chicken feet

i hate kalafong (hell). there are many reasons for this (here, here, here, here, here), most emotional, i confess. but if i am honest there is one incident that stands head and shoulders above the myriad of traumas that i experienced there.

one of the strange idiosyncrasies of kalafong (hell) is that some time during each night shift, all the sisters of each ward get together in the duty room and eat chicken feet. i have no explanation for this. maybe there is an abundance of chicken feet in the area. maybe the sisters are paid in part with chicken feet that absolutely must be eaten before they leave for home after their shift. maybe it is part of some bizarre ritual that initiates all kalafong sisters into some secret evil cult. i simply do not know.

i was a mere fourth year medical student which meant i was at the absolute bottom of the rung that night on call for internal medicine. i knew nothing and was of almost no help to anyone. the only thing that i could do was to put up drips, so the senior medical students would send me to the wards whenever they got a call that a drip needed inserting. for some reason kalafong sisters never put up drips. maybe there was a fear that the patients were allergic to chicken feet and the residue of the no doubt scrumptious delicacy on the fingers of the sisters could potentially cause the patients harm. they were clearly not about to take that chance, so there was plenty of opportunity for me to hone my already very well honed drip inserting skills.

i had just left the female medical ward after inserting a whole host of drips and was quite keen to see what was going on in casualties. i walked in.

"drip to be inserted in female medical." the sixth year student smiled. i don't think it was really meant to be malicious although it felt that way at the time. i think it was more a relief that he had done his years of continuous drip insertion honing and was glad that he honed no more. it was the natural cycle of things and he had passed the batton to the next group. it was simply my turn.

"i was just there!" i protested at no one in particular, turning to leave with my shoulders sagging just enough to be noticable to the discerning eye.

i entered the ward through the back door. the main door had been locked by the sisters. this was another thing one got used to there. it was just something the sisters did at night.  the reason for this behaviour elluded me, especially when they had just called for someone to insert a drip. you would think that they would unlock the door in anticipation of that person actually arriving to insert the drip. maybe they needed their privacy while performing strange initiation rites with chicken feet.

as i entered the ward, a patient looked at me.

"doctor, help me! i'm dying!" i froze. it was dark. i could only make out the patient's shape, silhouetted against the dirty cream coloured wall. yet her eyes were so wide with fear that i could see her white sclera. i felt a shiver go down my spine. what was i to do? i was only a fourth year. i didn't know this patient and even if i did, i had no knowledge to actually help her. in my naivety i hadn't yet learned the rule that more often than not, if a patient tells you they are dying, it is because they are in fact dying. the one thing i knew is that i couldn't ignore her.

i walked up to her. she lifted her arm weakly. then suddenly her fingers encircled my arm and all her remaining strenght seemed to go into her grip. her nails bit into my flesh as she pulled me close to her face.

"help me doctor, i'm dying!" she repeated. she scared me, so i pried myself loose and checked her file. she had been admitted the previous day with the diagnosis of meningitis. antibiotics had been prescribed but only one dose had been signed for since admission. probably the drip had been out when the other doses were due and once some poor fourth year had reinserted it, the sisters hadn't bothered to put up the dose that had been missed. at least there was something i could do, i thought. i could check to make sure the drip was working and get the sisters to give the last dose of missed antibiotics. somehow i allowed this thought to make me feel better. i would help this lady and all would be well.

i checked the drip. it was working well.

"don't worry, mamma, i'll send someone to help right away." i said as i turned to leave. she lunged for my arm again when she saw that i was going, but there was no strengh left and she missed. as i walked away a knot developed in my stomach. i felt that i had failed this old lady. i had done the little bit my knowledge had permitted me to but i had also allowed my fear of her and of what she was facing to intimidate me to such an extent that i hadn't really stayed to comfort her. i was determined to be a change in her circumstances and her life. i would speak to the sisters.

i walked to the duty room. the door was closed but there was an almighty din emanating from inside. the sisters seemed to all be shouting and laughing in unison. i knocked and opened the door. for a moment the bright light from their happy little room blinded my eyes that had become accustomed to the darkness of the ward. the light seemed to pour out into the gloomy ward behind me. all the sisters were sitting around the table eating chicken feet. when they saw me they all went silent, but continued eating.

