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.

callous

in a previous post i came across as caring and in touch, but sometimes i forget to be this.

i was doing an above knee amputation. my consultant had recently explained a technique whereby one attaches the muscle to the bone stump directly and not just to the membrane around the bone (the periosteum). this required that holes be drilled into the bone which would be the anchor points for the muscle. i had never done this before and was grappling with the drill.

at this point, as serendipity would have it, the small porthole window of the door leading to the scrub room filled with the eager faces of a bunch of youngsters. a theater sister who was taking them around came in and informed me that they were school students that were considering medicine as a career and had come to the hospital on some sort of career day outing. she asked me if i'd mind if they came into theater in groups of two to get a better understanding of what we do.

now, understand, i love surgery. any opportunity i get to promote it i take, so i thought this was a great idea. of course i said yes. the first two came in.

let me take a moment to sketch the scene. i've just removed the leg. the bloody stump is sticking out like some cheap prop in a second rate horror. i'm trying to get the bloody (or should i say blasted) drill to work, so i'm not really doing anything besides getting more frustrated by the moment. the students come in and see this setup. not being overly busy, i ask them where they are from. the first guy says he is from a particularly good rugby school in town that, coincidentally, had just lost the gala match to my old school. even the drill could wait. i asked him about the game and what he had thought. he seemed a bit withdrawn and non responsive. i couldn't understand this. it had been closely contested and although his team had lost, they had played well.

then i noticed that the poor fellow was pale and his eyes seemed to be glazing over. the sister quickly took them out. no more scholars came in after that. i did see the horrified face of one young girl peep in just before they moved on. i think i even saw tears. later i heard that some of them needed to be resused with tea and sugar.

in retrospect i was a bit foolish. not all school children who think they want to be doctors are cut out for the job. and not all doctors are cut out to be surgeons. if i had had the opportunity to go into theater as a school student i'm pretty sure i would have thought, 'cool! he's actually cutting a leg off!! wow!!' but that doesn't mean these particular students are also going to think like that. i actually should have known that it was fairly unlikely that my and the sister's good intentions would have fallen on fertile ground.

p.s i never did get that drill to work.