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.

the state of it

some readers may have been following this blog for some time. some of those readers might be interested in what has been happening in surgery in the state hospital. for this small group of readers, this is the state of it as it stands now.

well after i was instructed to stop operating in the state hospital (which you may remember i was doing for no charge) i left them to their own devices. the one remaining surgeon, partially registered, took an extended leave of absence. the junior doctors went on as best they could. as you can imagine, chaos reigned.

this went on for some time. after a number of months, the mec of health in the province (politician in charge of health) decided he should meet with the doctors working on the ground. when he did, he was 'surprised' to hear that there were no surgeons at all in the hospital in the capital of the province. he also didn't seem to be aware that the state was sending patients to the private hospital for treatment at astronomical costs. by chance, the person that i had crossed swords with had been replaced by someone else who, on the face of it, seemed more determined to fix the problem and less focused on saving face. the mec placed her in charge of sorting things out. he wisely gave her authority over her boss who, in my opinion was the cause of most of the chaos and as it turns out was the person who had instructed the hospital to give me my marching orders.

she got to work. she approached all the private surgeons. only two responded. i was one. a meeting was called and a path forward was discussed. without going into too much detail, the final result is that the two private surgeons are on standby for the government hospital. instead of sending patients to the private hospital and thereby paying that hospital we would operate at the state hospital and charge per patient. they would therefore save a massive amount of money but not get the free ride that i often referred to in my earlier posts.

so these days i once again operate (quite a bit actually) at the state hospital. it still remains to be seen if they are true to their word and pay us. (hasn't happened yet)