die taal

dit moes 'n misverstand gewees het, ek weet nie. watookal dit was het dit 'n slegte smaak in my mond gelos.


toe die nuwe regering oorgeneem het het hulle stelselmatig ontslaegeraak van alles wat hulle geassosieer het met die ou regering. een van die dinge wat moes waai was afrikaans. volgens hulle was dit blykbaar sleg vir een of ander rede. ek het nie saamgestem nie. so toe ons afrikaanse prof druk op ons uitgeoefen het om net engels te gebruik by alle amptelike vergaderings het ek hom min of meet geignoreer. ek onthou 'n saalrondte 'n maand of twee daarna.

ek was die senior kliniese assistent in die prof se firma. volgens sy nuwe beleid het hy net engels op die rondte gepraat. tussen die pasiente, as hy net met my gepraat het het hy wel afrikaans gepraat. dit was natuurlik sy moedertaal. ek het al sy engelse vrae in afrikaans geantwoord en al die pasiente in afrikaans voorgedra. hoe meer hy probeer het om vir my die boodskap oor te dra dat ek engels moes praat hoe meer het ek volgehou om afrikaans te praat. by omtrend die derde pasient kon hy homself nie meer inhou nie.

"bongi, speak english. why do you refuse to speak english on rounds?"

"prof, my english is perfect. i don't have any reason to practise it." het ek in engels geantwoord.

hy was kwaad, maar hy het dit redelik goed weggesteek.

'n maand of wat daarna was ons almal by een van ons m&m bespreekings. die was 'n gesamentlike m&m met die vaskulere departement. die prof van vaskuler het ook sterk gevoel oor die taal beleid, maar sy gevoel was presies die teenoorgestelde van die prof s'n. hy het gevoel ons moet aangaan om afrikaans te praat in die universiteit, want engels was klaar so dominant in die land as 'n mens nie moeite gedoen het om afrikaans as 'n taal wat op 'n tersiere vlak goed kon funksioneer op daardie vlak te hou nie, sou dit vinnig agteruitgaan. ek het met hom saamgestem. baie van die afrikaans spreekende studente het klaar gesukkel om pasiente in afrikaans voor te dra, self as hulle aan 'n afrikaanssprekende dokter voorgedra het. hulle het medisyne in engels geleer en kon nie mediese afrikaans praat nie.

die m&m het voortgegaan. toe dit die beurt van die vaskulere kliniese assistent was om sy pasient voor te dra het hy in engels begin. onmiddelik het die vaskulere prof iets op 'n stukkie papier geskryf en dit vir sy kliniese assistent gegee. die kliniese assistent het dit gelees en onmiddelik in afrikaans oorgeslaan. dit was nie nodig om einstein te wees om te weet wat op daardie stukkie papier gestaan het nie. sy prof het duidelik vir hom opdrag gegee om afrikaans te praat en hy het wel so gemaak. die res van die vaskulere gedeelte van die m&m het min of meer gegaan soos my saalrondtes met die prof. die prof het al sy vrae in engels gevra en die vaskulere kliniese assistent en prof het albei alles in afrikaans geantwoord. dit was vir my nogal komieklik. na die m&m het ek maar aangegaan met my lewe.

omtrend 'n uur later het die vaskulere kliniese assistent vir my gebel.

"bongi, daar is groot kak in die land," het hy gese. "die prof het my vaskulere prof ingeroep en ordentlik in sy broek gekak oor die feit dat mense in sy departement weier om net engels te praat by enige bespreking of saalrondte. hy het drie kliniese assistente uitgesonder. dis ek en jy en dr b (ek het al van hom geskryf). natuurlik het my prof vir ons al drie opgekom en toe ek uitgejaag is was hulle amper op die punt om mekaar te lyf te gaan. hoe dit ookal sy dis blykbaar ons drie wat die prof se woede gaan voel. hy het self gese dat as ons volhou om te weier om engels te praat gaan hy bedank as hoof van die departement."

ek kon dit nie glo nie. in een opsig het ek amper trots gevoel dat ek so 'n invloed gehad het oor die prof dat hy 'n persoonlike beroepsbesluit sou maak gebaseer op my doen en late. maar eintlik was dit nooit my plan om soveel aandag van die grootkoppe te lok nie. daardie tiepe aandag was nooit 'n goeie ding nie.