"good evening sisters." no answer, unless silence is an answer. "sorry to bother you but the patient in bed 5 in cubicle d is in a bit of distress."

"we'll check on her now now." i knew what now now meant in our strange south african english. now now was not as soon as now and implied no urgency. now now was not as now as i wanted it to be.

"ok," i said, knowing that if i antagonised them they would purposely postpone checking on her just to teach me a lesson. "also i see that she hasn't yet received her last dose of antibiotics. her drip is working, i checked, so please give it to her when you go to her." the sister looked up from the chicken foot she was now toying with between her fingers. i saw in her eyes that she despised me, although i had never laid eyes on her before in my life. some things in kalafong one learned to accept.

"i said we would see to it now now!" she repeated. then her head dropped back down to give the chicken feet the full attention they seemed to deserve. i stood still for a minute. then i quietly closed the door.

as i walked away to do the drip i had actually come to the ward to do, raucous laughter errupted from that small brightly lit room. it brought me to a stop in the middle of the floor in the dark ward. i felt tears well up. i didn't know if i wanted to cry because the sisters were clearly enjoying a joke at my expense or at the futility of an old woman who lay in bed 5 in cubicle d all alone with the fear of death over her. i just knew there was something horribly wrong with the whole picture.

i got the drip up and running in double quick time. i then rushed off back to casualties, but not before quickly checking on the patient again. when i approached her she still had the same stare. this time her arms lay still on the bed beside her.

"don't worry, mamma," i said, "i have asked someone to come and help you. it is all going to be ok." she didn't react. "i promise i'll also come back myself tonight to check on you." a little of the fear went out of her eyes. only a little.

on the way back to casualties i made sure i composed myself. it wouldn't be good to show the senior students that i had been so affected by something they no doubt had seen quite a lot of. anyway everyone always said not to let kalafong get to you, otherwise it could change you forever. at that moment forever seemed like such a long time. the sixth years were busy doing a lumbar puncture behind one of the flimsy curtains in the casualty unit that seemed designed to give the impression of privacy without actually delivering any real privacy. one of them looked up.

"sorry dude, but they just called for another drip in male medical." i turned and walked out without saying a word. the quiet of the open air kalafong corridors could possibly afford my soul a bit more peace than the overwhelming noise of human suffering of casualties. usually i could handle it, but then i felt a despondency and futility that was too much to bare.

in the end there were three drips in male medical so it took me longer than expected to get them all up and running. this time it didn't bother me. i was in no rush to get back to casualties. also i knew i had told the old lady in female madical i would check on her and i was afraid. i was afraid of what i could not do for her. i was afraid i would be inadequate. i was afraid of the face of fear that i had seen in her eyes. somehow her reality at that moment was too real and i didn't want to face it. i wanted to be at home in my warm bed, ignorant of how terrible life could be. but i knew i had to go to her. if for nothing else, i had to just be with her so that she was not alone. i walked slowly to female medical.

i walked past the duty station. this time the door was open, but besides that there was no discernible difference. all the sisters still sat exactly where they had been. some of them were still eating the last of the chicken feet. the light from their room lit up half the ward, but did not reach all the way to cubicle d. they didn't see me slip past them so their laughter must have been aimed either at someone else or just part of the normal merriment associated with people sharing a meal together. still, just like the light, it seemed to me to be out of place.

