Monday, May 24, 2010

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.

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