"hy kan seker bedank as hy wil." het ek vir my mede beskuldigde gese, maar toe onthou ek wie in sy plek sou oorneem. ons prof het sy probleme, maar tog was hy beter as die moontlike alternatief. moontlik was die beste ding om maar engels te begin praat.

die volgende week by die m&m was ek 'n bietjie verbaas om te sien dat my vriend en kollega, dr b sy gevalle in afrikaans voorgedra het. dit was weer die geval van die prof wat sy vrae in engels gestel het en my vriend wat alles in afrikaans geantwoord het. tog as dit die prof geirriteer het, het hy dit goed weggesteek.

onmiddelik na die bespreking het ek met my vriend gaan praat.

"b, is jy mal?" vra ek toe. "na verlede week se storie, hoekom weier jy om engels te praat." hy het effens geglimlag toe hy geantwoord het.

"ek weet nie wat die prof se fokken probleem is nie. voor verlede week het ek nooit afrikaans gepraat by al die amptelike besprekings nie. ek het wel engels gepraat. en tog is ek een van die ouens wat in die kak beland het. wel, nou het ek klaar die straf gekry omdat ek afrikaans gepraat het al het ek dit nie eintlik gedoen nie. omdat die straf klaar uitgedeel is moet ek dit darem die moeite werd maak. daarvoor se ek nou vir jou, ek sal nooit weer engels in hierdie plek praat nie!"

en volgens my kennis het hy nie.

doll eyes

it affected me. not just it, but the fact that it didn't seem to affect my colleague.

i was a lowly fourth year medical student, delivering babies for all i was worth. looking back, i realize i enjoyed it. the whole 'joy of a baby coming into the world' really gave me joy that a baby was coming into the world. call me sentimental but i saw each birth as beautiful. somehow i could look past the meconeum and the amniotic fluid and the episiotomies and see what was actually going on. it was a happy time for the mother (mostly). it was the beginning of hopes and dreams. it was a new start for the baby (obviously) and for the mother and in a sense each new birth may have signified a potential new start for me.

she was excited about her new baby, but there was a cloud over her entire admission. the reason she had come in to hospital was because she hadn't felt the baby kicking for the last 24 hours and she was worried. quite soon we were worried too. not only could we detect no movement but we couldn't hear the fetal heart beat with our fetoscopes. my registrar was one of those amazing people who really felt for each and every patient despite the massive torrent of humanity that moved through the labour ward on a daily basis. this patient was no exception.

actually we all new what had happened, but the registrar wanted to make sure. i suppose she just didn't want to tell the mother her baby was dead before she had confirmed it on sonar. actually i think she wanted to use the sonar to show the mother there was no heartbeat to avoid problems of denial once the news was broken. whatever the reason i followed the whole drama as it unfolded, as did my fellow fourth year green medical students.

i remember sitting there in that small labour room where mothers are usually introduced to their new babies while the registrar ran the sonar probe over the mother's swollen abdomen. i remember her bringing the probe to a standstill over the heart. we could clearly see the heart, but there was no movement. the heart was not beating. as we actually already knew, the baby was dead. all that remained was to tell the mother. with genuine sympathy and very sensitively the registrar broke the tragic news to the mother. i saw her face drop as the realization of the loss set in. i could see her fighting back the tears. i was too.

finally it was over and we all slowly filed out to leave the mother to absorb the blow. of course we still had to decide how to deal with the problem of getting the baby out so we didn't have the privilege of dwelling on the human drama that had just unfolded before us. still i took a moment to allow myself to feel it. this involved no small amount of swallowing back the tears.

the registrar turned to us.

"and that is that. which of you is going to deliver this baby?" my colleague was the first to speak.

