Friday, June 4, 2010

Flying Solo

June 1, 2010
Today we went back to surgery after a successful day yesterday. When we got there the nurses and doctors greeted us. We were observing a shoulder dislocation manipulation. This guy had screwed up his shoulder pretty bad and it needed to be surgically. A couple of minutes into it, another doctor walked into the operating room. He was very charismatic, loud, and started cracking jokes immediately. He also wore a hearing aid so he spoke a little louder than he needed to. He was one of the consultants for ortho surgery and he was helping out Ernest. We introduced ourselves to him and he was very enthusiastic about us being there. Right off the bat he asked if one of us wanted to scrub in. Since I had the first one, Hailey got to do this one. A hour or so later it was all done. The next operation wasn’t really an operation but required sedation. This fourteen year old boy fractured had a greenbranch fracture (imagine taking a green branch and trying to bend it one direction to break it, that’s what it looks like). So obviously, this green branch doesn’t break all the way through. In order for the arm to heal properly, the doctors needed to sedate him, give the arm traction, make the fracture worse by bending in the direction of fracture, and then forcefully bend it back in the opposite direction by pressing directly on the fracture itself. Sound familiar to any of my family?? This is the exact same operation I had when I broke my radius, and I was fourteen years old too. Ernest told me I was going to do the entire thing. I got a really weird feeling inside because now I was going to find out what they did to me when I broke my arm. Actually, I was now going to do what they did to me to this kid. They briefed me on what I was going to do thirty minutes beforehand, so I was practicing on myself so I wouldn’t forget. When it was time, we knocked the kid out and Ernest held his torso. I grabbed the kid’s arm and simply just leaned back with the arm in my hand. I had all my body weight on the arm and the bones got some traction (hopefully). After that, I quickly jammed his hand upwards towards the fracture and held it with all my weight. Then I put my thumb right on the fracture sight and hyperextended the hand back down. Ernest told me to keep as much force on the hand as possible. I seriously thought I was going to break another bone or might as well rip the entire hand off. Suddenly I heard this pop and I glanced at Ernest for a look of approval or a look of terror. His face looked promising so we took an X-ray and just like that, perfect realignment. The procedure was pretty quick but thank God I was sedated. I really felt like I was flying solo throughout the whole thing. The doctors trusted me and were there if I were to screw up. I felt like this is how education should be. Both doctors are extremely praising and are willing to help along the way. I’ve got more patient interaction than ever before or ever will have for years to come. And we wonder why there are so many problems with the American medical education? As medical students, we don’t get true patient interaction until our third year of medical school, and even then you just sit in the back and shut up. Then when you’re all done and ready to practice, you’re anti social, lack patient interaction skills and overall extremely awkward. Everywhere else in the world, the medical program is combined with the university. Essentially, there is no such thing as “pre med”, just six years of education and clinical combined and patient interaction/hands on education starts at the third year. A ridiculously long, grueling, and difficult path to attaining a medical degree does not make the best doctors. It has become one of the frustrations that I’ll take back to the states. Somebody could show me how to put an IV line 300 times, but once I do it myself, it’s completely different. While on the subject, Dr. Rowe couldn’t have put it any better, “in South Africa (or pretty much anywhere else), you practice medicine. In the U.S., you practice law”. The whole purpose of medicine in the States it seems like is to cover your own ass so you don’t get slammed with some sort of ridiculous lawsuit. With that, I wonder what I’ll do when the time comes.
Anyway, back to bone crushing. After the radial reduction, the next surgery was a tibial/fibial (both leg bones) shortening and reduction. This seemed like a pretty intense surgery so I stuck around to watch it. This time this fracture was a couple years old. He was given a Hoffman exoskeleton (external pins and needle apparatus) and when they took it out, the bone failed to heal properly and crushed under pressure. The Xray was insane. His tibia (big leg bone in front) essentially slipped out of place and fell all the down to his foot. It looked absolutely terrible. Of course, he waited months to come in and get it looked it. I looked at the chart and this all happened when he jumped out of a window while running from his apartment landlord… that’s one of the weirder ones I’ve seen. Dr. Rowe and Ernest began the operation and started the incision. Right off the bat they knew this was going to be a complicated surgery. Dr. Rowe turned to me and said, “we need some man power, Miles go scrub in”. I jumped up like a little kid and ran to the scrub room and got scrubbed in. We started the surgery around one and began taking away all of the erratically growing new bone formations. I held the retractor as they were scraping away. I looked inside the leg and it looked like a total mess. There were bones overlapping, in places where they shouldn’t be, and missing where there should be bone. But they continued to hack away and we were all having a good time laughing and talking about various things. A favorite amongst South Africans—U.S. politics. I explained that my dad likes Bush and they all just burst out in laughter… I think thats happened 100% of the time. You mean to tell me nobody likes Bush outside of the U.S.? Hmm news to me : )
Time chugged along and we kept hacking away at bone. Ernest is hammer happy and loves to crush things with his large muscles. Since he’s a new ortho sugeron, Dr. Rowe needs to put him in his place sometimes. Then we had a T.I.A. moment, we were going to saw off the tibia completely using an oscillating saw. The nurse hooked it into the wall and Ernest began sawing away and then the saw died. They got the back up, then that died as well. Both air hoses had leaks in them so it made them useless. All that was left was sawing manually using a hammer and chisel. Ernest set up his chisel against the tibia and just started pounding away with the hammer as hard as he could. **remember the patient is awake!** All the sudden, we hear this very audible crack and a crunch. He had broke the bone as desired, but to hear your tibia be crushed to bits must not be easy to hear. They lifted the leg up and I saw something not human. Since they broke both leg bones, when they lifted the leg, the foot just kind of fell off and hung only by its skin. It was hanging probably four inches above the ankle so it looked completely abnormal and inhumane. I was told to hold the foot and leg at a 90 degree angle so the leg bones stick out and they could do their carpentry. I almost forgot we were working on a person, this had become a butchery experiment. A couple hours later, we were ready to put screws and plates into the newly formed tibia and fibula. We had taken out about two inches of bone so his leg was going to be permanently shorter. I had the honor of doing three screws with the drill gun along with putting it in with a screwdriver. The entire operation lasted three a half hours and I definitely felt like I helped out a lot without being a nuisance. It took a lot of force to manipulate everything back together. Plus, we all had to wear really heavy lead filled vests so we didn’t get penetrated by the x-rays. When we took it all off, we were all sweating through our scrubs. I had no idea it was that grueling. Surgeons always talk about how time seems to fly by and you feel nothing until you’re done, and it’s true. I had no idea I was sweating that much and all the back pain came after I was done. So another surgery down, assisted in a tib/fib shortening and reduction. Pretty cool I think! As of right now, I’ve really come to love this week in surgery. I have learned so much from the doctors and have received so much opportunity.
Final Countdown: 4 days

