ideal

i have been following the story of the baby that was brutally assaulted recently with more than a little horror. it is disturbing to say the least. those who follow this blog may know that i struggle with the suffering of children. it is not something that i deal with all that well. so i have been dwelling on this story quite a bit.

i thought about what causes someone to try to kill a defenseless little baby? obviously the thought that the perpertrators are mad comes to mind, but that is just too easy a coppout. to be honest i hope it turns out to be the case, but there may be a more sinister reason.

recently in our beautiful land quite a number of fairly highly positioned politicians have publically encouraged the murder of afrikaaners. it would be a misnomer to say it is official anc policy...yet. but it is most definitely not frowned upon by them. now if one is serious about an ideological principle there may be a few unsavoury things required to bring this principle to fruition. we see examples throughout history, the most prominent probably being the genocide of the jews by the nazis. once they had decided the jews needed to be extermionated, ideology drove them forward and outweighed social norms. along with the adults the jewish children were also herded off to execution. the nazis were very serious about what they believed.

i can't help drawing parallels. the perpetrators may well have been drawn up by the rhetoric of their leaders and may even have felt the government would come to their aid if they were indeed caught and brought before justice. they at least have the courage to carry out the conviction of their leaders who simply hide behind the words without following them up with deeds.

lets rather hope they are mad.

compassion fatigue

a while ago i ended up in conversation with a psychologist. she mentioned the danger in her profession of compassion fatigue. the term struck a chord in me. she was referring to people moaning about how tough their lives were when their lives were nothing close to tough. it irritated her and she knew she needed to guard against this. i decided not to even mention to her what my compassion fatigue was like. it might have made her think less of me. i know i did.

he was no more than a common criminal of the south african variety. on that fateful day he decided to rob a small rural supermarket. i suppose he had gotten his hands on a gun and it seemed like the natural thing to do. anyway he entered the store with gun at the ready. he entered the outer door and was in the tiny area of about two meters between the inner and outer doors. just at this moment the owner of the shop was exiting the store and the two found themselves together in this rather cramped space. the owner immediately realised there was something amiss. this might have been due to the fact that he was staring straight down the barrel of a gun. then all hell broke loose.

the criminal didn't say a word. he started blazing away, spraying that tiny space with a hail of deadly lead. the owner dropped instinctively to the ground, drew his own weapon and fired one single shot. when all was tallied at the end, the shopkeeper had come off better. he had been hit in the arm but the damage was minimal. his shot, however had entered the criminal's head on the side just in front of the temple. it had then passed through both eyes and exited on the contralateral side at about the same place. the guy would be blind for life. i reflected that his terrible aim would now be even worse. it would definitely be a problem with his chosen profession.

the other case i thought of was a car thief i once treated. he got shot in the line of duty. he was innocently driving away at high speed in a car he had just liberated from the rightful owner when the police, who were on his tail, shot him twice. the one bullet took out his femoral artery. the other shattered his knee and tibial plateau of the other leg.

to cut to the chase, we cut his leg with the arterial injury off to save his life, he was that far gone. the orthopods stuck an exfix over the knee on the other side. and then he gradually recovered. at about this time i was transferred to orthopaedics so when he developed a pseudoaneurysm of the popliteal artery of his good leg i just heard about it via the grapevine. i also heard that they were going to give it some time before they operated, hoping that...well i don't know what they were hoping actually. anyway safely tucked up in the orthopaedic hospital it was not my problem.

then i learned that the orthopaedic surgeons were going to try to repair the tibia and i was going to be involved. step one was to get the patient down to the orthopaedic hospital from the main hospital. other than the usual administrative frustrations, he was finally loaded into an ambulance and brought down. it was the loading out that proved to be tricky.

as the ambulance drove into the parking area of the orthopaedic hospital the aneurysm burst through the skin and the patient started bleeding all over the place. he was rushed straight into theater and yet still by the time he got there once again he was flirting with death. the vascular surgeons were called and they arrived amazingly quickly. they then sort of looked at the leg for a while. after a few minutes of inaction they pointed out that the muscles of the leg were dead. it seemed that the pseudoaneurysm had gradually decreased the blood supply to the leg and by the time the thing had burst in the parking lot, the leg was already in a bad way. they then instructed us to remove it and left. the orthopaedic surgeon in turn instructed me to remove the leg and then he too left.