"mamma, i'm here" i whispered as i approached her bed, just in case she was asleep. she lay with her head to one side. she didn't stir. i walked closer and took her hand. it was cold and clammy. i leaned towards her face. even in the darkness i could see her eyes were open, but they were fixed in the stare of death. she had died alone and i had failed her completely.

i have hated the sight of chicken feet ever since.

you've got to hand it to him

some students refused to listen to good practical advice. sometimes it hurt us all, but sometimes it was good for a laugh.

general surgeons have a reputation amongst doctors. they are viewed as crude, arrogant and even aggressive. this might be because they are often crude, arrogant and aggressive. but yet they are simple folk and can easily be pacified.

he was a private consultant. he was a typical surgeon but he was also a great teacher, if you could look past his rough mannerisms. he only came in one day a week and did a sort of a ward round. but in all reality it wasn't a ward round at all. he would ask us to show him some interesting patients and then he would teach us all about the condition of the first patient we showed him. he never addressed the patient. he never examined the patient. it was more coincidental that we would be standing next to the bed of a wide eyed patient while we listened to his tutorial. he taught us so much, including what a bedside manner should not be. he was also a great example of how not to present a patient to the professors.

"when you present a patient to doctor l," i would coach the students before the time, "do not go into all the detail!! he doesn't care. simply point at the patient and in a loud clear voice shout the diagnosis. then have a piece of paper and a pen ready. every word you hear after that is worth its weight in gold for your exams, so take notes." they all nodded, but i somehow knew they thought i was exaggerating.

the allotted time of the allotted day arrived and we all stood around waiting for the consultant. true to form he was exactly on time. he ignored the students as was his habit and only acknowledged me with an almost imperceptible nod of the head. i greeted him curtly and headed off in the direction of our first patient, which i had specifically chosen because i felt he had the condition the students most needed to brush up on.

we arrived at the patient and the consultant turned to the students. normal human interaction always seemed to be an effort for him. more looking at his own feet as anyone in particular he asked;

"right, whose patient is this?" the student stepped forward.

"mine!" he whimpered.

"well? what are you waiting for? present!" i had trained them well how to present to this consultant and yet i somehow knew what was going to happen.

"uhmm, the patient is a 25 year old black male..." the consultant lifted his head. his eyes were suddenly ablaze with what seemed like years of pent up frustration and anger. he cut the student short.

"do you think i am a blerrie idiot?? i can see the patient is male. i can see he is black. i can see he is about 25 years old! next thing you are going to tell me he is the third child in a broken home? i don't care about all of this. and if you even try to tell me he lives in a house with running water or no running water or whatever i think i'll kill you!! just tell me what is wrong with him!!!" i managed not to laugh, but as the student looked to me in supplication i confess a smile darted across my face. i had warned him. he shrugged his shoulders, pointed at the patient and in a clear voice shouted;

"alcoholic pancreatitis."

the consultant grumbled under his breath and extended his hand to the side, in the true fashion of a surgeon in theater. i was ready with the pen and slapped it sharply into his waiting hand. as if by magic, a sheet of paper appeared before the consultant. i remember thinking that they were at last listening to my practical advice.

thereafter the students (and patient if he was paying attention) got the best tutorial on alcoholic pancreatitis that they would ever be exposed to. i confess i didn't pay too much attention. i was otherwise occupied trying to suppress a laugh.

focus

specialists tend to be focused specifically on their field. some might say narrow minded even. way back during my psychiatry block i was made acutely aware of this.

one thing i noticed quite early on in the psychiatry rotation was that, with few exceptions, the consultants weren't interested in teaching us. it seemed to interfere with their tea time and their going-home-ridiculously-early time. so when we were told to go to a particular ward to get a tutorial from one of them i wasn't expecting much. i got exactly what i was expecting.

we walked into the tea room where the consultants were hard at work drinking tea and introduced ourselves. the designated tutorial giver groaned audibly. he then glanced over at his colleagues and rolled his eyes. they chuckled. funnily enough i think they thought they were being subtle. after all we were mere medical students and therefore couldn't easily pick up on the finer points of non-verbal communication like specialist psychiatrists could. i was immediately annoyed, but i chose to hide it.

