Already one week!

Hello!!

I can't believe how it's already been one week and 2 days since I have left Montreal. They say time flies when you are having fun - that's exactly what's going on here in Joburg!! It has been quite the week, I did not expect things to be this busy. I mean, I have heard from Oliver and Brendan when they came out here and recapped their experiences. Being able to experience this first hand is a whole different thing! I will try to explain things the best I can, but there are some things I just can't describe, for the sake of keeping this for a general audience.

Where do I start?

As I had described to you all, on Monday, this was more of an orientation day. Get acquainted with the medical school, the hospital, paperwork, meat the team, etc...

Tuesday was our first real morning. We started at 7am, where we attended the morning surgery division wide M&M rounds (morbidity and mortality). All specialties of surgery are expected to present their cases over the week, every week (not like back home where it's every month). As the registrar (resident) presenting these cases - you must know your patients history COLD. The profs and consultants use this time to grill you hard and ask impossible questions (even though you never saw this patient). Although stressful time on the stand, this is rather educational for those in the audience, ie. medical students. After this, we attended hand over rounds, where the consultants go over all the cases that occurred the day before and discuss them with the registrars. This as well can be a very intimidating process. The consultants sit at a table facing the registrars, the medical officers sit behind the registrars and then the seats all around the walls of the room are for the others. I did not know this and was lucky I didn't sit in any of these seats because they would have asked you to move, as if you should have known this already! After hand over, we then attended ward rounds with the consultants and rest of the team. We mostly round on the patients in the Major Injury Unit (trauma ICU), while the registrars manage the ward patients. These rounds are an opportunity for the consultants to ask you questions and you realize how you have forgotten a lot of the anatomy you once learned in first year! "Can you describe to me the course of the vertebral arteries from start to finish?" Uhmmm...no I can't was my first answer, laughing. And then he asked me to try - by then, I was saying things that didn't make sense, out of fear/embarrassment! It is amazing how well trained the registrars are here. They are VERY strong in anatomy, they know it COLD. However, after hearing the answer, a light bulb light up and I said "Oh yeaaaa" LOL. So I have now been looking back at anatomy, to refresh my memory because it has been so long (only 3 years).

Morning ward rounds

As you can see, they round a lot here. However, this is great teaching opportunities because they are very keen to teach you what they know, despite sometimes making you feel dumb. It's all part of the game! Once rounds are over, we grabbed some lunch at the medical school cafeteria. They have great selection of food, however the caf is always packed with students! It's really a great place - so many students everywhere and it's a fun environment. After lunch, we headed to 163, known as the casualty care area, where all the traumas come in. On our first day in 163, we were a little lost! Lots of people working and lots of patients coming in and we were standing in the middle of the room, trying to figure out what we can do to help! We met one of the Medical Officers (MO), Freddy, he wants to be a vascular surgeon, but needs to work as an MO until a spot becomes available. He helped us out and got us to start seeing some patients with him. This was a rather quiet afternoon, a couple of PVAs (pedestrian vehicle accident) these are very common here! Some hand and feet injuries - to which he asks me "Can you tell me about all the tendons in the hand and arm?" Geez! What's with all these anatomy questions on the first day...in my head, I was like I want to be a surgeon...but quickly thought that this is important to know and maybe I should brush up on this as well. Again, they mean well and want to push you to learn while your there. We left that night around 6pm and when I got home, I quickly turned to my anatomy book online and studied a bit. Felt much better after that!

On the next day, we repeat the same routine. Only this time, we started at 9am, when the handover meeting occurs, then ward rounds, then lunch and then 163 for trauma. This day, we met Sofie!!! She's an awesome international student from Sweden. She was our life saviour. She basically showed us everything we needed to know, how it works, what to do, where to go - she has been around for 7 weeks of a total of 9 weeks. This was very much appreciated!! She even brought us to 163 and showed us where everything is, where to suture, what they use, how to draw blood gases and run them yourself, what to do during resuscitations. We were now properly orientated by Sofie :) So the next few days were fun, seeing lots of patients coming in with all kinds of traumas. I will save the details for when I talk to you about my friday and saturday call!

On Wednesday night, we decided to go out for supper with Li, Niki and Olivia. Our electives administrator had suggested we go to Gramadoela's, supposedly a fantastic south african restaurant, very famous and we would love it! Trusting her advice, we all decided to go. However, we ran into a little bit of trouble. We left the house around 7:30pm, which was dark outside and followed our GPS. Only thing is, our GPS was a little confused and brought us around circling what looked like a very dodgy, unsafe area! Niki was following me with her car. At one point we ended up in this area with no lights and two guys in the middle of the road. Li asked me to open my window to ask them for directions - I thought she was crazy, but yet I opened my window just a tad and asked them. These guys had no idea, but wanted us to park our car in a spot they had reserved in the dark for us. They are parking guys - basically, people who find parking spots for u and promise to keep your car secure and you pay them. We quickly drove off and called the restaurant asking for directions. They claimed they didn't have an address, because they were in the theatre market square, which we couldn't find! Then at one point, we ended up on another street with no lights, few hundred people or so all sitting along the side of the streets (was like a scene from a horror movie). We quickly drove towards the light part of the city and again found ourselves in a dead end. Backed out, weren't stopping at red lights, and finally found the place! It was right beside the theatre market, very well hidden! We parked in an area with a real parking security, who watched our car for 2 rands (almost 20 cents) and off we went to eat! Honeslty, I know I am probably scaring some of you with this experience, but the restaurant was well worth it! The food was amazing - it was a buffet style of south african dishes! Here is the website for those interested! http://www.gramadoelas.co.za/ We ate and arrived safely back home :)