Doctors of Carpentry

May 31st, 2010
As winter progresses here in South Africa, so does my inability to wake up in the morning. It is pitch dark whenever I wake up and it doesn’t get light until I get to work. Also, for those who think Africa is just one big giant sun-fried continent, that is so far from the truth. The African sun is not what kicked my ass (well maybe in Durban, but this is like comparing Costa Rica to Finland), it was the African cold! There is no central heating in any of the houses and as a result, the houses are generally freezing. My house is full of tile and hardwood, and my room feels the coldest. For the past week or two, I wear socks, BOTH pairs of pajamas, a thermal shirt, my black sweatshirt with my hood on, and a beanie to bed. Yet, I’m still cold. Also, my family’s hot water isn’t the greatest so I have learned to take cold showers…a lot. Additionally, as the days get shorter, the calls for prayer start later. Now I didn’t think these existed, and then I went to Dubai. Then I thought it only exists in the extremely Muslim countries. But these occur throughout South Africa as well. Muslims pray five times a day for twenty minute each session, and they like the whole world to be aware of it. There are speakers at the mosque about a mile and a half way in a town called Gatesville (same town as the Gatsby). So every morning at around 6:15 I am “gently” wakened up to some man screaming to Allah. I can only imagine how loud they are at the mosque. In the summer, they start around 5:20AM. I didn’t realize how strong of a Muslim community I lived in. Our driver, Uncle, is Muslim as well. The mall across the street is strictly Halaal, which means no pig products are sold. At Mugg and Bean, bacon is called macon…and to be honest I have no idea what macon is, so I don’t order it.
We got picked up at the usual time without Lauren. It was strange not having that third person in the car. We got to Jooste and went about our business. I feel so ready to come home so it becomes difficult to keep my head in the game here. The motivation is beginning to fall and the daydreaming continues to increase. For our final week, Hailey and I decided to challenge the surgery department. After our disastrous beginning in Durban, we had been apprehensive to go back to the surgery department. We put on our scrubs and had a choice to go into the orthopaedic theatre or into the general theatre. I’ve always wanted to see how barbaric carpentry works, so I went into the orthopaedic theatre. When I walked in, I saw the surgeon at work doing a tendon repair on a hand. She had been stabbed seventeen times by her ex boyfriend because he didn’t want to let go of her. It was sad because I could tell which wounds were defensive and which ones were inflicted unknowingly (yay for watching years of crime shows). Thankfully, I didn’t get nauseous at all. I wasn’t expecting it though because I really have an interest in it and anything beats perianal abscess drainages (there was three of those happening back to back in the other room). He introduced himself as Ernest and he was wrapping up the surgery. He took off his scrub gown and WOW what was underneath was insane. This man was built like a train. He had huge arms, shoulders, back, chest…everything. I guess you really need that build for this occupation. We watched another surgery after the tendon repair and I was really enjoying what I was seeing. After he wrapped the next one up, he turned to me and asked, “are you keen on scrubbing in on the next surgery?” Hell yes!! But then I retracted and asked what that consists of and he says just holding things and helping out.
So I was hustled into the scrub room and was taught how to properly scrub in. I walked into the operating room, hands in the air in order to keep sterile and was dressed by a nurse into a scrub gown. She asked what size gloves I am and I had no idea. I compared with Ernest and I actually dwarfed his hands. Turns out I’m the biggest size of gloves you can get, sad. After I was all gowned up, I approached the table careful not to touch anything non sterile. My first operation would be a complete ankle reconstruction filled with plates and screws. The lady fractured her foot 10 weeks ago and is just now coming in (nothing out of the ordinary). Her ankle had essentially fallen apart and had shifted to the left. Also since it’s an old fracture, tons of new bone grew erratically. We had to take away all of the new bone and then reposition the fibula in an attempt to shift the ankle back into place. We opened her up and it was quite a rush. It was so amazing because I looked around and it was just Ernest and I on the table and a couple scrub nurses helping us when we needed it. I was told to hold the retractor and put a couple clamps down. Things were running somewhat smoothly (it had been difficult to remove all of the improperly grown new bone) and we began to get the plate ready. Ernest put the plate against the fibula and asked for the drill gun. The nurse pulled out this giant drill gun hooked to an air compressor. With help from the X-rays being taken every minute or so, he began drilling into the ladies fibula. He did the first and last screws with ease. After he drilled, he inserts a depth gauge to see what size screw needs to be inserted manually with a screwdriver. Right as he finished his second screw, he looks at me and says, “your turn” and hands me the drill gun. I don’t exactly remember what went through my head; I think it went a little like “no way. YES. No I can’t. Oh my God it’s a human leg. Now is my time” so I said yea, sure. He put the drill guide into place for me and said to drill away. I put the bone-residue covered drill bit into the guide until it clicked against the bone. Then I realized this city boy has never really used a drill gun before. I put some elbow grease into it and drilled into the damn thing. Midway into the drill I realized he didn’t tell me when to stop, but I remember hearing how it went. I pierced the fibula, which took some force, and the drill went straight through the marrow like butter and then hit the other side. When I felt the drill exit the other side I stopped immediately. I put the depth gauge in, took the X ray and it was in the right spot. The proper measurement for the screw was between 14-16mm. My measurement: 14mm : ) and I repeated this procedure three times and got 14 each time. After each drill I was given the screwdriver and screwed the screw in. Under all those blaring surgery lights, I broke a sweat putting those screws in. It takes a lot more effort than I thought! I guess when you’re trying to bore a screw through some bone; it does take some intense effort. Now I know how Ernest got his massive arms.
This truly felt like a pinnacle moment in my experience here in South Africa. I couldn’t believe I scrubbed in as a first assist for an ankle reconstruction and was able to drill holes into some ladies leg. It felt so good to do it (not in a sadistic way) but I thoroughly enjoyed the entire surgery and think orthopaedics is an awesome field. Here is the craziest part of it all; the entire time this operation happened she was AWAKE and alert! She was given an epidural before the surgery began so she couldn’t really feel anything. But I’m pretty sure she can hear a drill going into her leg. Oh well, welcome to Jooste.