"you medical students think that when you rotate through psychiatry you don't need to examine patients anymore. where are your stethoscopes?" we all pulled our stethoscopes out of our lab coats and presented them. i considered asking him where his was but decided this was already an unpleasant experience and i wouldn't be popular with my friends if i further antagonised our antagonist. i held my mouth with difficulty. he continued.

"go to the ward on the other side of the hospital and ask to see mr g. examine him fully and report back to me." with that he turned his head back to the tea and seemed to drift off in thought. glad to know our future mental health is in such good hands, i thought.

we entered the ward and soon found mr g. we had all rotated through both surgery and internal medicine so we were quite confident in our examination skills but still we were taken aback by what we saw. with a simple glance it was clear mr g was not well. he lay almost motionless in bed except for the movement of his chest with every laboured breath. we got to work.

during the examination it was clear he was in heart failure and had a massively dilated heart. he also seemed to have pneumonia on the left. his abdomen was tender but we put that down to en engourged liver secondary to the heart failure. his mental faculties were almost non existent but were in keeping with someone who was on the verge of death as we thought him to be. as a side note we noticed he had one glass eye.

as we walked back to the consultant still sitting in the tea room sipping on his so-many-th cup of tea we chatted. we were actually quite worried about the guy. at least we could let the consultant know that he needed some real and urgent medical help at the hands of consultants that actually do have stethoscopes.

"you're back!" he greeted us, "why did you take so long? did you stop at the cafeteria for tea?" tea was clearly an integral part of his life.

"umm, no. we were examining the patient like you told us to."

"ok. present your findings to me." we started with a formal patient presentation the way we had been taught to do in internal medicine and surgery, methodically going through all the systems, one by one. as we spoke and the condition of the patient was painted in increasingly grave hues the consultant seemed to become more and more edgy. at least we were getting through to him, we thought. when we had just explained that the patient was struggling for every breath and his last ounce of strength was being drained from his body even as we spoke, the psychiatrist could no longer contain himself.

"did you at least notice he had a glass eye?" he exclaimed with a bit too much irritation. it seemed his edginess was nothing more than boredom.

"umm, yes. his right eye is a prosthetic eye." we ventured helpfully.

"ok. that is all i wanted you to find. well done." i couldn't help laughing. this guy had probably noticed by chance that the eye was fake when he admitted him some time ago. since then the patient had not been examined at all. also one would like to think that the fact that the guy was just about to die trumps a glass eye, but apparently not.

hear this

recently a plastic surgeon i know was called out to fix a lacerated ear. it is the domain of plastic surgeons pretty much all over the world. but in my neck of the woods it may be tricky to extricate a plastic surgeon from his warm bed on a cold night. let me also say that back in those days all registrars of all disciplines earned the same overtime each month. even opthalmologists and dermatologists and pathologists earned exactly the same overtime as surgeons. they weren't complaining. we, however, were.

as calls went it was fairly standard for us general surgeons. i had found a moment to empty my bladder which was a nice change, but other than that one reprise there had not been a moment to even realise that i hadn't eaten all day. at least there hadn't been any lethal disasters...yet.

somewhere in the madness the house doctor asked me to evaluate a patient with a lacerated ear. he had had half his ear detached in a bar brawl. it was hanging precariously from what still connected it to the body. now at this time in that hospital there was a policy that once a patient had been referred by a casualty officer they would not take the patient back. if the referral was erroneous then we would be required to refer further as appropriate. so when i heard my house doctor had accepted the patient i was not impressed.

"you suture his ear." i told him. poor guy, he hadn't studied at our university and therefore wasn't used to our sink or swim approach to medical training. he freaked. my level of being impressed dropped even more. i'd have to phone the plastic surgeon myself.

the plastic surgeon was not keen. by that i mean he basically said he was not coming out. by the tone of his voice i assumed he was getting a back rub from his significant other under the warm duvet on his bed. who could blame him. if you're not in the trenches why would you want to go into them, even for a short while to suture an ear.