as i lopped off the limb i reflected on this twenty something year old who now had to face the challenges of life without a leg to stand on. it seemed sad. but then i realised my own car had been stolen only about a month before and it was not completely impossible that this person could be the very person who had stolen my car. it was the life he had chosen and the risks were part of that life. i struggled to feel sorry for him. besides, i reflected, he would no longer be so fast when running away from cops in the future.

the first time i realised i had compassion fatigue was around intermediates (roughly half way through specialising). i was warn down from cases like the two mentioned above. but there also seemed to be a run of gunshot wounds of criminals that i ended up trying to keep alive at unearthly hours with exams looming. in the end i just seemed to get sick of them and overly sceptical.

then one day i was required to go to some or other awkward social function. at that time my work was so all encompassing i didn't get out much and it showed. i ended us standing away from the normal people and whenever i was forced to speak to one of them, when i looked at them my mind kept on repeating one phrase over and over again.

"fresh meat."

i needed a holiday.

who heals the fallen

this is not really my story. but in a sense this story belongs to all south africans. it is our shame and may be part of our downfall.

we are a people at war. we war against ourselves and we war against peace. each fights for himself and bugger the rest. but who heals the fallen? it seems in south africa, quite soon maybe no one.

recently a story made the news. it was shocking, but it actually gives an inclination of how morally decayed south african society has become. an ambulance was despatched to some informal settlement after a household fire burned a child. the caretakers of the child brought the child to an intersection that the ambulance would actually be able to find. quite soon the paramedics were hard at work stabilising the screaming child. at about this stage two armed thugs turned up. they threatened the child's caretakers with their lives and forced them to flee. then, while the child continued to scream in pain, they raped the female paramedics. they were not caught.

yes it is shocking and now the ambulance personnel need to wait for police escort before they respond to calls in certain areas, greatly increasing their reaction time. we would like to believe this sort of thing is isolated but is it? just the other day i heard on the news about another case where a crowd assaulted the ambulance crew because they wanted to help the victim of a stabbing. as i said we are at war with each other and the victim was their enemy for whatever trivial reason.

but the question i end up asking has little to do with the morality of what's going on. that, it seems to me, is obvious. to discuss morality with the people involved in these stories is a waste of time and effort. i wonder when at war, which we clearly are, how is it in your interest to antagonise the medics? yes you may have won today's battle and not actually need a medic, but what about tomorrow? who will help you when you find yourself on the business end of a knife or panga? also the people who give their lives to help the injured and downtrodden are not quite as involved in their petty squabbles as they may imagine. to drag them in and try to kill them for helping the wrong person is both small minded and short sighted. we didn't really need evidence to know the people that engage in this sort of activity fit nicely into this category, but there it is if you want.

a number of years ago a paramedic friend of mine responded to a gunshot case in mamelodi outside pretoria. what he didn't know was that the mob around the patient had little interest in the survival of the patient. they actually wanted him dead. the paramedic therefore in their narrow view of events was the opposition. as far as they were concerned anyone from the opposition should also be dispatched.


he drove into the thick of things in all oblivion. when he arrived he opened the car door to find out how he could help. the crowd immediately tried to drag him out of the car, beating him with fists and the weapons they had at hand as they did so. he quickly realised he was going to share the same fate as the patient, which was, by that time, sealed. by pure accident the paramedic's safety belt was not loose and they could not pull him out. he slammed the car into gear and throttled out of there with his torso leaning out of the open door in true hollywood style.

thereafter the ambulance service refused to respond to calls from mamelodi except with a police escort. bearing in mind our police are stretched thinly on a good day, the whole situation became ludicrous. i would love to believe in some sort of karma where the people that suffered because no help was forthcoming were the people who were responsible for the problem in the first place, but, like all wars, the actual people who suffer will be the old and the weak, the vulnerable and the children. but that is the african way.

exemplary

part of the job is to treat some unsavoury people. sometimes you know what it is they have done. mostly you don't. sometimes you even may make a difference. but mostly you just do your job. after all it is not our part to play judge and jury (and, in our case, executioner). but recently i heard a story from some fellow surgeons about one of their colleagues that i'm sure creates a warm fuzzy feeling in the hearts of all south african surgeons.

i can attest to the fact that after a long night on call your general mood is usually not the best it can be. also it becomes more difficult to see the humour in situations that on a normal day you might be able to laugh off. so when this particular registrar finally wrapped up his post call work and meandered off to his car to go home he was not delighted to find someone busy stealing it. he did what any south african surgeon would want to do in his situation...he shot the guy.

the person in question was, however a surgeon, so his training kicked in. they were already at the hospital so all he needed to do was drag the punctured villain to casualties and get him ready for theater, which is exactly what he did. despite the fact that he was post call, he even took the time to operate the guy himself. i suppose he had the best idea of the tractus of the bullet?

i can just imagine how the post operative ward round went when he presented the case to the prof. how would he have worded it?