12 course meal with UFC fighters

May 30th, 2010
Sunday morning Gregg picked us up, our friend who owns an adventure tour company. We were going to west coast where they are known for their seafood. When he picked me up, I saw this huge bus out front with about 15 of his friends piled in. I had no idea who any of them were so it took a while to get to know everybody. Two hours later we pulled up to some beachfront that was covered with netting and buoys. We walked through this little tunnel and came out into this open area filled with grills, brick ovens, and benches sprawled throughout. This was all on the beachfront and the people were grilling freshly caught fish on an open fire. We sat down and got informed what we were getting ourselves into, a twelve-course seafood meal! He said the meals come out throughout the day and it is a self-serve method. They also are known for freshly baked breads. I could see bread being put into the brick oven to be baked. The finished result was incredible looking. We began our first course and it was just some sort of fish, I can’t remember the exact kind. All I remember was snoek (fish only found in Cape Town), Hake, Angelfish, and something with the word “stump”. When I dished myself a piece of fish with my friends, I was wondering where the utensils were. I must have looked confused because some man came over and said the utensils were right there in front of me. I looked down and into this bucket and saw the utensils. How fitting, they were emptied mussel shells. Cheap beer and wine flowed everywhere and the environment was very relaxing. Again, I’d love to take my friends and family someday. This city continues to amaze me with the amounts of activities to do. You don’t even have to be a tourist and you’ll still be able to go here whenever and have a good time. As the day progressed I noticed a lot of the conversation was about beating people up. Most of the friends were comparing one to another saying who could take on who. I asked why everyone is having this fascination with beating each other and got the strangest answer, “Oh, we’re all UFC fighters”. So I was having a 12-course seafood meal with 15 UFC fighters. They are all friends and train 5 days a week, 4 hours a day. At that point, these people became instantly cooler yet instantly weirder at the same time. I would have never thought any of them were UFC fighters but I found it kind of cool that the cute blonde girl next to me was a ferocious cage fighter. At the end of the meal, they started to make some coffee the old school way. They threw everything into a giant cast iron pot and let the coffee percolate over the fire. Towards the end they take one of the steaming logs from the fire and throw it into the coffee pot. In the end, I got the best coffee I’ve ever had… done over the fire with a smoky chicory kick.
That night I realized where I was at in my trip, the end. I was going into my final week and couldn’t believe this was all coming to an end. I was looking through my pictures on my laptop and did the whole beginning to end thing. I couldn’t believe over two and a half months ago, I was roadtripping with Jayson (who I miss terribly) down to California. Then came the Dubai pictures, I can’t believe I actually traveled there! By myself! That was the just the beginning of this journey. The pictures of my host family in Durban made me smile, and they seem like such a memory already. Time has truly flown by in some regards, but I can appreciate its duration through all the photos. Lauren left on Saturday and it was so strange because I felt like I was saying goodbye to a friend who came to visit me at home. The reality is that I will be in her position 7 days later. I think I’m ready to come home but I know will be an adjustment.
Oh ya, and another crazy revelation, I graduate from University of Washington in a week and a half. That was weird to type.

