Altitude Schmaltitude

I had no right to show up for this 32km road race in Springs. Ever since I came back to Johannesburg work has been insane! My work hours and load are disturbingly similar to how things were when I was an intern (having to write that makes me a little depressed). So while I’m generally not the type to put in 5 or 6 runs per week I have noticed myself tending more toward the I’m-too-tired-from-work-I-can’t-run/work-out-this-evening type. Obviously that just won’t do, so I’ve had to force things somewhat.  There’s nothing quite like an 18km evening run through the city after being on your feet all day. Patient to patient, ward to ward, walk to radiology to book scans, walk to the lab (which is literally or at least feels like 2km away on the other side of the hospital!)

I’m not being fascicious when I say that one of the first things that popped into my head when I found out I was coming back to Johannesburg was: I’m gona have to figure out some new running routes! (insert quizzical emoji here), and map out a training plan for the new year. Within a week of having moved back here I found myself on a street in Kensington not far from where I stay doing hill sprints. Now Johannesburg is at about 1500m above sea level, higher in some places. The air is thinner out here and oxygen is literally not in the abundance that one finds down in heaven (I mean Port Elizabeth!  :-P) at sea level, and therefore one cannot simply go about trying to engage in the insane athletic endeavours that one is used to doing down at 0 meters altitude. At least not within a couple of days of having arrived. No, not without feeling an acute sense of nausea and being momentarily convinced that one’s lungs and other essential intrathoracic organs are going to project out of one’s mouth onto the road for all to see. That is how I felt after the third of my 8×100m uphill sprints and after everyone therafter, on that particular day. 20 minutes after I got home from that session my body (yes my entire body, not just my legs) was still shaking. Witness the fitness, or rather the lack thereof!

A few days after my sprints session up the hill-from-hell-in-Kensington I ran the Wits Kudus 15km race, in 1hour 20minutes. This is a good 10 minutes or 45 seconds to a minute per kilometer slower than I would normally expect to. I consoled myself thinking: At least you got out there you know,  you could’ve slept in… A familar mantra of mine. That  was then, (early January). Today, roughly a month later, feeling a little undercooked after one or two weekly longish runs and a repeat hill-sprint session in which my internal organs only once or twice threatened to start suggesting the idea of exiting my thoracic cavity via the oral route, I thought I’d get up just before 5am and make the drive across to Springs, East of Johannesburg and give this 32km race a bash. I finished in 2hours 49minutes, beating my previous personal best for 32km by about 3 minutes, completely surprising myself!

It has been good being back in Johannesburg, the best part of course is that I get to see my girl EVERYDAY. Most days I finish at work and drive over to Sandton City to pick Meryl up from work and we have impromptu dinner dates and it almost feels like the last one year and 8 months of doing the long-distance thing never happened.

I am working at Helen Joseph hospital in Auckland Park as a medical officer in the department of internal medicine. It’s rough going as I’ve described, my typical day/work load is triple what I was doing down in Port Elizabeth. I am loving it though, it’s busy I feel stimulated and I’m eager to soak it all up. The plan is to work my way into a registrar post eventually, become a physician and go on to change the world (insert semi-serious sarcastic/fascicious emoji here, just for that last part!

There is a lot more to say regarding what’s been going on with me lately and especially with Meryl and I but I will save it for the next time I am inspired to sit and pen out the goings-on in my life (as in-frequent as those ocassions arise), but the overall theme of how I am feeling lately is that I am exceedingly happy to be back home. Quite frankly I wouldn’t be anywhere else right now, for anything!

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What we won’t do for love

3:04pm… the time I arrived at the Mango airlines check in counter at OR Tambo airport for my 3:35pm flight back to Port Elizabeth on Sunday afternoon. Just in time for the 3:05pm gate closure :-P. It was the end of another short fun weekend in Johannesburg.

