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.

Culture Shock Round 2-Cape Town

Obviously it has been a while since I’ve updated my blog. Reasons being that I don’t have as much time as I did in Durban amongst other things. Either way, at least I’m getting to it now rather than never : ) . I just want to start off and say how much I love Cape Town. Upon arrival, I immediately fell in love with the city. It is totally different than Durban. The climate, people, language, and overall vibe of the city is just different. Again, I felt the culture shock slap me across the face. Hailey and I were greeted ecstatically by our program and medical directors, Marion and Avril. They ran up to us and gave us a big hug and welcomed us to Cape Town. Immediately, I felt welcomed and a sigh of relief came to me. We drove to Avril’s house for orientation and were initiated via a song named “Welcome to Cape Town”. How fitting. We were sitting on the outdoor/indoor entertainment area. The sun set and instantly it became freezing. This is very typical of CT, when the sun sets, the temperature begins to plummet. Table Mountain towers over the entire city, wherever you go it just towers over everything. Again I saw the clear divide between success and poverty, more so than in Durban. During Apartheid, families of colour were forcibly relocated to an area called the Cape Flats. It is a massive area containing millions of people in townships and neighborhoods. This is where my homestay is. I live in an area called Athlone, a coloured neighborhood.
I met my family and right off the bat I can tell its completely different. The mom Carol is very nice of course, and the dad George is a riot. The first thing he told me is to make sure the cops don’t bring me home if I’m too drunk. This is also the family that has been with the program for the longest of any other family. Another thing they emphasized was my availability of privacy. I didn’t have too much in Durban since the boys or Sibongile would come in at their leisure. To be honest, I didn’t mind it at all. Actually, I kind of liked it. Either way, it was just very different. But the best part of all, was that the family has a SHOWER!! I was so excited to finally shower instead of taking a bath. After taking baths for 5 weeks straight, a shower was the closest thing to amazing. Dinner is also very different, this family is very independent and you can have dinner at your leisure and it’s never together. Again, no big deal, I am here to live with the family and how they run their lives. I’m not expecting anybody to change the way they live their lives for me. Also in the family, there is three year old Mikayla. She lives with Chantal who is the daughter in-law in a separate part of the house. I see Mikayla all the time and she is cute as can be. She loves to play…a lot. Whenever you ask her how she’s doing, she responds “fabulous”. Diva in the making if you ask me!
That night, Ryan (the previous intern that would leave the next day), Hailey, Lauren, and I went to Camps Bay for dinner. Having no idea what to expect, I was quite curious. My oh my was I in for something completely unexpected. After a 15 minute drive, we pull up to this immaculate, beautiful, palm tree lined, luxurious, amazing waterfront filled with restaurants. You could drop me in Newport Beach and I wouldn’t be able to tell the difference. I couldn’t believe this was Africa! I got out of the car with the strangest look on my face. I was thinking what a transformation this is from where I had just spent 5 weeks in. Also, the raw amount of success and money that’s apparent in this part of town is just astounding. It is common to see a Ferrari roll down the street and nobody attack it. We had dinner at this place called Blues. We were sat down by this lady with a seductive dress and were given luxurious blankets to keep ourselves warm. What the hell, where am I?