Monday, May 31, 2010

Ortho, Winelands, Table Mountain

This week at work, we went into orthopaedics. This is a field that I haven’t had much exposure to and have had some interest. Tuesday was fun because the doctor gave me the X-rays, the charts, and the patients to myself in the room for about 5 minutes. He told me to look at the X-rays and see if I can determine where the fracture/break was, what type it was, and to find the history on the patient (how he/she is doing, how the break happened, how long he/she has had the break). It was awesome to get some one on one patient time and to see if I actually knew how to read an x-ray correctly. Doctor Chivas (yes, like the whiskey) was more than willing to help me out whenever I had no idea what was going on. A lot of patients were victim of assaults, gunshot wounds, and just simple falls. What was scary was when this obese woman came in complaining of severe ankle pain. She fell in 1982 and since then her ankle has become increasingly difficult to walk on. I looked at her ankle and it looked incredibly swollen. The X-ray had just come in from radiology so I took a look at it and with my rookie eyes I knew something was not right. Doctor Chivas came in and his eyes widened. He explained that her ankle has essentially been completely condensed and crushed, leaving no ankle. It was her leg bones attached directly to her foot bones. This most likely happened because her ankle never healed correctly in 1982 and now her walking and weight crushed her anklebone down to nothing. At this point, there’s nothing we could do, except one very permanent option. The doctor offered a very expensive, painful, and major operation. Essentially, we could fuse the ankle together permanently. They would install plates connecting her foot bones to her leg bones. Her ankle would be permanently immobilized and she would be too for 3-4 months. She also has a couple kids and takes care of multiple grandkids. He tried to explain this to her pretty quickly but to me, I don’t think she really understood. But she said “my ankle hurts, so I guess I’ll do it.” I was shocked… I felt like she truly didn’t understand what Dr. Chivas was saying and thinks that it’s going to fix the problem. Oh ya and the pre-op meetings take about 3 minutes and happen right after you make the decision. It’s so much information to take in I’m sure one could lose track of everything.
After that, we went into the casting room to see how things were going on in there. We met Dr. Smith, a 75 year old retired doctor who came out of retirement just to help out the hospital while the other doctor was on leave. He was such a great guy and really knew what he was doing. These doctors here can manipulate almost any broken bone back into place. Again, South African doctors are known for their ability to see, feel, hear, and then treat and are spot on a lot of the time. We helped reduce some foot fractures and put some plasters on people’s limbs. One lady came in screaming on a wheelchair, she had fallen and had one of the nastiest fractures I’ve ever seen. Who knows how she fell but her upper arm bone had been absolutely dislocated into her chest leaving her ball joint literally floating down her arm somewhere. Dr. Smith put the X ray and started laughing, “Lady there is no adjustment, no plaster, and nothing I can do to help with this ridiculous looking fracture. Ow that looks painful.” But he did suggest a plaster around her arm to make the pain go away somewhat. That would require her lifting her arm so that they could put the plaster around it. My God she screamed like hell. All I could do was tell her its going to be ok and let out a laugh every twenty seconds. She was cussing in Afrikaans and in English and apologizing after every word. It was funny and everybody was somewhat laughing too. After she was plastered, she was laughing about the whole thing as well. It was lunch around then so we headed upstairs and had some lunch. I started feeling dizzy and didn’t feel too hungry. Then I became nauseous. Wednesday would be my last day for that week… my great health streak would come to an end. I got some sort of stomach bug for the rest of the week that kept me in bed (or in the bathroom) for most of the nights. I had plenty of sleepless night and felt pretty miserable. My appetite has been pretty much zapped as well. I tried to push through as much as I could. We hired a car later that day since we have so much to do. I didn’t go to work Thursday and spent all day in bed just trying to get better.
The girls got off early from work on Friday and picked me up. Since our time was limited we had to cross some things off our list. I was actually hungry for the first time and fulfilled one of our “must-do’s”: buy a Gatsby. Now, this is a serious meal and not for the faint of heart. This is a health freak’s nightmare and an artery clogger. We went to the Golden Dish, home of the Gatsby, in Gatesville. It was a pretty sketchy area of town, of course only five minutes from our house : ). We got more than a few obvious stares but I was determined to try this thing. We ordered a full house Gatsby and it only took about five mintues or so to make. So now to describe this monstrosity. We initially asked how big is regular, the lady help up this 2 foot long log. After seeing that, we decided to share a mini size. When we got it, it was easily two pounds and the size of a small child. Now for the Gatsby description, it’s a sandwich jam packed with pretty much anything. Ours had lettuce, some sort of sauce, steak, fried eggs, French fries, and cheese…and probably some other stuff they decided to throw in there. My appetite suddenly came back with a vengeance and I ate more than three quarters of the whole thing.
I planned on staying in that night and hoped I would get better by the next day. Justin (my host brother) was home as well and asked what I was doing. I said not too much and ten minutes later we were on our way to get Cape Town’s best milkshake. I thought it would be a good idea to get some liquid nutrition inside of me. After we got the milkshakes, we drove around the area and ended up driving by Galaxy, South Africa’s oldest nightclub. Before I knew it, we were going to go inside and check it out. I wasn’t feeling too up for it but I just wanted to power through and hang out with Justin as well since we don’t too much. We picked up his friend and went from there. I remember walking in the club and feeling completely out of place but somewhat welcomed at the same time. I got some pretty intense stares from people in the club but was also welcomed by some of the people he knew in there. Maybe because I was one of the five white people in there? I think so. The whole night I people watched and just talked with some ladies who immediately knew I was not interested. At least somebody knows now : ). The grossest part of the nightclub was definitely the hottub they had on the deck. Who knows what goes down in there or what’s festering in the water. It was a fun night overall and I’m glad I got to spend time with Justin.