"anyone can suture an ear. you're there now. i'd have to come in to the hospital. you just do it." i considered telling him that i'm at the hospital because i have so much bloody work to do and that he is drawing the same overtime that i am and that it is his bloody job and not mine. but i knew that at that stage, even if i walked on water and then turned it into wine he was not going to come out. i hung the phone up. my house doctor looked at me questioningly. he had already told me he couldn't do it. but he was not from our neck of the woods. i needed a student. one walked past, unsuspectingly.

"you! have you ever sutured an ear back on?"
"no."
"when i ask this same question tomorrow, you will answer yes. come with me."

he did quite well.

the leroy-burnell syndrome

when we were in medical school as with all medical students we were bombarded with many new words. not the least of these were the myriad of syndromes. and each syndrome had symptoms that overlapped with pretty much every other syndrome. it was one large conglomeration of new words all mixed together.

but there were a few other things we noticed. firstly every syndrome worth its salt had a double barrelled name with a hyphen in between. exotic sounding names worked better than simple names like mark or john. also the more symptoms associated with a syndrome the better the syndrome was.

and thus we invented the leroy-burnell syndrome. the name was perfect. and seeing that we used it to explain any conglomeration of symptoms that we could not otherwise bring to a diagnosis, any symptom known to man could be attributed to our neologistic syndrome. (if only house md had known about this syndrome the episodes would all be half the length.) if we had no idea about a patient, my clinical partner would lean across and say,
"this is a classical case of leroy-burnell syndrome." and doff his head intellectually. if the prof was not looking we would laugh.

then one day we were doing our usual ward chores in internal medicine. a group of fourth years came in with a rotating consultant. the consultant lead them to a patient. he told them to examine the patient and make a diagnosis. he would be back in 30min to discuss the case with them.
as fourth years generally were they seemed a bit nervous about direct patient contact. finally they drew the curtain and one approached the patient.

it was about then that my clinical partner decided to 'help'. he stuck his head through the curtain and said.
"you guys, this patient has the leroy-burnell syndrome so make sure you don't miss that. but don't worry, the clinical signs are easy to pick up. good luck!"

the gratitude on the nervous face of the fourth years was clear as they simultaneously thanked my friend for his kind gesture and reached for their pocket references to look up the leroy-burnell syndrome. it seems they hadn't come across it in their studies yet.
i turned away to hide my laugh. i was imagining the pride on the unsuspecting face of the fourth year when he announces to the consultant that this was a classic case of leroy-burnell syndrome.

alone

the south african sink or swim approach to medical training tends to grow on you, but in the beginning it could be quite terrifying.

i was a house doctor. in fact i had only been a doctor for about a month and a half. i was realising that there was in fact knowledge in my head. when i saw patients it seemed to come to the fore and i actually knew what to do. it was an exciting time. all those years of study seemed less in vain.

so when i saw a young lady in casualties with severe abdominal pain, one of the conditions i considered was an ectopic pregnancy. sure enough her pregnancy test came back positive. i immediately knew what confirmatory test to do (we didn't have sonar or ct scan, scanman). shortly thereafter i stood with a syringe in my hand full of blood that didn't clot. it was all coming together so well. i had single handedly made the diagnosis of a ruptured ectopic pregnancy. i was actually using my years of study. i was being a doctor!
i quickly booked theater and called the cuban gynaecology consultant. he soon arrived. like a proud cat with a dead mouse i showed him the syringe with the unclotted blood. he obviously agreed with my diagnosis and management plan. i was the man.