Monday morning rolled around before we knew it and it was the first day of work. I ate breakfast and got picked up by our new driver, Uncle. He strictly goes by Uncle and nothing else. Another thing about him, he is EXTREMELY punctual. Since I’ve been here, he’s apologized for being late one time by three minutes. If I remember correctly, three hours late was OK in Africa time. Anyway, we were driven about 5 minutes to Jooste Hospital. This would be the hospital I would stay at for the entire duration of my rotation. Now Jooste has quite the reputation. It is situated in between Manenberg and a couple other gangster towns in the Cape Flats. They have a huge patient population that overwhelmes the hospital all the time. As a result, the hospital has suffered. Jooste has become the Friday night hangout for stabbings and shootings. Also, it’s been deemed the hospital where all hope goes to die. If you have a staggered chance at living, just don’t go to Jooste. Barbed wire and tight security surround the hospital and for a good reason. When word gets out that the person that got assaulted survived, the assailants would ambush the hotel, run to the ward, and finish the victim off.
We were taken to Estelle, the hospital program coordinator at Jooste. Right off the bat, this program seemed very organized. We choose to rotate at the infectious disease clinic for the week. When we arrived there, we were split up and we all had our own doctor. My doctor, C.J., was an amazing doctor. He was young, just completed all of his schooling, and was able to communicate effectively with his patients. I admired all that he did throughout the week. Most of the week consisted of seeing HIV and Tb patients. Overall, it was a somewhat low key week. We would go on rounds on Monday and Thusday with the doctors. I remember one moment in particular however. During rounds on Thursday, we were in the women’s ward attending to some patients. They were examining this very sick woman with meningitis, HIV, and Tb. She has sputum and blood coming out of her mouth and did not have a mask on. I had to stand back from her because it just looked like a whole lot of contagiousness going on. Right next to me looked like a bank vault door. It had a sign on top of it that said “isolation”. I had been by there earlier and the door was shut, abiding by common sense and protocol. This time, with the meningitis and Tb spewing woman to my left, the isolation door was wide open to my riiht. I glanced over at the isolation charts lying on the table, highlighted in pink highlightier was MDR-TB. Awesome, multiple drug resistance Tb air drafting right at my face and I couldn’t really move anywhere. At that moment I realized that I hadn’t seen anybody really throw up. So that made me somewhat happier so I moved closer to the meningitis woman who had just been given a mask. No less than thirty seconds later, she starts vomiting through the mask. I felt so trapped and felt like I was getting hit from all angles with all sorts of dangerous aerosols. I’m hoping I don’t get exposed to Tb (long shot at this point) because if I test positive even as a carrier in the U.S., I have to be put on antibiotics for 9 months to a year. Those medications come with its side effects and eliminate the ability to “party” if you know what I mean. Personally, I think this is insanely overboard for the U.S. (you can’t pass on tb if you’re a carrier), but hey it is the U.S. afterall. From what I’ve observed so far, it is the land of the overly paranoid and wasteful. This is definitely something I’ll take back with me. I hope I can go back and only utilize the resources I truly need and not waste them on uneccessary precautions (i.e. the Tb medication, spending millions of dollars on research for something that happens 0.00001% of the time).

