We’ve got a bleeder!

Posted on July 25, 2006 by Phil

The traumatic adventures continued this weekend, with me volunteering for a Friday and Saturday night. Friday was quite sedate, with a mixture of stabbings and slashings which required suturing, as well as a couple of chest drains, one of which I put in.

Saturday was quite a bit busier – there had been a big football match earlier that evening, which when combined with your typical saturday night drinking meant we were quite busy. There were a number of muggings aswell, one of which ended up with a man with quite a deep stab wound in his ass, which I happily sutured closed…

Saturday wasn’t busy, but there wasa staedy stream of patients coming through Surgical Casualty which kept us busy until about 0530. I was getting ready to leave at about 6 when two strecher cases rolled in off an ambulance – one of them was a stab wound to the side of the neck, which looked like it might have gotten the apex of the lung. The main problem was thyat it wouldn’t stop bleeding – we had to get the surgeon on call to come and take a look – he ended up clamping and ligating 4 arterioles in the recovery room before the bleeding was under control.

As I was getting ready to go home, one of the Casualty doctors asked me if I’d be interested in going to a ‘Charismatic Church’ that morning (it was 8 on Sunday morning at this stage). I agreed, which might have been an indication of just how sleep deprived I was. I got home, into bed, and an our later, my phone went off. 30 minutes later we were sitting in a church which I thought could only exist in the world of Hollywood – there was a band and singers and a choir and karakoe style lyrics on a big projection screen, and the preachers definitely liked to preach. I can honestly say I’ve never experienced anything like that before, and while I may have had a problem with a lot of what was being preached (which was at odds with a lot of the catholic beliefs I’ve been exposed to over my school years), some of it was very relevant to the congregation, and you couldn’t fault the presentation.

I was planning to visit a DeBeer’s diamond mine today, but when I rang yesterday it turns out that the last mine in Kimberley ceased operations last August, so they are understandably not running tours any more.

Just a few more days in Kimberley, and then I start on my backpacking adventure – I’ll post up my itenerary in a few days once I’m sure it’ll all work.

Posted in Africa, Elective, Travel | 2 Comments

Trauma

Posted on July 20, 2006 by Phil

I started on the Trauma side of casualty on Monday. They’ve been very willing to let me flex my surgical muscles here, I’ve been assisting in Minor Ops (Lipoma removal, sebaceous cyst removal, pressure sore débridement), performing some minor procedures (trochar biopsy, abcess drainage), some wound closure (stitching) and, of course, bloods and exams.

I was in theatre on Tuesday night, and got to see a toe amputation (which was quick) and a below knee leg amputation (which was less quick).

All in all, the surgeons seem a lot more prepared to let me go and do things. I’m going to come in for the evenings / nights over the weekend and see what its like, apparantely it will be busy, so lots of suturing practice for me. Stabbings are a big problem here too, so I should get a chance to put in some chest drains :)

On the tourist front, I’m hoping to do an underground tour of the De Beers mine next week, and other than that, I think I’ve exhausted Kimberley’s tourist charms. I tried the McGregor museum, but it is much less interesting than the Lonely Planet would have you believe.

I’ll be back with more news after the weekend.

Posted in Africa, Elective, Travel | Leave a comment

First Day on Call

Posted on July 14, 2006 by Phil

Today (Thursday), I decided to do a full day’s call in Medical Recovery. That means starting at 8am and finishing sometime around 11am the next day. So far its been a quiet day – only 4 new patients so far (as of 1530). Lets hope its a quiet night too…

Well. As soon as it hit 5, the floodgates opened. By 9, the short stay ward was full and patients for observation were beginning to pile up in the medical recovery area. Then to make matters worse, we were visited by a sister who insisted that we had too many people waiting downstairs and that we should admit patients to the wards, where there were at least 20 beds available.

Liza, the intern on call, was unhappy with admitting patients who actually needed observation because they were unlikely to get it on the wards where the nurses are at their station, as oppossed to recovery, where all the nursing and medical staff are 2 metres from the patients. Then we had a visit from the CEO of the hospital, the head of the casualty department and the provincial minister for health (I have no idea why). The decision was to admit stable patients, even if they would normally be observed overnight and discharged the next morning.

The most pressing case we had was a case of severe lactic acidosis (arterial pH 7.1). We consulted with the ICU doc on call, but they were full and unable to free a bed, so we had to manage the patient in recovery
By 11 we had pretty much gotten the situation under control. The Medical Officer on call went home at that stage leaving Liza in charge. At about 2345 we left casualty for the on-call room.

We managed to get a good 40 minutes rest (and at least 20 minutes sleep) before the first phone call. That kept us in A&E until about 0215. We got almost 2 hours sleep before heading back down to A&E at 4 for an acute exarcabation of asthma in severe respiratory distress. Back to bed for about 5, and up at 7 for a quick breakfast to prepare for the post intake round. Liza had to go do anaesthetics stuff so I was the only one who’d been there all night who would be there for the round.
This should have finished at about 10, there were only about 8 patients in recovery. Except, we had to go and see the 8 we’d admitted directly to the wards. I didn’t get out of the hospital until 12. As you can imagine, I was a bit tired. And, this was a quiet night – I’d gotten about 4 hours of sleep in total.

I’m going to do a weekday and a weekend call in Trauma over the next couple of weeks, I wonder how they’ll compare.

Posted in Elective | Leave a comment