Same old brain, same old heart…

Down and around on Sparrow drive, left onto Villiers, right onto 14th, right onto Water rd, all the way down untill it turns a sharp right into 5th, then left onto Prospect rd, right into 4th, left into Fordyce, right into 1st then left into Heugh rd. It eventually becomes Walmer Boulevard drive and I have to decide between taking a right onto Forest Hill rd which will take me past the airport then back toward home for what ends up being a 16km run. Alternatively I could keep going on Walmer Boulevard and eventually turn right onto Humewood road and run along the beach front into Summerstrand for what ends up being a 24 or 25km run. Either way I usually end up back on Villiers pushing along the last 3 or 4km, a very slight uphill to the end of my run.

I live in Walmer now, still in Port Elizabeth. It is July and effectively the 3rd month of a new year for me. So new beginnings, new running routes, new legs (kinda feels like that 😌). Same old heart…

It takes me a little over an hour and a half to run a half-marathon (1hr 35mins is the best I’ve ever done). By contrast it took about a year and a half of studying before I felt ready to write the College of Medicine Part 1 exam (Primaries). It wasn’t a full on effort for that entire period of time. I made the decision to start preparing a year and a half ago. Deciding is one thing, executing is another thing altogether, but I did translate mentation into action, albeit intermittently at first. I spent the first two months of 2014 (the end of my time as an intern) studying like my life depended on it. The renal and endocrine chapters of Ganong’s Review of Medical Physiology were put away with aplomb. I then ran out of steam and seemingly motivation. I did continued, though at a more measured pace. I was on and off over the next few months, days and weeks went by when I was very studious, and other days and weeks passed when I was less so. I finished my internship at end of April 2014 came down here to Port Elizabeth for my year of community service. I continued to study intermittently. In about November of last year I pressured myself into making a decision about when to actually sit for this exam. ‘When I’m ready’ was no longer adequate. A definite time line would also serve to put me under a bit of pressure. After the new year I became a little more consistent, measuring my time more and more by what the amount of reading I had or hadn’t done.

On 31 April in the early afternoon I walked out of the medical ward at Dora Nginza hospital for the last time, having completed my one year of community service. I have now done my ‘Zuma years’ as some would say. I no longer owe the government anything in the way of being fully recognized as a medical practitioner. Nice I suppose, and following that, if I wanted to tomorrow I could open my own private practice. Naturally I’ll do nothing of the sort. No I have a much less comfortable, far less glamorous future in mind. Picture a medical registrarship, long hours and an unreasonable work load at Chris Hani Baragwanath hospital. Picture having ample time to read but way too much material to have to cover and master. Picture HIV and TB, and more HIV and TB. Picture me being able to conjure up obscure spot diagnoses in response to a long convoluted set of signs and symptoms blurted out by a fellow medic on a grand ward round. Picture that. That’s my kind of life.

I had a week-long holiday of sorts at the beginning of May. I spent the first weekend in Johannesburg with my girl, Meryl. We set up house so to speak, at a cool little backpackers on Doris Street in Kensington for 4 days. We spent the days studying believe it or not, she for her midyear exams, the first of which was the following week, and I continued to slog through Ganong’s. I then went across to Centurion, Pretoria to spend a couple of days at my parents’ house.

10 May, 8.05am. I was up. Much earlier than I normally like to be out of bed on a Sunday morning. There were church bells ringing (literally) not too far away, the sun was out and beating down hard. If Long street was a person he, or she (we’ll settle on ‘she’) would be elderly, not frail but hardened and somewhat jaded, with that seen-it-all thousand yard stare. On this particular morning she looked calm, expectant. Breathing easy after the shenanigans that she’d played host to the previous night. I was standing on the corner of Long street and Longmarket street waiting for an Uber. The car pulled up and I jumped in.

Long street, Cape Town

Long street, Cape Town

Grote Schuur Hospital, Cape Town

Grote Schuur Hospital, Cape Town

I had been in Cape Town since the previous Thursday evening for a refresher course for the Primaries organized by the University of Cape Town (UCT) department of medicine at Grote Schuur hospital. A friendly summarized version of ‘everything medical physiology’ with a sprinkling of pharmacology, microbiology, statistics and some other need-to -know stuff. All squeezed into 3 days of back to back two-hour lectures. What we do for kicks eh! 😌

#geekmode

#geekmode

Difficult thing to get used to again, sitting in a lecture hall and having to maintain concentration. It took me right back to medical school, dosing off every now and then, not due to lack of interest but just sheer inability to pay attention for such long stretches of time. “Let’s hope something something sticks…” Dale had said on Friday morning as the first lecture had started. He and Alex, my Dora-mates and fellow Witsies had made the trip down too.

Seagull. Harbour.  V n A Waterfront, Cape Town

Seagull. Harbour. V n A Waterfront, Cape Town

Caught a little bit of comedy on one of the nights

Caught a bit of comedy on one night

Back in Port Elizabeth after that weekend I started a new job, in the ICU at Livingstone Hospital (LVH). It has been a continuous, seemingly non-ending learning curve this last month or two, and I’m really enjoying it, surprisingly. While being quite challenging, working in the critical care unit at LVH has not been as scary as I had thought it would be before transferring across.