Tuesday, May 4, 2010

Brangelina Day

April 28th, 2010: Today we had went to visit an orphanage about 30 minutes outside of Durban. Today we also experienced “African Time”. We left the house around 7 and got to the bus stop at 7:40 to catch a 7:50 shuttle. We were informed that the bus is on the way and it should be here shortly. The shuttle was just going to take some sisters, Hailey, and I to the orphanage directly. 7:50 came and passed, so did 8:15, so did 8:45, 9:15, and yes even 9:30. Where the hell is this bus? Maybe it was a horse drawn carriage. We kept trying to keep ourselves occupied but a rock hard wooden bench can only be comfortable for so long. The lady behind the counter leaned over and apologized for the delay, “It’s the day after a holiday, it’s always a little hectic”. I didn’t know driving a car could be so hectic but hey whatever. I never got mad or anything, I actually thought it was an entertaining experience. Finally, we got picked up and headed off.
When we got there, we noticed that it was another Islamic compound. Every place we’ve been to in the past few weeks has been of Islamic influence (although some of the implications can be classified as brainwash). We got a tour of the place, fully equipped with prayer rooms and the whole shebang. I wonder if the kids are forced into this religion and what happens if they don’t conform while they are there. We eventually ended up at the ABC, a nice name for Abandoned Babies Cottage. Oh my God I felt like Oprah. A whole swarm of kids came running up the hill with their hands in the air screaming. We put out our hands and got about 90 high-fives from 18 kids. They were playing around on their tractors and tricycles doing their thing. They wanted to get pushed around and be picked up after a while. One boy gravitated towards me immediately. He seemed to be running the orphanage with his rambunctious attitude. Luckily, I liked him a lot too. Every kid cried like 5 times when they got in a fight over a tricycle or tractor. At one point, I had about two and half kids crawling all over me, all of them wanting to touch the ceiling or just be held or take a picture. For those of you who know my passion for kids (FYI, the word passion can be used negatively), you would think I would have lost it. But I really enjoyed running around and playing with the kids. Especially when I would hold them upside by one foot. It was the one really hot day in Durban we’ve had in a while and of course we would spend it outside. I was working up a sweat pushing three tractors at a time and throwing kids in the air. Also, it was a disaster to wear a white shirt to the orphanage. I got pretty filthy with the kids’ dirt, blood, sweat, and tears. They operate in a cascade, once one kid does something, the rest all follow. So if one kid threw dirt in my face, I would get 20 more. Eventually, I was worn out and went back up the hill for a break (this would constitute a tea break). While having our tea, we realized how nice the definition of a break is in SA. I actually felt rejuvenated having tea, cookies, and spending time reflecting what just happened. It was much better than booking it to Starbucks, stressing out in a giant line because you have to be back in time or you’re castrated, getting your caffeine fix to-go, running back before you get a parking ticket, spilling it on yourself, and making it back to your work station so the next person can repeat what you just did (shoutout T! ☺ ).
The rest of the day went fine, when it was time to go we went back to the front office to wait for the shuttle. It would be 2 hours late…again. Therefore, we had tea…again. T.I.A. man.

