these days there is more security (all armed of course) so it isn't quite so bad. there still is the occasional torching of a carriage if it turns up late. let it never be said south africans can't express their anger at trains not being on time.

anyway, while i was safely travelling on the czech (for americans, that is where prague is) public trains, i thought about a few of the patients i had seen. i don't think i'll talk about the guy that got corkscrewed between the train and the platform here. the bell bottom patient came more strongly to mind.

it was in the days of the indiscriminate throwing people off and in front of trains. most died on the scene, but a few got to us. for those who don't know, to get injured on south african train tracks is a sure recipe for sepsis. the trains drop their sewer directly onto the tracks, so to get an open fracture there usually ends up quite a mess. my patient was thrown in front of an oncoming train from the station platform. i suppose the people who threw him there thought it was quite funny at the time. we at the hospital did not.

the poor victim of this senseless crime fell with most of his body over the further track. in fact only one leg lay over the one track. unfortunately he had no time to pull his leg away before the train went over it.

now, to fully appreciate what happened one must realise the patient was fully awake and fully sober. he had in fact started extricating himself when the first wheel cut and mangled his leg about mid thigh. he continued to pull himself away. the second wheel therefore hit his leg about two inches lower down. the next wheel then struck about two inches below that and so on. so the leg was mangled worse than any mangled limb that i have ever seen and more than likely will ever see. it had deep cuts at two inch intervals. the femur was severely broken but it was not nearly as bad as his lower leg. the lower leg spread out like a bloody and distorted bell bottom ending in a very wide flat thing that had once been a foot.

suffice to say he lost his leg that day. (for up and coming south african surgeons, leave the wounds open from train track injuries, like we did. otherwise sepsis will set in and things will get worse.)

so while in prague, i was really confronted by the many acts of meaningless violence we see in our country because i had a clear picture what life could be like in a peaceful place. i honestly wondered what the point is here.


Philippa von Ziegenweidt said...

After I left Joburg in the late eighties and moved to Holland, it took me a while to get used to the seemingly pointlessness of the bland local politics.

I also had to adjust to standing at bus stops and not worrying about rubbish bins randomly exploding.

After a while, I did learn to appreciate the benefits of a functioning democracy, but I did find this hard to explain to people who had not grown up in a violent country.

rlbates said...

There is still plenty of trauma and disease to keep a surgeon busy.

Blaz V said...

Oh, Prague... I live a six hours drive and two countries away and go there any chance I get.
It's wonderful.
Thank you for blogging. It helps me keep perspective although I am no surgeon (internal medicine guy).

Dr. Val said...

Ew. That was graphic... and sad. :( I wonder what you'll make of Las Vegas????

Anonymous said...

Hey now. We Americans are perfectly aware of where Czechoslovaniland is. Right there next to Something-istan.

Jade said...

South africa public transport is really below par. Im currently doing trauma and have seen the most tragic cases ever. I have to say thank you 4 the 'fear nothng but fear itself comment'. I have since done an elective in surgery and have assisted in several surgeries (even at 1am) nevermind i only do my 1st surgery rotation next semester. Im considering surgery as a speciality but i don't think my autonomic system likes it :)

Enrico said...

Some of us Americans prefer the Olde Worlde "Bohemia" instead. :P

(and I know it's not even any kind of remotely similar comparison, but 90% of the time, I felt much safer in general in Mexico [proper, not border/cartel-controlled regions] than in most inner-city areas here in the US. It's not just an issue of who has the guns; the general attitude of everyone is trouble doesn't usually find you unless you're looking for it. I can live with that)

Bianca Castafiore? said...

Why do you stay?

(I've been led to expect a polyphonous response!)

Bianca Castafiore? said...

My comment was not terribly polite, not well put. I am sorry.

You stay because you stay. I meant no disrespect.

Anonymous said...

nice juxtaposition between the tags for this post and the picture.

Unknown said...

South Africa is in our blood :) Great read yet again, wrote my Med School application test today - 8hrs of Exams, yay! All your stories are wetting my appetite, keep them coming please :)