Bara Dora, potato potaato…?

My entire experience as a medical doctor thus far is coloured by the fact that I spent the last 2 years working at Chris Hani Baragwanath hospital (Bara), in Soweto. Asides from the short stints we did as students at the other public hospitals in and around Johannesburg, Bara is where I learnt how to function as a medic and it is almost all I know of the inner workings of a hospital. So I wasn’t surprised, just a little amused, when a few days ago, I found myself telling a patient to “…take your script to the pharmacy here at Bara…” I had to stop myself. “Sorry ma’am I meant Dora, the pharmacy here at Dora Nginza hospital…” Bara, Dora. The 2 almost sound the same in my head sometimes. The Dora experience thus far however, has been quite dissimilar…

 

I was on call for the first time out here a few days ago. From 8am on Monday to 8am on Tuesday morning I was the physician on call, or POC as they call it at my new hospital. During that time the intern and I saw about 35 patients and admitted 28. It was during this time in the admission area that my perception that my current place of work is so different from my previous hospital was most distinct. During my time on call I would clerk a patient, and while doing that I would start forming an idea in my head, of what I thought their diagnosis might be, and once I had finished the examination I would have a bit of a think about it, and maybe add to, or change something in my notes. Or perhaps I would come to the conclusion that what I had already written down was ok, and that I was happy with my working diagnosis.  I  was on call, and I had the time to think about what I was doing. I actually had time…

 

The first 4 months of my internship back at Bara hospital in 2012 were in internal medicine, the same department that I have chosen to work in now for my community service. On a day call, if it was a bad day I would  see the same number of patients (about 30) in a single afternoon. The best description I can come up with regarding those 4 months at Bara is that it was like being caught in a fast flowing river, going downhill. You just went with the current,  and you had very little control. Then you went home, invariably a lot later than you would have liked, slept, got up ridiculously early the next day and got swept up by the current again. Ward rounds, bookings, ward work, the odd meeting and next thing you know it’s way past 4.30pm in the arvo and you’re still at work. You finish up as much as you can, go home, sleep, and repeat the cycle on the morrow. I must admit that I speak only for myself. Although I know that there were other interns who felt the same way, there were those who were awesome, and thrived in that intense environment. Mostly I tried to manage the heavy workload as best as I could. Medical internship should ideally be a good balance between learning, and working like a slave. At Bara there were some days when I got that balance right and (or but? 😛 ) there were more days when I was just a workhorse (or a rat, yes more like a rat in a big warehouse). I learnt a very fast, instinctive type of medicine. Fast triage, a brief clerk getting the history and examination almost simultaneously, a provisional assessment, investigations and move on to see the next patient while awaiting the results of the tests you’ve requested. The pressure was such that very often the emphasis was on seeing and managing patients as quickly as you possibly could while being safe, because for every patient that you were seeing at a given moment there were invariably numerous more waiting to be helped. That was the typical situation when on call in the admission ward. Once a patient was admitted and in the wards it was the daily slog of seeing them and each of the 20something other patients you might have on your slate, making sure that they were well managed. You did this under the guidance of a registrar, and a specialist consultant, but as the intern you did shoulder a fair amount of responsibility. The number of patients one always had though, was such that all the time you remained conscious of how much there was to do, and how little time there was to do it all.

 

Dora Nginza hospital is less busy, and I feel somewhat more in control, I can be a little more deliberate in everything I do regarding patient management. I feel that it is a better pace that I can learn at and develop further. The physician in charge of the ward I work in keeps me and our 2 interns on our toes by asking very probing academic questions on the daily ward rounds, and there isn’t a day that goes by without his giving each of us a topic to read up on and present in a short sit-down discussion the following day. One of my fears after having left Bara, which is an academic hospital was that I would end up in a new work environment with doctors who hadn’t read anything new in years and I wouldn’t learn anything further than I had in my short career thus far. There doesn’t seem to be much danger of that happening, thankfully. Asides from being in a coastal town that is quite outdoorsy, catering to my sporting needs it seems that there will be no halting the learning curve. Along with my own studying towards hopefully writing SA College of Medicine exams sometime soonish (specialists don’t make themselves!) I’m having to squeeze in extra material every day that helps us better manage our ward patients too. Port Elizabeth was a good, lucky pick I think…

 

As I’m writing this it is late afternoon on Sunday. I just woke up, having slept since about 11am when I got back from the hospital where I was on call again since yesterday morning. We had a busy one for a weekend call, having again admitted about 30 patients. Some were seriously ill, others not so much. One gentleman that comes to mind is a 40something year old who was referred to us from casualty in a considerable degree of respiratory distress. We put him on oxygen by facemask but he just didn’t seem to get better, writhing and breathing laboriously. I ordered an X-ray of the chest, and while we were waiting to be able to view the film his girlfriend, who had escorted him in explained that he hadn’t been to the toilet in about 3 weeks. So we had a closer look and on further questioning he explained that most of his discomfort was in fact in the abdomen. He was given an enema, passed a little bit of stool and suddenly was much brighter, saying that he felt a lot better! His chest x-ray did show an extensive opacity in the left lung so we did admit him, but his story did provide for a fair giggle with the consultant on the ward round the next morning 🙂

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