Apathy

April 15th, 2010: Day 4 of surgery at King Edwards. After a chaotic day yesterday, Hailey and I went in with high hopes for a successful day. We headed up to the surgery ward and ran into some interns we had met from yesterday. They were just ending rounds and were about to split up. We stayed in the female section of the ward for the first half of the day. The intern needed to remove some sutures from the eyelid of this lady who just had surgery there. He asked for our help because she previously aggressive when they were trying to examine her. The nurses said, “I don’t want her to hit me again!” I looked over at the bed to see this old woman curled up in the fetal position. She looked like she could go Exorcist on me at any moment. Luckily, she wasn’t too bad. She was an old woman in pretty bad shape however. She couldn’t speak and had scars all over her body. I think she was mentally disabled as well. Curious, I opened the chart and started looking at her information. What I read was pretty horrifying. The first line I read was “Bushknife assault”. This woman had scars all over her head, body, legs, and face. The assailant had attacked her with a bushknife so savagely that it fractured her skull multiple times and caused her to have motor impairments on her left side. Her vision was deteriorating and she was just somewhat mindless. I continued to read in the chart and came across the following line “Son attacked patient with bushknife”. Her son apparently acted out of complete rage and slashed her all over her body to the point where she was incapacitated even further. It was pretty sad stuff to see, but these kinds of attacks are somewhat common in this area.
After caring for her, we checked on in the woman with cellulitis. She has been improving since the previous day. It was kind of cool to finally track a patient for more than one day and see some progress. As I rounded the corner to check on the next patient, I saw a familiar face that I thought I would not see again (nor would I want to). She turned over and saw us and gave us a friendly wave and said hi. It was the hemorrhoid woman from the gynie clinic. She had been transferred to this unit for some reason and here she is again…. hemorrhoids popped out for the fourth time. The doctor told us that he was going to try and push them back in again. This would require her being knocked out again and going through all that pain. Even better, we were the only people in that ward who had witnessed the surgery yesterday so we had to stay and tell them if the hemorrhoids had gotten any better. The patient had such a good attitude going into this whole thing, she was joking to save the anesthetic for after the procedure was done. So the procedure happened again, but this time I stayed pretty alert! I did not get queasy at all and was actually able to assess if they had gotten any better. I stayed with her until she woke up and felt just dandy. I wandered around the ward after that trying to find something to do or see. I was feeling pretty good and somewhat involved at this point. I saw the curtain pulled around this bed and decided to take a look. The nurse was taking off the dressings off a wound that spanned this woman’s back. I saw her carefully pull back the dressings to see these huge what looked like burn marks. I asked what happened and she got into a nasty car accident with one of those taxi buses (very common) and she got ejected onto the road and what was on her back was road burn. Ouch! The nurse then put some ointment on her back with a popsicle stick and it did not look like it felt good at all.
The next patient was downstairs in the high care unit. I was guessing that it would be some sort of anal problem. Well… wouldn’t you know, I was right on the money. We approached this lady who was definitely afraid of doctors. She had this terrified face on her and was apprehensive to let anybody touch her. I grabbed her chart and took a look. Eight days prior she had her sigmoid and rectum entirely removed because she had cancer in that area. She hasn’t been able to move this entire time and consequently developed bedsores. Further, I think she was pretty embarrassed, I could see it on her face.
Coming away from that patient, a doctor pulled us aside and just started talking to us and asking why we were here and how South Africa is going. He was very interested and engaged in the conversation. He gave us some an awesome opportunity at that point. He gave us a patient for ourselves. He emphasized the value of examining a patient and trying to see what’s wrong without the patient telling us how he/she is feeling. He gave us this man with a head wound and told us to examine him and see what special signs he is displaying. The doctor left the room and left us with this man who could barely speak. He had a pretty sweet laceration across his forehead and was pretty disoriented. I asked him to wiggle his toes, follow my hand, and see if he could feel my fingers on his foot. I noticed he had a left side motor skill deficiency among other things. The doctor came back and we reported our findings and we were right on with the majority of our findings! He was pretty impressed with us and continued to explain his condition. The patient had been hit over the head with a spade (South African for shovel) by his amigo. They were both drunk and now this guy has a pretty severe sub-arachnid brain contusion. Apparently his friend who hit him over the head brought him in…arm in arm laughing about the situation not knowing how severe it really was.
I know the previous couple of days have been somewhat brutal and frustrating for me. Whatever the case, I am enjoying my time here and soaking up the experience. Within the past few days especially (Friday went very well too, just to foreshadow), I really have enjoyed my experience on the jobsite and I’ll continue to have my positive can-do attitude there and then try to untangle my true feelings on here. I know it’s coming off as if I’m complaining most of the time, but let me just put this out there. When I write these blogs, they are uncensored, unedited, and sometimes not pretty. I write down how I’m feeling as raw as I can so the people back home can get a sense of what it is like over here. I am well aware that having the opportunity to experience something like this is rare. Directly, this experience is not pretty, it’s not glorious, and it’s not easy. I am not here to check little childrens' heartbeats, put band-aids on minor cuts and scrapes, or dangle little toys to help keep kids from crying. There is no time, no resources, and no advantages to doing such things here. The theme of healthcare in South Africa as one doctor put it kind of goes like this, “One thing the South African healthcare system teaches you is apathy. You appreciate and learn it because if we didn’t have that ability, there would be no doctors in South Africa.” Indirectly, when I arrive back home, I will be able to realize what exactly I have back home and how much of a valuable experience I just had. I love this continent and this country; this is one of the reasons I have returned. Obviously I am not on a 20 day safari, I am not getting serenaded by Zulu dancers with a gin and tonic in hand, and I’m not getting a detailed guided tour of everything beautiful. I returned to see the other side of Africa and work within its constraints. With that, that edited version with smiley face stickers can't be found here.