After getting back around 3:45AM, I had to wake up at 8 AM on Saturday so we could do the winelands. It’s very difficult to wake up early in the morning to go drink alcohol after having some the night before and not feeling too well either way. This was one thing I wanted to do since I’ve been here so I refused to cancel this trip. The winelands are only 20 minutes or so outside the city making it very convenient to get there. Our first stop was J.C. LaRoux, Hailey’s favorite champagne here in SA. Stellenbosch (wine town) is very picturesque, with grapes growing all along the countryside with Table Mountain towering above them. SA’s speciailty is red wine, btu they also have some great whites and sparkling wines. We sat down and started trying all different types of sparkling wines. I learned how to open a bottle of champagne with a sword and plan on doing that upon my arrival in the States (with a butter knife or something though). I tried to appreciate all the flavors they told us about in the sparkling wines, but I’m just not the biggest sparkling wine/champagne fan. After J.C., we headed to Waterford. This estate was beautiful and was my favorite of the whole trip. It had a very Mediterranean feel to it and were famous for their chocolate and wine pairings. Tastings are relatively cheap here and the quality is amazing. We went ahead with the chocolate and wine tasting and we were presented with three wines on top of this engraved wooden block with 3 pieces of different chocolate. There were two red wines and a dessert wine. The first chocolate literally had flowers in it, the second was sea salt with a dark chocolate, and the third one was too gross to even identify. The red wines were very good, the dessert wine was disgusting…too sweet for me. I purchased a summer wine I had tasted before the chocolate pairings, and walked away a happy and boozy customer.
From Stellenbosch, we drove to Franschoek for some lunch and well..more wine. The third winery was all about the view, the wine was a little sub par but nevertheless still good. All the superb bottles of wine at most of the estates were about $8.00. I wanted to stock up but I definitely didn’t want to go overboard. Charles Shaw/ two buck chuck won’t ever taste the same after this experience… At the end of the day, I could not even think about having another glass of wine. I probably smelt like mom’s kisses but hey, its all part of the experience.
Sunday morning began with a generally sunny day. There were some clouds in the air and not too much wind. It was an opportunity to do Table Mountain. We drove to the foot of the mountain and saw that the cable car was open. However, Lauren and I decided to hike up the mountain and take the cable car down. Little did we know what we were about to get ourselves into. The beginning of the hike was pretty brutal, straight uphill and a bunch of boulders put together that we had to climb up. We thought it had to get a little better from there. But that never happened, in fact it only got worse. We literally hiked above the clouds, straight uphill on rocky, unstable, and uneven rocks. It took us about two hours to get to the very top which is pretty good timing. My legs were shaking and I was completely out of breath. I drank my entire water bottle and was planning on filling it up once I got to the top. The view from the top was amazing, even though clouds started rolling in. The wind was picking up as well making the clouds fly over the mountain. I found this little rock projection with a great view of the ocean. After that bungee, I thought scaling a little rock projection that has a cliff on all sides would be a walk in the park. Of course once I got to the tip, the wind started blowing like crazy. For a second I thought I was going to be blown off and die down Table Mountain. After getting my daily adrenaline fix, we headed to the cable car, café, and bathrooms. As luck would have it, the cable car closes due to the wind unexpectedly. Now were trapped up Table Mountain with no desire to climb back down. I hadn’t eaten anything in a while plus I needed to refill my water bottle so we headed to the café for some food. Except there was a problem, it was closed. Why the hell is this place closed? I was STARVING after that grueling two hour hike. It felt like nobody else was up there with us. Lauren then had to go pee really bad, we headed down the steps to the restroom. LOCKED!! So now we are stranded on top of some mountain, with a closed cable car, a closed café so we couldn’t refill our water bottles, and closed restrooms for one god awful reason or another. There were no phone numbers, no employees, NOTHING to even give us a clue as to when the cable car would reopen. Now I was getting frustrated, thirsty, and hungry…not a good combination. Abiding to the laws of physics, what goes up must come down… and that applied to us. Jumping off the side of the mountain sounded appealing but I at least wanted lunch so we went against our will and began the long and painful decent. We thought maybe going down would be easier? WRONG again! Going down was much worse than going up. Since the surfaces are so uneven and steep at points, this was a huge strain on the knees. It hurt after a while and when you see how much you have left (~2500 feet all downhill/uphill), it can get depressing. I slipped a few times since my legs started to give out. I don’t think we really stopped, we were so determined to get down. Whenever we stopped, our legs would begin to shake and get weaker. I lost track of time but eventually we reached the bottom. Now to quote everybody else’s foreign blog entries (Paola, Bryan), that was the hardest hike I have ever done in my life. No picture can capture the sheer height, steepness, or difficulty this hike contained. I literally climbed a damn mountain, and coming from the 12 year old kid who complained of the concept of walking uphill for no reason, it was a big accomplishment. I did a 12 hour hike one time, but it was a pretty easy hike. I scaled the side of the World Cup stadium in Durban. Hell they were both nice strolls. Those two hours uphill and then back downhill kicked my ass. I was sore for five days after and avoided stairs and all things inclined during that time. I felt pretty accomplished a couple hours after we were done (I was still bitter over the closed bathrooms and water refilling station).