Malagazi Township Clinic

April 26th, 2010: Case of the Mondays. It was hard to wake up as usual, but I was actually excited once I left the house. Today we were going to Malagazi Clinic in Umlazi, which is a township. This would be the most rural clinic thus far. We pulled into the clinic to see the usual long lines. We were greeted by Clementia, the head sister of the clinic. Overall, it was by far the warmest greeting I have received since being here. All of the staff was so happy to see us and said hello whenever they had the chance. We began by witnessing the family planning clinic, which consisted of a line of women sitting in a chair waiting to get injected with birth control. Like cows getting branded, when it was their turn they got up, dropped their dresses, got injected, pulled their pants up, got their stuff and left…all in front of each other. We injected about 20 women what seemed in like 5 minutes. Next we got to do the regular clinic and sit with a sister. I became extremely excited when she told us Hailey and I had to split up due to the small examination rooms. Finally, I got to be alone with a sister or a doctor for the first time. I went with Clementia and Hailey went with the other sister. The patients started pouring in with a variety of ailments. There were lots of cases with children and adults with sores all over their body. The main cause of this was their diet. Since this was a rural clinic, we got to see the repercussions of malnutrition and poor diet choices. Clementia was a 75 year old sister with a hard hitting attitude to come with it. She obviously has done this for a while, and she sternly lectured everybody about their diet choices and how they’re doing it all wrong. Everything she said was very harsh, but very true. This one baby came in with sores all over his mouth and she told me to listen carefully. She asked the dad (very rare to see a dad there) what the child ate and he responded, “Whatever he wants”. And there is your first problem. A lot of people in this community have no sense of proper balanced diet and give their children whatever they want. They also think that once breastfeeding is completed that milk consumption should be halted. In a community like this, it is close to impossible to compensate all of the vitamins and minerals that are lost with no milk consumption.
We had another patient come in; she was this very beautiful 18 year old girl. She was complaining of a headache amongst a load of other things. We found out she had multiple STI’s and needed an injection. She admitted to not using condoms with her sexual partners and when Clementia asked why not, she didn’t say anything. She just shrugged her shoulders or looked off into space. Clearly, she was impossible to get through. I assumed she would develop HIV in the next year or so.
The most interesting case was this 25 year old man who came in. He didn’t even need to explain himself since he just looked completely emaciated. The sister asked what wrong and he said he has been sick for a couple weeks. She also knew that he had not been eating. He said that he had not eaten in 3 days. I lifted up his shirt and noticed he also looked severely dehydrated. I pinched his abdomen and it felt like I pinched pizza dough. The skin just kind of stayed where I had pinched it, but slowly returned to normal. He tried to remove the rest of his shirt but he had so many aches and pains in his joints that he needed help. He had oral thrush (white coating of the tongue that bleeds when you touch it), which is a good indicator of HIV and a green discharge coming out of his eye. I took his heartbeat with my handy dandy stethoscope and it was beating so fast that I had to recount it a couple times. Sure enough he has tachycardia, or a fast heart beat. We asked him what he has done to help himself out during the few weeks. He replied that he drank a whole bottle of castor oil (not Castrol motor oil…don’t worry). Castor oil is this translucent, extremely viscous, unpleasant smelling oil that was banned in South Africa years ago but has come back due to the introduction of flavors (it still is to be avoided however). It basically acts as an extreme laxative and “cleanses” your body to the point of mass dehydration. The usual dose is a couple tablespoons. Traditional Zulu believe that you need to cleanse the body whenever something is abnormal, so they take a WHOLE bottle of Castor oil only when the sun is down to cleanse themselves. Hence, we see the dehydration. The sister recommended that we stop giving him care and him be referred to the next level of care. The clinic refunded his R40 (~$5.75, the price for all public clinics) since they couldn’t take of him. I asked Clementia how he would get to the hospital and she replied “well he might not, it’s all a matter of how much money he can get to get over there”. It was a pretty sad case to see a 25 year old so sick and only to send him off hoping he has enough money to get to the referred hospital before he dies.
At the end of that case, Goodness (yes that’s her name and she’s 100% awesome) came in and said something in Zulu to Clementia. Clementia turned to me and said that my tea was ready. Umm excuse me? MY tea? What about hers? I told them they didn’t have to that for me and when her tea was. She replied that she only gets tea if it’s not busy, only doctors get tea. Too bad I’m not quite the doctor you think I am… I felt completely undeserving for the tea but they insisted. Hailey and I walked to the back room of the clinic and were pretty touched with what they did. They set up a little table with teapot, teacups, tea, milk, and sugar for us with what little supplies they had. Granted we were having tea on the same table that the birth control medications were administered, I was really humbled by the gesture. To them though, it’s standard to serve the doctors tea. But since doctors rarely make appearances in this clinic, they really tried to make us happy. I busted out my severely bruised banana (my plum had exploded in my bag…sorry Jay) and began to eat it. Out comes Goodness with the biggest smile on her face and apologized for only providing powdered milk. We laughed and said it totally fine only to be greeted with tea cookies. The ones with the raspberry filling…mmm. Again, they really didn’t have to give us cookies.
After tea, we went back into our rooms and continued to see patients. I was sad when the clinic ended. I really enjoyed my day with a fiery 75 year old sister named Clementia. In fact, this became one of my favorite days here. I had the most patient interaction thus far and felt like I contributed to the clinic. I gave Clementia a big hug and told her how much I appreciated everything and headed home.
At home, GoGo continues to blow my mind when I see her hobbling around without her crutch. I don’t think she likes the crutch too much so she manages to get around slowly. A lot of family has been stopping by to check in on her. She continues to smile and also offer me a lot of food… so basically nothing has changed. That night Hailey and I took our brothers out to the arcade to hang out. I bought them some tokens and we all had a good time. On the way back, we had all of them screaming to some rap and even some Poker Face ☺.