"excuse me, but when the baby is delivered, can we practice endotracheal intubations on the body?"

i felt nauseous and slightly dizzy. it hadn't occurred to me before then but suddenly i realized the entire humanity of what had just happened had gone completely over the head of my colleague. all he was interested in was the possible so called learning opportunity that he could get out of the 'situation'. quite frankly he had felt nothing for the baby and he had felt nothing for the mother. i couldn't help wondering what sort of a doctor he would one day turn out to be. i never wanted to be like that.

in the end i was the one that had to deliver the baby. there were a lot of tears.

perspectives

sometimes different people see the same thing from a slightly different angle, giving a completely different perspective. in my line this can turn out to be quite macabre.

it was one of those cases. it was probably hopeless from the beginning, but he was young and we had to give it a go. as soon as the abdomen was opened everyone knew things were bad. there was blood everywhere. it took a while to even see the damage to the liver because i needed to get rid of the blood in the abdomen before i could see anything. however, once i saw the liver even i was shocked.

the liver was ripped apart with one laceration dropping down to where the ivc sat menacingly behind it. it seemed to spit and splutter at my efforts to bring the bleeding under control in defiance of me. but i did what i could as fast as i could. at times like this the unsung hero is the anesthetist. if he can't get fluid and blood into the patient fast enough, no matter what the surgeon does, it will be in vain. that day the anesthetist was great. somehow he kept some semblance of a blood pressure in the patient against overwhelming odds.

after a while with large compressing stitches in the liver, the worst of the bleeding finally subsided. usually, unfortunately, at this stage of these operations we are confronted by another problem. you see with massive blood loss the patient loses or uses up all their clotting factors and platelets. even if the hole in the vasculature is closed, there is a general ooze of blood from pretty much everywhere. to attack each ooze with an injudicious suture not only doesn't help a bit, but it wastes precious time that could be better spent in icu replacing these vital factors. i made the call.

"there are no more surgical bleeds that i can control here. i'm going to pack the abdomen and send him to icu to optimise his condition and we'll take him back in a day or two." the anesthetist looked up.

"if you say so, but he is not looking so great here." he pointed at the monitors.

i packed and closed. the gas monkey continued throwing every available fluid into his system as fast as he could.

"i'm just going to top him up as much as possible before we transport him to icu." he informed me. he was definitely worth his salt, this one.

this is now a time that the average surgeon doesn't like. we are not the stand back and wait types. we struggle to sit still and give it time to see what happens. but sometimes it is needed. i didn't have to wait too long before the the gas monkey told me what was happening.

"bongi, this guy is not improving on the fluid and blood i'm giving him and his abdomen is distending. are you absolutely sure there is nothing inside you can't make better?" the problem was i knew there was nothing i could do that i hadn't already done. however the anesthetist's observations were undeniable. the question was was there something i had missed or was the patient so far gone that he was lost already? it was clear that despite a valiant and heroic resus effort from the anesthetist, the patient was clearly dying. there was only one thing to do. we had to open and look again.

we opened. immediately i knew everything we did from here on out was futile. the patient was in irreversible shock and had absolutely no clotting. there was nothing that i had missed from a surgical point of view which meant there was nothing i could do. after poking around a bit i packed and closed again, but this time with a heavy heart. i knew what was going to happen. the anesthetist also had no illusions about where we stood, but we both continued to go through the motions.

the motions led us eventually down the deserted passage way in the middle of the night to icu with a patient that was sort of alive in the broadest definition of the word when we left theater. both the gas monkey and i didn't want to check the vitals during that quiet sombre journey. what did it matter? we knew what was going to happen and we knew it was out of our hands. the only questions were where and when it was going to happen if it hadn't already happened. so when we entered icu we were quiet and reserved.

when icu receives a new patient, there is usually a flurry of activity and this was no exception. all the sisters descended on us like a swarm of bees, each going about their respective duties. soon the patient was connected to the ventilator and the reassuring rhythmic sound of it pumping away filled the room. however once his pulse oxymeter and blood pressure cuff were connecter they did not give any comforting sounds. quite soon their alarms were blaring away. i glanced at my anesthetic collegue and we both shook our heads. we had done what we could. the icu sisters hadn't seen what we had seen. all they knew was we had delivered this patient and things didn't look good.