Monday, May 24, 2010

Adrenaline WeekEND continued-Garden Route

Soon enough, the weekend rolled around and it was to be an exciting one. We had the opportunity to drive along the Garden Route with our program coordinator and medical director, Marion and Avril. The day started with an alarm going off at 4:30AM. Somehow, I stumbled into the shower and did my thing. As I was drying off, I put my finger over my ear lobe and noticed something was missing. My earring must have fallen off I thought but it was really sore. I felt the backing of my earring still in my ear and then I got worried. Upon closer inspection, the ear lobe was bleeding and swollen. I probed at it some more and lucky for me my earring was still in….inside my ear. Somehow the stud went inside my ear while I was sleeping. Feeling pretty shocked, I phoned Avril and told her the situation. She told me not to worry and we’ll figure it out. Sure enough, I got picked up at 5AM and drove 30 minutes to Marion’s house. At her house, she busted out her medical kit out the back of her car and she started inspecting my ear. Without warning she yanked on the backing that was in still lodged in the back and pulled out the entire thing. Yes, it did hurt… but it felt good to be out. Finally, we were on our way to our 3 day adventure.
The drive was pretty (after 730AM that is, it was dark before then). I was also falling asleep intermittingly. We stopped for breakfast at the Country Pumpkin honestly in the middle of nowhere. The breakfast was delicious of course. A couple hours later we arrived at the Cango Caves. We were able to climb through caves in a ninety minute tour. Some of the caves had super tight squeezes. The worst one was definitely where we had to crouch and walk for like a minute straight. Other tunnels included the tunnel of love where we had to walk side by side, devil’s chimney (I thought it was the best one, consisted of climbing up this really tight tunnel 5 meters high), and the letter box where we had to slide through it on our stomachs. After climbing out of there sweaty and smelling like hot cave, we headed to an ostrich farm (duh what’d you expect?). As we began driving, we noticed the mass amounts of ostriches in this town called Oudtshoorn. It soon became an ostrich extravaganza. EVERYTHING in this place was ostrich themed… the restaurants, cleaning supplies, lifestyle, meat, and many more. Eventually, we pulled into this place and sat in on an ostrich lecture…hmm. The lecturer held up a pellet and told me since I’m the only guy that I have to kiss the ostrich. Eff are you kidding?! These things are gigantic and dumb as screws. I really had no desire to do this but I don’t think I had a choice. We proceeded into the ostrich holding area and he shoved me into the pen and told me to put the pellets in my mouth and close my eyes. Betsy then bolted over to me and nipped the pellets out of my mouth. Like the dumb bird that she is, she missed twice and left marks on my face. It was something bizarre and slightly unmemorable. Let’s just say it was a one time only thing. Since Hailey didn’t feed or kiss the ostrich, the guide demanded that she ride first on the ostrich. How they wrangled the ostrich was another thing. First off, ostriches are absolutely retarded. If you look at one you can see how tiny their head is, inside their head must be a brain… putting it together, ostriches have brains the size of a peanut. Anyway, the wranglers go out into this ostrich confinement and they start going crazy and running. Given that they’re all dumb as hell, all you have to do it put a blindfold around the ostriches head and it thinks they’re all alone and nobody is around them. Once they did that, the ostrich stopped running around and panicking. They guided it back to this horizontal A-frame looking thing and Hailey had to straddle the ostrich reluctantly. They lifted the wings up and she sat on top of it and began to scream. Suddenly the removed the blindfold, the ostrich backed up, and they just threw her into the confinement and the ostrich ran like crazy. She lasted only a little bit but it was the funniest thing I’ve seen in a while. She ran over to Marion and Avril and cried in their arms in sheer terror.
I was up next, and soon we were realizing we were the only ones doing it out of the entire group (there were some Dutch and Italians with us). Again, I straddled this ugly monstrosity and it just backed up like it was nobodys business and took off. The video is pretty funny and is also on Facebook for everybodys enjoyment. The guy shaked my hand afterwards and told me I did a really good job. I guess I lasted a long time? Or maybe owning an ostrich farm is my true calling. After that we drove a long time until we hit out hotel in the town of Wilderness. Creative huh? We went out to dinner later that night and had a good time with Marion and Avril. When we came back, the three of us opened up a bottle of J.C. La Roux champagne and partied in the room.
The next morning, none of our alarms went off for some reason, so we woke up and had to eat breakfast in five minutes before taking off. During those five minutes, we received some sad news. Avril received a call when we got back from dinner to let her know that her mom has just passed away. It was a pretty devastating blow but she had been suffering for quite some time now. It was all a matter of time before it happened but it was sad that it happened that day. Avril insisted that we continue with the trip after we offered to go home early. The whole day was to be filled with crazy things to do but it was definitely bittersweet. The first stop was ziplining. We were able to zipline through some pretty tall canopies. I’ve always wanted to try it, so it was awesome that I got the opportunity to do that. We got lunch after we returned and we had to take it to go because of time constraints. As we started eating our lunch we asked what was next. Marion turned around and casually said “bungee time”. We all looked at each other, then at our lunches, and then quickly put it away and began to panic. I had been dreading this moment since even before I came to South Africa. Thirty minutes later, we saw the bridge that we had seen online and my stomach felt like it dropped 216 meters. We pulled into the place and had to rush to get registered because this giant Indian tour bus pulled right behind us. We were harnessed up and then were told to wait for 30 minutes or so. I walked over to the viewing platform across the way from the bridge and looked down. It was HUGE. No picture, no video, or anything can really put into perspective how absolutely gigantic this drop is. A bungee-er was about to jump (or be thrown) and I decided to watch it. Big mistake. I could barely even watch it since I began to put myself in that body flailing around. The person dropped so far it felt like it never ended. A canyon surrounded the bridge with a stream leading out to the ocean down below.