"well prof, i shot the guy and then i did a laparotomy. well you always told us we should actively look for work to do if we wanted to get experience."

proudly south african

being south african at this moment in time comes with certain risks. recently my reaction to an incident brought this home.

i was on my way back to nelspruit from pretoria late at night. suddenly on a fairly deserted part of the road a small buck jumped out in front of my car. i didn't even have time to react before i hit it. hitting even a small buck at 140km/h does quite a bit of damage and this was no exception. the front of the car was smashed in. the radiator was ripped open and the bodywork was pushed up against the left front wheel.

i was far from anywhere so i soldiered on. fortunately i was just entering the lowveld so i turned the car off and free wheeled down the two passes. but quite soon i was forced to stop. in this time, while gently limping the car down the passes the necessary calls to insurance, and by implication, tow companies were made, so by the time i actually stopped, people had been mobilised.

when the car finally came to a stop it was in a totally deserted part of the road. there were no lights visible anywhere and an overcast sky hid any trace of the moon. i turned on my hazard lights and waited.

then i had a south african thought. what happens if someone comes past? would i be the victim of violent crime? this is a real consideration in the modern south africa and in no way reflects paranoia. on a regular basis we read about hapless victims of car breakdown who are attacked and often killed on the roadside. recently there was a criminal element that would patrol the very road i was on and pull cars over to rob the victims, quite often shooting at their cars or them. my concerns were real. suddenly the hazard lights were glaringly bright. they seemed to advertise the car's presence for miles around. i quickly turned them off. as the very occasional car drove past i used their headlights to scan the road in both directions looking for a would-be attacker. i didn't even bother trying to stop a car. south africans don't risk stopping for someone on the side of the road, ostensibly in trouble. it is too often a trap.

then i thought if i do see someone, if i jump out and run they will see me too and i'd be a lead magnet. to stay in the car wasn't safe. i turned the hazards back on and got out. i readied my knife, just in case, crossed the road and went into the veld just out of sight. there i was safe. if someone did come along i would just slip away. the hazard lights marked the car for the tow company and my friend who were on the way. when they arrived, i would join them.

the way i dealt with the situation, from flogging the nearly dead car to hiding in the veld and the thoughts that went trough my mind were typical for us south africans. in fact when i discussed it with my colleagues the next day at work there was no one that teased me or thought it strange. across the board everyone fully sympathised and agreed with my way of handling it.

once again i find myself in a reflective mood about staying in this crime-ridden society. what is a small disaster turns into a possible major catastrophe because of the serious risk of sudden violent death. does it really need to be like this? unfortunately that question would have to be directed at the government of the day who so far have shown no sign of addressing crime at all. on the contrary they have even disbanded the one effective crime fighting unit because of the danger they would also target corrupt officials. we just can't have that now can we?

the african dream

i had been working too hard and long hours. i found that i was a bit irritable on the whole. usually i enjoyed talking to people and hearing about their hopes and joys, but i found myself rushing through consultations. then an old couple came in. he needed a hernia repair but had no medical aid. they had heard i did some work in the state and wondered if i could help. i explained that i could not book my own patients there but would do operations at the request of the normal state staff. i was willing, however, to put in a good word for them. shortly thereafter i found myself waiting to get the relevant state doctor on the line. so we got chatting.

they lived in a small flat and it apparently drove him mad. you see he was born on a farm and had farmed his whole life. he went on to tell me that all his old neighbours, like him and his wife, had left their farms. life became too dangerous. you see farm murders are a fact of life in our country.

they explained that life on the farm became too stressful. they always had to carry guns with them, even when going to church. when approaching the farm house they would drive slowly looking for any movements in the bushes. i asked if anything ever happened. no, they said, not to them. then i got to hear about their one neighbour who was killed at night in his bed (he had erected an electric fence around his farm house to no avail). and the close family member who took a bullet through the chest but survived. then they went on to talk about the night they heard cattle rustlers and went out in their bakkie, the old woman on the back with a shotgun and the old man at the wheel with a hunting rifle. the lights had apparently driven the criminals away. there were other stories, all boiling down pretty much to the same thing.

