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.

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.

time to leave?

recently i posted on the effect some stories of violence had on me. but recently i heard another story that once again made me think.

the doctor who starred in my post bringing balance to the force was the main character. as it turns out, he was on his way home after what i assume was a busy day at work. he got hijacked. common in south africa and very often fatal. the two hijackers, apparently both about 18 years of age, made him drive to his house. there they stole what they could. thereafter they forced the doctor back into his car (as if they hadn't done enough damage) and drove off to some deserted area.
the hijackers then tried to suffocate the doctor using a piece of an inner tube of a tyre. he fought back. can you imagine the scene? a 60 year old man fighting for his life against two strong young boys almost in their prime? he must have done well for himself because they had to try three times. on the third attempt, the doctor realised he wasn't getting out of this easily. fighting hadn't worked. so he went for plan b. he held his breath, struggled a bit and then went limp.
they left him for dead. he was not and that's how i know his story.

amazingly enough, the man is still positive about staying in this country we both love so much. i am starting to wonder.

there were a few things about this incident that worried me. in sangoma, one of my commenters was so keen on knowing the racial breakdown of the players. that made me think she had once been south african, but was no longer. maybe i was wrong. but south africans that watched the trc when it happened would, like me, have been horrified to hear that one of the methods emplyed by the apartheid regime to torture and kill their opponents was to suffocate them with the inner tube of a tyre. for that commenter, i mention that the doctor was white and the perpetrators were black. yet they were too young to have known first hand anything about apartheid and such. they just heard the stories. a coincidence that they employed this method to try to dispose of their victim when a bullet to the brain would have been faster and more certain? somehow i think not. there was at least an element of racial selection in their crime. they wanted to be able to say they had killed a whitey (not that there are so many left, relatively speaking, in the country). they can no longer claim their crimes were motivated by some political ideology or fight for freedom. but in their minds it is about us vs them. it's black and white. no shades of grey here.

anyway it seems to me we have gone through so much to revert back to our racist ways like these two youths did. south african violence is maybe too much now. yes, maybe it is time to leave.