Eventually, it was time to walk out to the bridge. Since the bungee platforms are slightly below the bridge, they needed to construct a tunnel to get us over there. This walkway had a hollow grated bottom… so as we were walking we could see what was down below. It was already terrifying and only making the pre-experience worse. Finally we got to the bridge bungee platform and the music was playing which eased my nerves a little bit. They instructed us how everything works. The order we signed up for was not necessarily the order we will be jumping. It all depended on what cable was attached at the time, so it went according to weight. The guy held up the clipboard to his face and was like “hmm… ok let’s have our first jumper be…Miles”. Out of our group of twenty, I get to go first. Lovely. Going first on these thing carries a big role of making sure you don’t screw up. I started to get strapped up…which took a whopping 20 seconds because it consisted of simply strapping on a little booty. Phew, glad this nifty booty that’s been used thousands of times is going to keep me from falling 708 feet to my death. I remember looking behind me and seeing everybody’s faces. Most of them had their hand over their mouth. Hailey and Lauren were genuinely concerned and Hailey even began to get tears in her eyes. Soon enough I stood up and the crowd started cheering for me. I was helped/hobbled over to the platform where I had to stand at the very edge of the bridge with my toes dangling off the edge! That was by far the scariest part of the entire process. I gave a wave to Marion and Avril who were hopefully watching from the viewing platform at one side of the canyon. If not I just waved to nobody. The people behind me started to cheer, which was nice and encouraging. The wind would gust at times and when you’re standing at the edge of the bridge you either want to jump prematurely or run back to safety. But they spreaded my arms out like a damn eagle and before I knew it, “5 4 3 2 1 bungee!” and all I remembered from our mini orientation was to jump out… so I did just that… I jumped like a crazy man. I honestly didn’t know what was going on at first. I remember it being about 7 to 8 seconds of flat free fall. That feeling of your stomach in your throat and feeling of self-implosion. I flung back up and down again which was another huge drop. That hang time between the first and second drop is pretty awkward and long. At that point, I realized what was going on… I had just jumped off a 708 foot bridge attached to a stupid cable that I put my life on the line for. But instead of being mad, I became high or something. A feeling of complete euphoria came over me and I just relaxed and enjoyed all that this jump had to offer. I was completely alone bobbing around in this canyon, I remember hearing my echo and thinking how cool this really all was. After having that little moment, I realized my head wanted to explode since I had been dangling there for what felt like forever. My eyes felt like they were bugging out of my head and I’m sure I just looked like I had been asphyxiated. It seemed like an eternity before this guy came down and began pulling me back up. Eventually I was getting pulled back to the bridge and right as I was pulled up, Lauren had jumped off (she was the next person on the other cable. Hailey was 15th or something). Apparently Lauren had grabbed onto the guy during the first countdown with a death grip. This girl managed to jump even with a fear of heights. I was placed on the platform and the guys played a trick on me and almost threw me off again. When I was released from my straps everyone came up to me and congratulated me and asked how it was. They also told me I had red dots above my eyes and also that they were bloodshot. I saw a reflection in a metal bar and saw that I got patikeye which are essentially blood vessels that exploded. You can see them in autopsies when people have been strangled to death. But I guess I can get them while bungee jumping. Nobody else got them so I have no idea what the hell was up with that. Hailey continued to have tears in her eyes and apparently screamed when I jumped. I couldn’t believe I actually did that jump, after all the nauseating YouTube videos I watched… I finally did it. Overall, I think it was a once in a lifetime experience. Even though it was a crazy feeling, once is just fine :)
After that exhilarating experience, it felt like everything else to follow would be just so calm. But I think that would be fine considering that was enough adrenaline to last me for a while. Up next was the Knysna Elephant Park. When we got there we sat in on a little elephant movie and then hopped in a tractor and was lead to the elephants. Right as the truck pulled up, the elephants immediately knew what was going to happen. They rushed over and seemed very happy. They all got behind the little post where they belonged and we were able to feed them. Of course you get your selfish elephants that try and steal every piece of food that’s put out. I tried to help the less fortunate ones but those trunks can ambush your bucket in no time. Also I had a runaway elephant reach from behind and steal some fruit. It was quite scary to turn around to this massive thing reaching in your bucket. After that we were able to mingle with the elephants like they’re our buddies. They didn’t mind the company at all and were able to be touched by us. Definitely not everyday you’re able to just hang out with the elephants and touch them...or hang on their tusks. The day didn’t end there, after that we drove and went on a sunset cruise around the bay. We were all able to catch up on the day and see how everyone was doing. It had been a long and rushed day. Avril was in good spirits despite her loss this morning.

Adrenaline Week-Casualty Department

This week in the gangyard, we were going to be put in the forefront of the action, the casualty department. Here we get the emergencies, walk-ins, referrals, and the infamous wheelbarrow dumps. Since Jooste caters to most of the townships, not many people have cars and transportation. If somebody was to get hurt, they put the victim in a wheelbarrow and rush him or her to Jooste and literally just dump him or her there and hope that somebody will help them. I was very nervous to work in this department at first. I was actually dreading it. Given my previous experiences in Durban, I didn’t know if I could see all the stuff all over again. When we walked in casualty, sure enough we were met with chaos. The doctors were all over the place, but eventually took the time to introduce themselves. They are always on their toes, know how to act resourcefully, and most importantly remain calm. The sisters were fantastic, probably the best I’ve worked with since my time here in SA. They were all so friendly, so enthusiastic, and quick on their feet. Within the first hour, somebody died from a stab wound to the pelvis. Wow that was quick. The environment of the casualty department is very quick and dirty. They have an extremely high turnover rate, crushing any U.S. turnover rates. When patients come in, they are triaged, and hopefully sent to one of the wards after coming through casualty. We basically just followed some doctors around and met two 5th year medical students, Jon and Kamlin. They were awesome guys and were a great source of information. Luckily, they were rotating in casualty that week so we would stick with them the rest of the time.
Later on that day, a guy came in with severe shortness of breath. He was panting pretty hard and the x ray showed he pretty much had one lung left. He had full blown pneumonia that had gone untreated for weeks. He was put in the resus (resuscitation) room where we tried to control his breathing. Nothing was working so we put a tube in his throat so we could breath for him. I could tell he was in a lot of pain and panicking. As he was getting ready to get tubed, the doctor told him he would be knocked out for 2 days and that his wife already knows about it and said it was fine. He died later on that night due to too much fluid in his lungs. In one day, there were already two deaths in the unit. Needless to say it was quite an action filled day. Strange thing is… I wanted more.
Wednesday came around and the casualty ward felt like a mini psych ward. Due to the massive tik (crystal meth…is this where Tik Tok came from? Nice going Ke$ha) problem here in Cape Town, we get a lot of psychosis. It is not uncommon for an 8 year old to become addicted to meth here in Cape Town. It’s readily available in schools and around the townships. Overdoses are also pretty common and we saw our fair share of them here in casualty. Most of them are suicide attempts by the younger crowd. Eventually, they just get charcoaled (real charcoal that’s shoved down a nasogastic tube into the stomach in order to bind all the toxins so they don’t get any further…gross stuff), vomit, and are released. One of the sad cases was this 19 year old girl who OD’d on heroin, meth, and cocaine. She screwed up her body so bad that now she is mute. She just had a child a couple weeks ago and obviously its in the wrong household. The doctors were able to talk about taking the child out of the household and put into foster care right in front of the mom. All she could do was look around with this clueless smile on her face. After seeing her, I kept hearing this noise that sounded like MAAAA!! It was getting quite annoying. Eventually I found out who it was. It was this woman in her 30’s who overdosed on insulin. Now overdosing on insulin highly fatal especially if you’re not a diabetic like she was. We have no idea why she decided to take insulin, maybe she thought it was a different drug. What happened though was essentially all of her glucose in her body was depleted. When the brain has no sugar, it begins to die. Somehow, she took just the right amount of insulin to survive. Now, her brain is just a piece of matter that continues to deteriorate. She has essentially reverted back to a 4 year old and has no idea who she is, where she is, or what she’s doing. Every 2 minutes or so she gets up and tries to escape the ER. Security then has to go retrieve her and bring her back in. It is then where she starts screaming and sometimes falls on the floor. She has to wear a diaper because she has no bodily function anymore. It’s sad to see it happen all the time, but why she remains in casualty to this day is beyond me.
As the week persisted, my interest for emergency medicine continued to shock me. A doctor asked me to put up a line and draw some blood. Since I had no idea how to do that, I asked her if she could teach me. Thankfully, she was very willing to do so. I was expecting just to watch her do it and then maybe I’ll help collect the blood. She handed me the needle was said to get comfortable. She pointed towards a vein in the wrist and told me it’s all about feel. What the hell does that mean? I looked at her one more time for assurance and said it’ll be just fine. I took the needle and went straight for the point of convergence. Sure enough, she was right, it’s all about feel. I could feel the needle enter the vein and I was able to set up the entire line and draw some blood. Yay for accomplishments right? Back in the resus room, there was a guy with badly beaten appendages. He had been a victim of a community assault. In the townships, when rumor goes around that somebody has committed something bad in the community, they have a “community task force” that takes crime into their own hands and retaliate against the suspect. They use long, elastic, and plastic white batons to beat the person but never to death. Since they are elastic, the plastic turns into a very hard whip. A group of 6 people or more usually ambushes the person. This guy was beaten pretty badly and he couldn’t move most of his body.
I remember taking a moment and looking around the room, there were people crawling on the floor, crying, bleeding, coughing, and just had the vibe of a miserable place to be. There were dead people being wheeled in and put into an empty patient “room” that has been partially curtained off. That environment never goes away but it also rewarding to know that you have saved someone’s life long enough to get him or her to a specialist. I know now coming away from that week that emergency medicine was that hidden passion I didn’t know I had. I remember challenging myself before I came to South Africa to go to a department that I really had no previous interest in and see if my perception changes. Fortunately, I can say I have completed that goal.

