night walker

one of my senior registrars once said that the night belongs to surgical registrars and prostitutes. we all had a good laugh. it didn't strike us as odd being compared to prostitutes at all. if anything in those days we often got the feeling we were being screwed over, however the remuneration wasn't as good. but there was another time the comparison was a bit odd.

on a certain sunny day i decided i should do my duty and donate blood. i felt it was not right that i complain when there is a shortage in the hospital if i am not at least trying to make a difference by donating myself. so off i went to the nearest blood bank with my phobia of needles and my sweaty palms, all trembling in fear to donate. the lady behind the desk took my details down and pricked my finger to make sure i was not anaemic. after that formality (which in itself did nothing but heighten my dread of sharp objects), she gave me a questionnaire that i was required to full out. i thanked her and moved off to a table to nurse my painful finger and full out the form.

the form was pretty much what one would expect. it asked if i was aware if i had had any blood born diseases that i knew about like hepatitis b or hiv etc. it touched on family histories and the usual medical things that may have an influence on whether one should donate blood or not. then it fired out a question that i though quite interesting.

"are you involved in any high risk professions like prostitution or surgery?" prostitution and surgery were sort of lumped in to the same question together. also they were both considered professions of, as far as i could tell, the same standing. there was a block to mark yes and a block to mark no. i marked yes.

i took my questionnaire to the lady behind the desk. she scanned all the answers until she came to the one i had marked yes. she froze. she then glanced up at me. actually i think she maybe looked me up and down. she then hurriedly disappeared into the back room. after a few hushed whispers she emerged with another lady and i was led away to a room with a sign above the door that proudly identified it as the counselling room. now where i come from, the word counselling is pretty much always what happens just before you get tested for hiv. i considered telling them that my last test was about a month ago and it was negative, but i was somewhat bewildered and still beset with fear for the large needle that i still expected would be sunk into my arm.

once we had settled down into comfortable seats in the counselling room the lady asked me what i had meant by answering yes to that particular question. i told her i was a surgical registrar and was therefore quite often engaged in high risk surgical activity. she then also looked me up and down and gave a sort of smirk. she clearly didn't believe me. i was obviously much too good looking to be a surgeon and better fitted the profile of one who sells his body for cash. then, without missing a beat she went on to talk about the dangers of hiv and all the ways you can get it (she meant by selling your body of course). i wasn't sure if i should point out that other than getting screwed by the system in the state hospital on a regular basis i was not a prostitute but rather a surgeon. but she hadn't believed me the first time and nothing had changed between then and now so i decided to just keep quiet. after all, maybe i was simply too good looking to be a surgeon after all.

suffice to say they did not want my tainted blood and i therefore never had to face the business end of their needle. i just wish they had only checked my blood for anaemia after the counselling session rather than before.

monster

i recently read quite an interesting post on one of my favorite blogs. it had to do with religious zealots. it reminded me of two experiences i had, both of which i found disturbing.

i was rotating through paediatric surgery. the prof operated a 7 year old child for obstruction. intraoperatively we found intussusception in the ileocecal region with a golfball sized leading segment. we did a resection. already intraoperatively, the prof suspected a lymphoma (lymph node cancer). and histology proved him right. the child was referred to the chemotherapists for treatment.

during treatment, the child developed pancytopaenia (all blood products were low, including red blood cells) and became dangerously anaemic. at about this stage i discovered he was in foster care, because his biological parents suddenly crawled out of the woodwork. due to some legal technicality they still had a say over him in the legal sense. they then proceeded to refuse to allow a blood transfusion on the grounds that it was against their religion. i felt like i was watching a horror movie unfold before me. i could watch no more. i left it to the chemotherapists and didn't enquire about the child anymore.

the second incident was in some respects less dramatic. i saw an 8 year old girl who had fallen out of a tree onto a cast metal fence. the fence had sharp spikes and she had been impaled. when i saw her, she had four stabwounds in a row about ten centimeters apart running diagonally across her abdomen. omentum was protruding from one and she had an acute abdomen. fortunately she was stable.

i informed the mother that an operation was essential. she nodded. then she asked,
"will you be giving her blood?"
"i hope not." i replied.
"good, because our religion doesn't allow us to receive blood."
she didn't ask about the condition of the child or the nature of the operation or the chances that it would be successful or anything. she just told me that i was not allowed to give blood.
"i would only give blood if it turns out to be a matter of life or death." i replied.
"no, you may not!" she retorted.

i asked her if it was worth gambling her child's life (not her own life but the life of her child) on a religious ideal. but the blinds had gone up. she wouldn't even talk to me. she just kept repeating, as if in a trance, that no blood was to be given no matter what the circumstances.

the operation went well. one of the spikes had missed the aorta by about 2mm. slightly more medially and she would have been in dire need of blood to survive. while closing the multiple bowel perforations, i thought about her blase gamble with another human being's life. i also thought about the very difficult situation i would have been in had the aorta been injured. maybe the mother was willing to stand by idly while her own child expired, but it would not have sat well with me.

my feeling is that if an adult makes this sort of decision about their own life, who am i to go against it. but the children in these stories had no say. their lives were gambled with by others. they probably were too young to make decisions about religious ideals, and yet they were both being expected to possibly make the ultimate sacrifice in the name of religion. in fact they were going to be sacrificed by their own parents in the name of their religion.

it was monstrous.