then he turned to me.
"i need to go to the bank" he said. "will you be able to handle her in theater?"
"definitely not!" i replied. "you'll have to come with me."
"but i'm on my way to the bank now, so you go ahead so long. i'll join you when i get back. anyway it's just like doing a sterilization, except the tube is more bulky." at that stage in my career i had in fact done maybe three sterilizations. i started sweating.
"i don't think i can do this" i retorted.
"you'll be fine." and with that he turned and walked out. i couldn't help wondering if the patient was going to be fine though.

so i took her to theater. i was so scared i could almost not talk. but what could i do? i was the only one there. and where i did my house doctor year, we operated without an assistant. there was no one available to assist anyway. i did the operation alone. my hands were shaking so much i'm surprised i got it done.

towards the end the consultant did arrive. his banking done, he was free to observe me closing the abdomen. pity, because i still didn't have steady hands by any measure and i probably looked pretty clumsy.

flatus

surgeons like flatus. it is a sign of an intestinal canal that is at least not totally dysfunctional. after most operations we ask the patient the next day if they have passed any and hold our breaths for the answer. if the answer is no, the bowel is still sulking and refuses to kick into gear. if the answer is yes, we get a warm fuzzy feeling, permeating right down to our toes. but flatus humour is not lost on us.


two stories come to mind. one happened during registrarship and one happened many years before when i was at school. lets start with the former.

i was the senior registrar in the boss's firm for so called rounding off. it was the toughest rotation as i have said before. the boss had a particular interest in everything anal, including flatus. he often waxed lyrical about how normal it was and how much wind the colon should be expected to expel in a day. but i did have a rotating orthopod (as part of surgical training you are required to rotate through the other disciplines and this guy was presently rotating through general surgery).

this guy had a very laid back approach to life. he was somehow immune to the pressures of surgery (maybe because he knew he was leaving after a short month and also, as a guest he had no direct responsibility) and he had a vibrant, spontaneous sense of humour. one day we were walking down from 54icu which, due to mad apartheid planning, was miles away from the rest of the hospital. on the way down, another prof joined us and engaged the boss in conversation. i moved back from my designated place at his right hand side and followed with the rest of the firm at about 5 paces behind, next to the rotator.

at about this stage it became apparent that someone's colon had done it's duty. the orthopod started making faces and not too quietly lamenting our lot in having to be subjected to smelling the very displeasing aroma. obviously the offending colon belonged to at least one of the professors walking in front of us, so i told the guy to put a plug in it (i qualified that i meant his mouth because i was afraid of exactly where he was likely to put the plug). but he just would not stop.

after a while the boss obviously heard the continuous tirade of disgust from his entourage following in the foul wake behind him. he turned around and said;
"'skies mense." (excuse me guys). without missing a beat this upstart orthopod replies;
"prof, i know it is normal to pass three liters of flatus per day, but do you have to pass it all at the same time?"

everyone fell apart.

resus fun

some time ago i read a post about the worst resus ever. i thought i've seen worse. so here is the first installment in what might be a short series.

i was a junior registrar i was working in kalafong/hell. it was late at night. my house doctor and i were relaxing in the anesthetists' tearoom. we were the only one's there.

suddenly the phone rang. it was a sister in high care.

"hello, can you come and tube a patient?" i had no patients at that time in high care.

"whose patient is it?" i asked.

"the physician's". (small note. in south africa, we call an internist a physician. the word physician is not generally used for doctor. in fact if you were to call a surgeon a physician, he would probably be offended.)

"why doesn't he intubate his own patient?" i asked.

"he is here trying but he needs your help." the picture came into focus. i asked my standard question.

"should i run or can i walk?"

i entered high care out of breath, even though it wasn't all that far from the tearoom, my house doctor in tow. i expected to be given charge, but the physician was at the head of the patient. he immediately told me i was there to support and that he was going to tube. i took in the scenario.

there was a 20something male in clear distress. the physician was holding a mask to his face, making sure he formed an airtight seal between his skin and the mask. only problem.. it was a venturi mask that is not meant to be used in a resus and has large holes on the side. a seal, airtight or otherwise, is useless. also you can't actively pump air into the lungs, so if the patient is in trouble, in trouble he will remain. i took a step back. my house doctor and i exchanged glances.