the man looked at me and said. "you know, doc, we thought we would live our entire lives on the farm and die in peace. but it became too dangerous. now we live in a tiny flat and i hate it." i thought of how somehow our dreams don't work out. it was a poignant thought and i felt quite depressed.

like in zimbabwe the farmers here are being driven off the farms. the lucky ones survive and end up with shattered dreams in small flats (apartments) in the city. we read about it all the time, but when you speak to them in the privacy of your consulting room waiting for a state doctor so you can maybe help him get an operation he can't afford and hear the longing in his voice for the african farm he loves, it somehow makes more of an impact.

swimmer's chest

the following story isn't really mine, but because the meeting of the two protagonists happened in my presence during an event that i've previously posted about and because it touches on a very relevant south african topic, i thought i would pen it down.

when i was in my training, a very good friend and i had the privilege of treating a pregnant woman with a gunshot abdomen (take a look at the incident here). when we took her back a private consultant who was associated with our firm offered to join us in theater. but he was no ordinary private surgeon. he was one of only a few hepatopancreatobiliary surgeons in town and a particularly good one at that. truth be told, the reason he offered to join us had to do with the fact that i initially thought that the hepatic artery proper had been shot off. as it turned out the artery in question was an aberrant left hepatic artery and didn't count for much so his presence was not needed, but that is beside the point.

the consultant had never met my junior colleague who was a bit late for theater that day because he needed to sort something out in the wards. when he joined us we had just opened.
"sorry i'm late" he said "i just had to sort something out in the wards."
"doctor 'consultant' this is my colleague and friend doctor b." i said by way of introduction.
"are you a swimmer?" asked the consultant. there was a moment of silence.
"no." answered my friend, somewhat surprised.
"you look like a swimmer. you have a swimmer's chest." at this my friend looked down at his own chest concealed by his theater gown as if to see what a swimmer's chest looks like. even in the presence of this prestigious surgeon and, it seems, swimmer enthusiast, i laughed out loud. from that moment on i always referred to him as the swimmer's chest.

time passed. it seems to do that quite well. then in true south african form, the consultant's family was the victim of violent crime. his house was targeted. his daughter and wife were held at gunpoint as the place was cleaned out. by south african standards it went quite well. nobody was shot and nobody was raped. but by standards of humanity it was too much. it helped him with the decision to leave these shores. thus south africa lost a great surgeon.

before he left he gave the swimmer's chest a call. basically he handed his very successful and lucrative practice over to him, lock, stock and barrel. what a gift. what a privilege to just fall into such a tub of butter, rear end first. what an extraordinary result of the ridiculously high level of crime in this beloved country.

south african crime

i recently watched the movie capote. i enjoyed it. but, being south african, i was interested in the reaction the movie portrayed of the american community to the murders that the movie is indirectly about. their reaction was shock and dismay. their reaction was right.

but in south africa there is a similar incident every day. i don't read the newspaper because it depresses me too much. you might wonder why i, a surgeon, am posting on this. one reason may be because i often deal with the survivors (two previous posts found here and here). at the moment i have three patients who are victims of violent crime. one is the victim of a farm attack. an old man who had his head caved in with a spade. why? just for fun, it seems. but maybe the reason i'm writing this post is because i'm south african. this is my country and i'm gatvol.

just three recent stories. some guys broke into a house. they gaged the man. it seemed that whatever they shoved into his mouth was shoved in too deep, because as they lay on the bed violating his wife, he fought for breath and finally died of asphyxiation.
then there is a woman alone at home. some thugs broke in and asked where the safe was. they were looking for guns. she told them she had no safe and no guns. they then took a poker, heated it to red hot and proceeded to torture her with it so that she would tell them what they wanted to hear. because she could not, the torture went on for a number of hours.
then there is the story of a group of thugs that broke in to a house. they shot the man and cut the fingers of the woman off with a pair of garden shears. while the man lay on the floor dying, the criminals took some time off to lounge on the bed eating some snacks they had found in the fridge and watch a bit of television.

these are only three stories, but, if you do read the papers, you can hear about similar stories on a daily basis. and our great and mighty president, the eminently blind thabo mbeki, believes there is no problem with crime here.

yes, you americans were right to be horrified by the story upon which capote is based. we south africans, through the leadership of possibly the worst leader of a country in the world today, well we just get used to it.