"i can't get a blood pressure. i can't feel a pulse. crash trolley!!!" she yelled to one of her juniors who scurried off in obedience. neither i nor the gas monkey moved. we just sat there, defeated at last.

"doctors, this patient is dying! aren't you going to do anything?" i laughed. i didn't mean to and i think it was more a nervous laugh. i was too emotionally exhausted at that moment to react appropriately. my colleague also laughed, but more at my response than the situation, i think. he then explained that what could be done had been done and any further resus would be in vain. we turned off the ventilator.

and so there we sat, feeling like the very life had been wrung out of our souls as the patient expired and some of the sisters looked at us as if we were heartless bastards for laughing.

tongue twister

in the old days at kalafong (hell) we sometimes had to deal with obnoxious people. alcohol tends to make the worst of a personality come to the fore. most of us tended to ignore these irritations and get on with the job, but there were exceptions.

he was a senior registrar at the time. before going into the whole surgery thing he had been in the army and had served in the angolan war in the special forces. i occasionally asked him about those days, but he never spoke about it. i think it messed him up a bit and he probably didn't want to dwell on that stage of his life too much. only once did he ever actually say anything to me that alluded to what he had gone through.

"bongi, when you are in battle and people are shooting at you with the intention of killing you, it somehow changes your perspective on life." i suppose part of his changed perspective was that he tended not to take crap from mere mortals (hy vat nie kak van kabouters nie), especially those with more than a liberal dose of dutch courage.

the patient was drunk beyond description. he lay there in casualties with a nice neat bullet hole through his chest. however the injury had done nothing to his foul mouth. he maintained a constant stream of verbal abuse directed against anyone and everyone who had anything to do with him. when the poor house doctor inserted the intercostal drain she had to contend with both his sharp tongue as well as the occasional flying fist. he even managed to land a blow which had reduced the house doctor to tears. to her credit, she had continued the procedure but was unwilling to go near him after that. she called her senior, the registrar, to make sure the patient had no other injuries.

my friend walked into casualties, quickly found out what the trouble was about and approached the patient. he stood just outside the reach of the patient and casually observed his fists flying around, keeping everyone away. he listened as the patient flung a stream of obscenities at him. he seemed unmoved, but the wry smile that until then had been on his face slowly slipped away to be replaced by a stern grimace. he tried to speak to the patient to explain that he needed to check him out but this was met with such aggression that he ended up walking away. the house doctor tried once more to approach the patient, but caught a heavy body blow and slumped to the floor in pain. that, it seemed, was too much for the registrar.

"sister, put the patient in the procedure room. i'll be back in five minutes."

five minutes later the registrar returned. he went straight to the procedure room. just before he entered he turned to the sister.

"sister, call the maxillofacial surgeon and tell him we have a patient for him with a broken jaw."

"does the patient have a broken jaw?" she asked, surprised.

"well not yet." and with that he entered the room and closed the door.

after that, so the story goes, the patient was as tame as a lamb, albeit a lamb with a very swollen face.

covert operations

the consultants didn't always need to know what was happening on the floor. but sometimes keeping things away from them became downright clandestine.

i was a senior registrar at kalafong (hell). an old friend of mine had just taken up a post as consultant in the department of internal medicine. one day he approached me.

"bongi, what are the chances you can do the occasional open lung biopsy for me?" now there was no thoracic department in kalafong so it seemed to me to be a reasonable request. in fact i was quite excited. it would give me a chance to do a few thoracotomies, something us general surgeons don't do all that regularly.

"sure! anytime. just let me know and i'll book them on my list."

"uhmmm, there is just one small problem," he continued, "i've already asked your consultant when the previous registrar was here and he bluntly refused, so i suppose you would need to convince him." this was no small problem. my consultant tended to be a bit hard headed and i knew if he had already decided, then there would be no convincing him. if i were to ask his permission he would refuse and that would be the end of it. if i just went ahead at least i could claim ignorance, that is until he catches me out. there was only one thing for it.