Sofie, Niki and I decided that we were to be on call on Friday and Saturday night. Basically we were going to work in 163 from 6pm to 7am. Friday and Saturdays were known to be the busy nights. Obviously, this is the weekend, people drink, have fun, get violent, etc...This makes sense, I mean we are busy back in Montreal on Friday and Saturday. However, not the same busy at all! The trends that have been described to me are the following: there is a baseline of violence all the time around here, it increases much higher when there are soccer games, mid-week and end of month (pay day) and holidays. The week before when there was a soccer game and South Africa lost - they had 9 stab wounds as of a result. So this Friday, we were ready (it was mid week).

Our office :)

One side of the 8 bed trauma bay

Niki and Joan (Swedish Orthopedic Surgeon) - on call

Night sisters!

I kept a record of all the cases we resuscitated and this was just in 12 hours: 7 stabs, 3 severe PVAs, 2 gun shot wounds (one of which was in the head with brain matter exposed and another was a guy who got shot at a bar after getting into a fight, his friends brought him by taxi - when we carried him out of the back of the car, he had already passed away. Shot went through left side of chest and out the right side), 4 assaults (most of which were community assaults - if you are being robbed in South Africa, you can scream "Injur" or something like that and people around you will know you are being hurt. The members of community will then take it upon themselves to run after the suspect and stop him to be arrested, however they sometimes take matters into their own hands and assault them first, very badly.) The casualties didn't stop all night. There was never a dull moment - we were busy all night long!! We get a lot of hands on experience here. We start all the IV's (getting in 14G needles is tricky - they are huge), do all the bloods, blood gases, etc... You learn fast and I am very impressed with how good the trauma surgeons are here. They manage with the resources available to them, but they still have most of the resources we do back home. Next morning when I was done, I went home and slept all day! I woke up at 2pm. Li was going to the mall, so I went with her to Sandton City mall. We went for a walk near Mandela Square, had lunch at an italian restaurant, then went shopping. The mall is absolutely gorgeous - its huge!! Did not expect this! After that, it was 5pm and I had to get ready for another night on call.

Mandela Square

Saturday night was even crazier and busier than Friday night. To sum up the night quickly - non stop from start to finish. 6 stab patients, 4 serious PVAs and random stable traumas. We had one transfer by helicopter of a patient run over by a truck. The helicopter landing is right outside the trauma unit, in the parking lot.

Helicopter landing with unstable patient

Around 2am, we received a patient who was stabbed in the chest, in the heart to be more specific. Patient was unstable, dropped his blood pressure and then quickly lost all vitals. We did an emergency thoracotomy. Basically, open up his chest and get to his heart which is being surrounded with blood and basically can't beat anymore because of the pressure chocking it from the blood. The trauma surgeon found the hole and put a stich in it, stopping the bleeding. While we were doing that, another patient came in, stabbed in the chest, in the heart. We quickly got him ready and another thoracotomy was done! I couldn't believe my eyes - in 15 minutes we had done 2 emergency thoracotomies!! This was insane, but when speaking to the other South African doctors, this was normal, business as usual. Luckily for the two patients, they survived and doing well now on the ward. WOW After a long night, Niki, Sofie and I decided to go for breakfast. Got home at 10am and then I slept until 6pm :)

Breakfast at Walnut Grove! Steak, eggs and billtong!!

I know that all of this sounds horrible and that it seems like there's nothing but violence out here. But I do have to remember that I am working in a busy Trauma centre and see nothing but trauma. They have patients being transferred over from all over the surrounding areas. I am getting great first hand experience - as one of my friends said - gotta find the silver linning. All of this has gotten me thinking and reflecting and trying to understand why this is so abundant out here. While I was at the mall, I bought a book on the history and direction of South Africa, which I started reading. I will reflect on this and get back to you on my thoughts :)

For now, this is truly an experience of a lifetime! I am enjoying every minute of it. I am surrounded by good people, making lots of friends from all over the world, meeting great doctors, and will be visiting great places in South Africa!!

Please do not worry. I am being safe, staying out of trouble and aware of the reality out here. I find that this experience will be teaching me a sense of security when not in a place that I am familiar with. I am learning lots out here and I hope that this will make me be a better doctor one day.

My fav house buddy Elvis!

Thanks for reading :)
Phil

P.S. Evie reminded me today that we are getting married in exactly 5 months!! AHHHHHHHHH but I can't wait :) Love you babes! Missing you like crazy!!