It is a high pressure environment with a neat set of rules and regulations. If A happens then we must respond with B. If C happens then the patient must receive D, if X then Y etc… Protocols. Know what to do, how to do it and when it is appropriate to do so. Not so intimidating when looking at it like that but the thing to do obviously, is to determine why or how X happened isn’t it? That is the real art of what we do as medics. The lady is in low output heart failure, she has a valvular lesion. She has had it for many years, so what is different now that has caused her to tip over, caused her to decompensate…? There is a lobar pneumonia and she is in sepsis. What is the offending organism? What is the appropriate antibiotic? If we decide to initiate… Can we wean her off the inotropes? Get her well enough to get off the ventilator? The gentleman in bed 5. Severe pancreatitis, most likely due to years of excessive alcohol. Now a couple of days post-op, and in respiratory distress, tachycardic. Septic markers inconclusive. Antibiotics? Nope. No real temperature spikes, blood cultures haven’t yielded anything. Is there a fungal infection, maybe…

I’m only a few weeks in and am admittedly a slow learner. The goal is to get to a place where one understands rather than just knows the protocol, why do we do B when A happens, and Y when X etc… I have the rest of the year more or less, to get comfortable and to get better. I am definitely enjoying myself and who knows, perhaps I’ll become an intensivist one day after I deal with this minor detail of qualifying as a physician that is :-P. Oh and while we’re on the subject of my current situation, regarding Eazy in the EC: ‘One year in the Eastern Cape’ has turned into two…

In between all of this new learning at work I continued plugging away at the material for the Primaries. I finally got down to doing some statistics (my favorite! 😦 ) Research is how medicine and hence patient care moves forward these days. One can’t be a medic and not have at least a basic understanding of statistics, to my chagrin.

Towards the end of May and through most of June my life seemed to become ever more streamlined. Simplified if you will. Life became work, eat study, study, study, sleep. In that order, in ever repeating cycles. I went through an eerily familiar phase towards the end of June. Everything other than what I was supposed to be studying became interesting. On numerous occasions as I was about to sit down at my desk I would think “What was that thing they said on the radio earlier? Lemme google that, I can’t believe Kanye West would…” or I’d realise that I hadn’t been on Instagram for a little while and before I knew it I’d have spent a whole half-hour of my life perusing through images some pretty, and inspiring but mostly bland pointless and entirely non-contributing to my ambitioned future life as a specialist physician… Then I would eventually sit to study and I’d be quite productive for a while until I would think: “What if they ask a question about this…?” I would fret, and quickly look through my notes again, or “What if there’s question on this…?” and I would stop what I was reading and have a quick look at that too. All these questions about these little things. These little molecules, ligands and receptors, these pathways. “My brain is tired, my backside is sore, my back is aching… ” “My everything is everything!” I said to Meryl over the phone one night (insert sad, self-indulgent emoji) “Maybe I should stop studying and download a movie…” There’s a good way to spend this precious time!

This is not dissimilar to my pre-exam behavior back when I was at medical school. In fact the mental merri-go-round, emotions and sense of subdued-yet-bubbling-over stress I was going through felt exactly like it did when I was a hapless student. “That exam is quite soon isn’t it, you look so calm” my colleagues would say. It is most definitely just a look. People also said that about me at medical school, alas it is very different to what I’m going through on the inside. The older I get, I realise the more I still stay the same. “I wish I could redo the last year and a half with a different brain!” I found myself saying to a friend.

I still ran, but only about twice a week and when I did run I seemed to be squeezing it in between the studying. I’d get home from work and put in a couple of hours at the desk and get out onto the road quite late, knowing full well that it would be dark by the time I got back if I covered 15 or 16km as I felt I had to. I felt sluggish, barely ever able to push myself very far under 5min/km pace. Healthy body, healthy mind, a teacher once told me back in high school. But when the mind is preoccupied the body can but to follow suit.

On Saturday 20 June I ran the Heartbreak Hill 21.1km, organized by Charlo running club. 1hr 44mins and a few seconds. Not a time to rave about but I was coasting mostly. I didn’t hang around after the race, briefly said hello and cheers to some of my running club mates who I hadn’t seen in what seemed like for ever, and promptly went back home and kept at the books. On the following Wednesday myself, Dale and three other aspiring physicians sat in a classroom upstairs from the library at LVH and each of us worked our way through the 150 questions on physiology mostly, some statistics, some microbiology and pharmacology. I walked outta there at 12h02pm having handed in my completed paper, after using every single one of my allotted 180 minutes.

That afternoon I was to the airport to pick up Meryl. It had been 6 long weeks since I last saw her and she looked gorgeous!

That was last week. The Grahamstown arts festival kicked off yesterday. There’s a marathon on next weekend. I’m not in very good physical shape at the moment but I’m gona give it a go

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