Bad Day for the Msomi Family

April 23-25, 2010: After a weekend in Durban, I began what is my last week here. I couldn’t believe I had reached this point in my trip already. I remember landing in windy Durban, completely confused, tired, and expecting anything. Now I feel like I have conquered this city (in my own way. I’m sure I would be conquered in like 5 minutes if I were to step out alone at night). My host family has now become my family and leaving them seems wrong. I have grown very attached to the family. Sibongile is such a respected woman in the community and she doesn’t take shit from anybody. She has raised her boys quite well given she can be quite intimidating. Since she is a school teacher, I asked the boys one day if she’s a cool or a mean teacher. They responded, “let’s just say we’ve lost some friends growing up”. Whatever the case, she has the biggest heart I’ve seen. She will take a bullet for anybody and could possibly kick anybody’s ass. Also, she wrestles with her boys all the time, each time giving them a run for their money. GoGo is the same way, being a GoGo in the household is an interesting position that I haven’t quite figured out. I think it is very revered and are looked at as the ultimate caretaker. GoGo has been through quite a lot in her lifetime. She is the oldest of 6 sisters and has lived in townships the majority of her life. She has gone back to visit frequently for days at a time. GoGo once told me that at one point, there were 20+ people living in her 3 room house in the township. She was the caretaker for that household as well. Like Sibongile, she can probably kick anybody’s ass. She also takes on her own grandkids and wrestles. Probably one of my favorite memories happened this weekend. Boom Boom and GoGo were beating each other up one day when Boom Boom ran into my room and slammed the door behind him, putting all of his weight against the door. GoGo attempted to push on the door to no avail. Boom Boom snickered back at her with his demonic sounding laugh. Before that could end, the door suddenly flies open sending Boom Boom onto the floor. Persistent granny actually charged the door with all of her might and knocked her grandson cold on the floor. At the threshold of my door was a huffing and puffing grandma wearing a yellow sundress. Best part is that her English becomes perfect when she gets angry, “Why are you laughing Boom Boom? It’s not Christmas! I’m going to throw you out that window and show who really raised you!” Essentially, I respect her immensely and do not want to challenge her to any sort of physical brawl. It was the next day that the entire family would be hit with a terribly stressful and sad day.
It was Sunday and the whole family went to church. GoGo goes to a Zulu speaking church while the rest of the family goes to an English speaking church. She walks there and back each Sunday morning and afternoon. It was the afternoon and she still had not returned. We got a voicemail on the house phone and it was GoGo but she sounded distraught and in a panic. There was so much noise in the background that we couldn’t hear anything. Eventually we get a call from Sibongile saying that GoGo was in the hospital. I thought maybe for her hypertension or diabetes but definitely not what I was about to hear. She was hit by a taxi bus while walking back to the house. She was literally the next street over, maybe a 3 minute walk. These asshole taxi buses that I’ve been talking about have added to the statistic. They are so aggressive and do not care for anybody else on the road. All they care about is getting to the location as quick as possible to make more money. They are in the highest incidence of car accidents here in South Africa. The story that went with it wasn’t much better. Apparently GoGo had fallen while she was walking and the taxi proceeded to run her over while she still down on the concrete. The taxi bus ran over her leg and it dragged her for a very short distance. Instead of stopping, the taxi bus kept going. She was put into another taxi and was taken to the hospital where she sustained a pretty nasty set of lacerations on her arm and a broken ankle. She stayed there overnight and was supposed to come back the next evening.
After all of that, you would think that would be enough for one day. But this wasn’t the case. After waiting 10 hours in the hospital, Sibongile came home from the hospital to the house. We helped open the gate and garage so that she could pull into the garage. The driveway is pretty steep and has some gravel patches. On her way up the driveway (driving stick, which she is new at), she slid on some gravel, lost control of the car, and slammed her new car into the side of the house. I don’t know what else we could do at this point… the day was simply not going to be a good one. She hit the house at the right front tire and the surrounding area. I checked out the tires and everything, and the car didn’t look moveable. I know at this point, I would have lost it if it were I. But Sibongile held pretty strong, although I know she holding a lot back. I felt so bad, I wanted to help out somehow but I’m not sure if I really could. To say the least, it was a bad day for the Msomi family.