"amazing!" she remarked. "i can't believe what i am seeing." i wasn't sure what to do. he had told me in no uncertain terms that i was not to take over and yet everything else about what he was doing was uncertain to say the least. to try to somehow get a better understanding of what was happening i tried small talk.

"what's wrong with him?"

"kidney failure and now pulmonary edema."

"he looks pretty pale."

"yes, his hb is 4" (extremely low but probably a chronic state.) "in fact i think i'd better order him some blood. here, hold the mask while i draw some blood." and with that he moved away from the head. this clown was actually going to draw blood while his patient died. before i could say anything i found myself holding the ridiculous mask to the patient's face while the physician moved to the arm and commenced drawing blood. i had two immediate thoughts. the first was that my senior registrar would walk in and see me holding this pathetic mask to a dying patient's face. i would never live that down. neither would the patient.
the second was that the physician had relinquished the head. i was in charge! immediately i told the sister to get the ambu mask and bag. (this is the correct mask to actively pump air into the lungs.)

i turned up the oxygen and began pumping. i then got the laryngoscope ready. i injected a bit of dormicum and prepared to tube. as i started to tube, the physician moved back to the head and tried to shift me out of the way. there was no way i was going to let him at the patient again. i tubed while he tried to shoulder me out the way. i just ignored him. i checked the position of the tube, told the physician to start bagging the patient and left.


other posts in the series.
tube.
cuban resus.
resus with hands tied behind my back.

blind chicken boy

we in south africa have been making it easier to study medicine. after all medicine should not be restricted to the 'privileged' few who have more than 3 possible synapses in their brains. we are truly the country of opportunity.

however, this may not necessarily be a good thing for patients.

when i was in witbank, we had a house doctor who could possibly be the stupidest person without diagnosed mental retardation i know. and he was a doctor. we nicknamed him blind chicken boy after the brilliant nando's ad that i've posted here. when he tried to examine patients, sometimes we had to move him up to the patient, like the trainer in the video.

he is the only guy i know who admitted a patient with a glascow coma scale (gcs) score of zero. when the other house doctors took him aside and told him the lowest gcs you get is three, he retorted that his patient's was zero. end of story. i must give him credit although for also being the only house doctor who admitted a patient with a gcs of 18. once again, if 15 is the highest, i assume the patient with 18 was hyper aware. i immediately looked for him. i wanted to ask what the meaning of this life on this mortal coil is. i couldn't find him though.

a friend of mine was in orthopaedics clinic. blind chicken boy came in and stood sedately at the door. my friend continued with his patient. it was a guy that had been operated for a fracture and needed his stitches removed. once the stitches had been removed, my friend turned to blind chicken boy. blind chicken boy said,

"doctor, i have a problem." he began everything he said with these words.

"what is your problem?" asked my friend dutifully.

"the patient in the ward with the tibula fracture has changed condition." only blind chicken boy knew what a tibula was, but we all assumed it was a bone somewhere.

"how has he changed condition?" asked my friend.

"he has just stopped breathing."

so blind chicken boy, when he came across a patient who stopped breathing, he had the presence of mind to call his senior. it seems a pity that he slowly walked to his senior, leaving the patient alone and then waited for his senior to finish with the out patient that he was busy with. no one could accuse him of being rude and interrupting people who were busy.

there was the other story when another friend was on rounds with blind chicken boy. they found a patient who was not doing as well as expected. my friend barked out instructions. get a full blood count. admit in high care. give a bolus of 300ml ringers lactate. report back.

about 2 hours later, when everyone was beginning to wonder what had happened to blind chicken boy, he suddenly turned up.

"doctor, i have a problem."

"what is your problem?"

"i have been looking everywhere and i can't find a bag of 300ml ringers lactate. there are only 1 liter bags."