"ok, i'll do it on one condition. at no point must you discuss the matter again with my consultant. everything must go through me." and so it was arranged.

a short while later the internist approached me with the first patient he wanted a piece of lung from. i took her name down and booked her on the back of my list. i then re-wrote the list, carefully omitting her name and took it to my consultant. we went through the somewhat abbreviated list together. he was happy. i didn't want to be the one to erode that fragile joy.

halfway through the theater list, as was his habit, my consultant asked me if i'd be able to handle the rest and went back to his office. i assured him i had everything under control and sent him on his way.

the thoracotomy went well and the hiding of the patient from the consultant in the ward for the next few days also went well. i was feeling good. i suppose i knew it couldn't last.

two more thoracotomies were pulled off in similar fashion. and then we prepared for the whole charade for the next one. again i put the patient on the list and again i discussed the abbreviated list with my consultant the day before. again everything looked good. i went home, looking forward to a great list culminating in a nice thoracotomy to obtain a piece of lung for my internist friend. but this time something went wrong.

how was i to know that my consultant decided to pass by theater that evening before he went home to check something on the list? how was i to know that he discovered my thoracotomy that until then he knew nothing about? how was i to know that when i walked into the morning meeting i was walking into a fire fight?

the consultant was clearly angry. before the meeting he called me over and asked me why there was a thoracotomy on the list that he knew nothing about. i told him the internist had asked for a lung biopsy and i had added the patient because we had some extra time on the list. he went mad (or slightly more mad). leaving no room for any misunderstanding he informed me, with much frothing at the mouth, that there would be no thoracotomies on his list....not now....not ever. i apologized. i thought that was the end of it. i was wrong.

after the meeting the prof asked if there were any announcements. my consultant raised his hand. it was so unusual for him to say anything during the morning meeting because of a certain amount of animosity between him and the prof that everyone sat up and paid attention. he then moved to the front of the room.

"it has come to my attention that bongi has been doing thoracotomies on my lists." he started. "now if this ever happens again i give you my word that i will personally see to it that the guilty party is put up against the wall in front of a firing squad and he will be executed! we will reinstate public executions here in kalafong. we will make it compulsory for all the registrars to attend so they can see what will happen to them if they step out of line. if he wants he can have a blindfold, or he can go without, but he will be executed. the registrars watching will not be permitted to use blindfolds."

i considered the question of the blindfold, but in the end i decided to rather stop doing the thoracotomies.

surgeon superhero

this is a post i wrote as a guest post for another blog a few years ago. since then that blog has been retired, so i decided to import the post back here.


yes i have an alter ego. yes, i dress in funny clothes with a cap covering my head and a mask covering my face. and yes, dressed as such i try to fight the powers of evil (mainly sepsis and bleeding and cancer and the like). i am ... a superhero. but there is often little understanding for what goes on under the paper thin masks and baggy gowns we wear. certain …um…occurrences, well, occur with us just as much as with other people.

a common cold behind a theatre mask is no small thing. remember you can’t blow your nose. sniffing loudly only works for a while and attracts all sorts of strange stares. just leaving it is really the only option. the positive side of this is you suffer less from the mild dehydration that accompanies massive loss of …mucus. there is, after all, fluid replacement (it is a very short trip from your nostrils to your mouth over your upper lip). ‘nuf sed. somehow this never appealed to me though. so, for all you budding surgeons out there, when you have a cold, plug your nostrils with tissue before scrubbing up. once you’re scrubbed, it is too late. The side effects are only a slight change in voice which is a small price to pay to avoid the constant lip licking and salty taste throughout the operation.

then there is a running stomach. this may be one reason to excuse yourself, handle the situation and rescrub. however, there is the real problem of dehydration, confounded by long hours of standing and concentration. here may i suggest a drip. the gas monkey (anaesthetist) can quite easily give a quick bolus or change the vaculiter when needed. (quick note, i’m not pulling this out of my thumb. i have actually seen this). stay at home, i hear you say? somehow that just doesn’t work with us doctors. i’m not sure why, but it is very rare that a doctor will stay at home merely because he is sick. what sort of a superhero would that be.