Cape Point Drive

After our accomplishing moment, we hiked back to our car. The weather was getting pretty hot at this point but we loved it. The entire workweek was rainy, windy, and cold so this was a well needed change on such an ideal day. We wanted to drive to this beach we saw from Cape Point. When we arrived there, the dreaded baboons greeted us. We were scared to get out of the car since they can hop in the car and steal all you have. Some guy with a bat was chasing them away so they eventually left the area. However they came back not too much long after this time with the whole damn family. We couldn’t even go down to the beach we wanted to go on because they were blocking the pathway. The baboons started hopping on some cars and the little ones found some fun out of a surfboard that was on top of a car. They played see-saw and jumped on one side to bounce the other side up. These people tried to get into their car but the baboons quickly came to the driver side and swiped their hands from the handle and tried to open it. Luckily it was still locked. It was amazing how quick and agile these baboons are. They are also not afraid to come near people (obviously). Finally the hero with the cut off jean shorts came around the corner and scared them off with his bat. The baboons just transferred onto another car and the head honcho baboon was eyeing us. I took one step towards the car and it lunged on top of my car and tried to open the car door. It eyed me the entire time and followed my every move. I tried using my car alarm but it didn’t even make him flinch. Finally, the cut off jean hero came to save the day again and made some gorilla noise with the bat in his hand and scared the entire family off in time for us to hop in the car and take off. So, my advice to people visiting Cape Point, the baboons are REAL.
We left the reserve laughing in complete shock that a baboon family almost shanked us. We continued to drive, now on the Atlantic side. We heard about this “local” beach called Noordhoek. We had lunch there and then headed to the beach. The beach was very nice, and seemed pretty untouched, and the sand was white and soft. We saw this cool picture opportunity on top of these rocks that were accessible when the tide receded. Eventually, we all made it on there and began taking some pictures and were waiting to hop on the next rock. Sad thing is that the tide never receded again. We started noticing our pathway of opportunity was never reappearing. The water level on the rock started to rise and it became very apparent that we were getting trapped. Waves started crashing into the rocks and the situation became scary for sometime. Nobody touches the Atlantic side, the water is ice cold even in the summer. Somehow, we managed to maneuver our way to the beach with minimal damage.
The sun was setting and we needed to get to Chapman’s Peak before sundown. We saw a sign for a winery and decided to pull in and grab a bottle of wine (with some free tasters of course : ) ). We continued with wine bottle in hand and made our way to the peak. This part of the drive is rated the most scenic drive in the world, and they were not exaggerating. We were so close to the cliffs and there were so many bays with waves crashing into them. Eventually, we saw the touristy sign for Chapman’s Peak. Eh why not, we pulled off. There were some seating built into the peak with people starting to file in. We sat along the railing when suddenly this girl with robin hood green felt shoes hopped over the railing and scaled down the mountain. She disappeared for a while and reappeared. I asked if she is staying down there for sunset and she just waved me down. We followed her down and when we got to her she whispered “Cape Town secret, don’t tell anyone”. She pointed behind her and we saw this inlet in the mountain that looked like a cave. It was the coolest thing I have ever seen. It was a perfect spot for the sunset, away from the crowds, and unobstructed views of the bay. The sun began to set and we popped open the bottle of the wine and enjoyed all the pretty colors. It was one of the prettiest sights I’ve ever seen. A lot of the time I was thinking how awesome would it be to bring all my friends to see this (one in particular : ) ). The sun disappeared as quickly as the wine did and then it was time to go. It was the perfect ending to such a perfect day. I don’t think I’ll ever forget that day. It was a true T.I.A. moment.