the last problem that can be encountered is best explained by thinking back to my registrarship. i was assisting the prof with some or other laparotomy. my stomach had been giving me trouble for some time. up until just before scrubbing up with the prof i had found it necessary to quietly leave polite conversation to allow the release of colonic gas quite a number of times. but once scrubbed up, this avenue was no longer open to me. what could i do? i simply puckered up and held it all in. this worked well, but became progressively difficult. we were approaching the end of the operation, but i could pucker no more. finally i reached a point where i had no choice. i needed release. i decided to quietly let one slip as to not attract too much attention with loud noises. so, as the professor started to close the sheath, i did just that. i was just inwardly congratulating myself for the stealth with which the…um…operation had been executed when the professor stopped closing and dived back into the abdomen. in a dry voice he quietly says, “someone cut the colon.” as he started carefully moving bowel out of the way to better examine the colon. now imagine my embarrassment when i was forced to say’...

“colon? yes. cut? no”

lingua franca

recently i was privileged  enough to go overseas to france for a laparoscopic course. unlike my last trip to deepest coldest europe, this time there was only one other south african on the course, but, as luck would have it, it was the same guy who gave us all a laugh last time. i think the laugh might have been on us this time though.

it didn't take too much time in france to realize theirs is a totally foreign culture to ours. what they are is simply called rude and obnoxious in our country. after a while one gets used to it and can only but look forward to returning home. however when there you sort of have to endure it. our usual south african responses to their behaviour might not go down too well.

the one night i went for a walk in the town (something not generally done in my country for safety reasons). at a stage towards the end of my walk i saw a quaint take-away place and decided to go in for a quick bite. i walked in. the place was totally empty except for the one single employee behind the counter standing with his back to me. he mumbled something in french which sounded to me like their usual greeting phrase, but only glanced up momentarily before he turned his back on me again. by this stage i was quite accustomed to being treated poorly by them so i greeted him back in two languages, both of which he probably understood just as well as i understood his french. he ignored me. i patiently waited for him to finish ignoring me. after a while he turned around and repeated his french phrase. i greeted him again, hiding my irritation well, i thought. i then went through the painful process of ordering something akin to a hamburger. he seemed to resist these attempts of mine, but finally took my order and got to work preparing it.

just about this time my south african colleague coincidentally walked past. he saw me in the small cafe and entered. i was just too grateful to see a friendly face and quite soon we were chatting away in a language there was no chance our french friend could understand. i informed him i had had difficulty with what i perceived as typical french rudeness but had managed to order something i was hoping would be a hamburger-esque thing. my friend greeted the guy in english and received the same french phrase i'd heard.

my friend then attempted to order something for himself to eat. it seemed to go even worse than it had with me. the menu was written on the wall so he simply pointed at an item. the french guy shook his head, indicating that that specific item was not available. not to be put off my friend moved from item to item, pointing to each one in turn and each time without joy. it was quite a comical scene to see him move systematically through the menu and be denied each time. after what must have been about the tenth item he selected, finally the guy indicated that he could supply it. my friend sighed, more from relief that the ordeal was over and we continued our light hearted conversation in our own language, somehow comforted in the knowledge that our words would confuse his ears as much as his did ours.

finally our food arrived and we tucked in.

while we were eating alone in that quaint french cafe late at night chatting in a language that reminded us of the open spaces of africa, probably too loudly for the refined french sentiment, something happened that gave me cause to reflect.

half way through our meal a local walked in. he greeted the guy behind the counter. the guy answered in the phrase that we had heard when we first came in. somehow hearing it just after the french greeting, it no longer sounded like the french greeting. just as i was wondering what he had actually said to us and therefore to this new local, the guy apologized and left. shortly after the same process repeated itself. someone came in, heard the phrase, said sorry and left. i then put it together.

the phrase obviously meant that the shop was closed. the whole time he had been ignoring us was more to do with him no longer being on duty than the usual french rudeness. i couldn't help laughing as i shared my suspicions with my colleague. i could just imagine what was going through his mind as he struggled to make himself understood to us;

"what is the quickest way i can get rid of these people that just refuse to leave? maybe if i just feed them then they will at least eat and go away."