 

Some of the stuff that happened that’s worth remembering:

 

The Hangover 4

The look of surprise on my friend Alain’s face when his brother Olivier walked him in through the doors of Metro, a restaurant in Benmore, Sandton on Friday evening was priceless. Alain was due to be married the next day (the main reason I was in Johannesburg this weekend). He was literally speechless for a few moments as he sat down at the table. Seated around the table were Jean-Paul, Alain’s best friend and the organizer of this impromptu batchelor party/dinner, and about four or five other guys and I. Yes I know, a batchelor’s party the night before the wedding… 😮 There is no end to the list of ways things could go horribly wrong obviously, but this was (necessarily) a very restrained effort, literally just dinner and a drink or two. I know what you’re thinking, there is always that one guy who with the intent of escalating the festivities will say something like “Come on guys it’s his last night as a ‘free’ man, and it’s still early!” And sure enough Arnoud a good friend of Alain, at the end of the night just as we were looking to disperse piped up “Tous à être à l’église à 13h00? Et puis nous avons beaucoup de temps!” Sure he could sleep in a little the next morning! 😌 Thankfully all such notions were quashed. The look of absolute fear on Jean-Paul’s face at the idea of having to deal with the wrath of Henriette, Alain’s betrothed the next day if he were to not show up, arrive late or be hungover on her special day just about said it all. So ‘The Hangover 4’ did not happen. Me on the phone with y best friend Rodney some other time this weekend, “…that’s the kind of chilled, controlled batchelor’s party I want when my time comes.” He laughed, “No, no, no!” And proceeded to inform me that I have no say in how my batchelor’s will go…

Yours truly and the guys gathered for a tame-I mean tea party-I mean bachelor's do :-P

Yours truly and the guys gathered for a tame-I mean tea party-I mean bachelor’s do 😛

 

What we won’t do for love…

On Saturday late afternoon I found myself sitting on a bench in Fourways Mall in the north of Johannesburg. Meryl was sitting next to me. She had her legs stretched out over my lap and I was massaging her feet, sore from being in heels for a few hours. Perhaps I’ll just stop there… 🙂

We were with two friends of mine, George and Peter who had popped into the @home shop for some last minute shopping for a wedding present for Alain and Henriette. We had all driven together from Braamfontein in Johannesburg CBD where we had attended a beautiful, serene wedding ceremony at Holy Trinity Catholic church. The mass was presided over by a Salesian priest speaking in both English and French, appropriate for the mixed crowd of attendants (Congolese and South African).

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The little shopping trip was a quick stop on our way to the Zulu Nyala Country Manor for the wedding reception.

 

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At the reception the MC ran things eloquently in French and every now and then Jean-Paul would grab the microphone and (apparently) translate what she had been saying. The speeches and pleasantries were gotten out of the way within the first hour or so after the newly weds had arrived. Yours truly was entrusted with the toast. No, let me tell the full story: I happened to have called Alain during the week “Monsieur homme marié!” I said as he answered. We had a little chat and at one point he said “Oh hey by the way we’re gona need you to say a few words on Saturday, or do the toast or something I think, I can’t remember now…” This was Thursday, and the wedding was on Saturday… 😌!! I put together a little something to say. Nothing like an anecdote from a previous experience between friends when you don’t know what to say, and also to be honest for such occasions there are certain generic words (although true and apt) that won’t fail, no matter how nervous or unprepared the person expressing them feels.

 

Alain and Henriette, husband and wife!

Alain and Henriette, husband and wife!

Once the party got under way the bride and groom outdid everyone on the dance floor. I cannot find suitable words to describe how happy Henriette looked. She had an air of absolute freedom about her as she and her man swayed and stepped the night away on the dance floor.

 

Keepin’ it natural

My girlfriend Meryl describes herself as a natural hair chic (amongst other things). Natural hair… In my apparently erroneous opinion this describes someone that wears their hair out, you know afro-like. But for the entire time that I have known Meryl she has always worn some or other weave or braids in her hair. I give her a hard time about it “So, where’s the afro? you’re were supposed to be all about ‘natural’ hair!” 😝 Apparently I don’t know what I’m talking about but, I think I tease her enough about it that she decided it was time to give me taste of what I wanted. “No weave this weekend…” she promised. So my girl’s hair was out this weekend, in all it’s glory. Curly wash and go on Saturday, and all in twists on Sunday. It was certainly different to what I’m used to. She always rolls her eyes when I say this but I happen to think Meryl looks good in anything! 😍 While I think the wise thing is to let her decide what to with her hair, I might try to convince her to try dreadlocks next… 😏

 

Me and my girl

Me and my girl

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Jozi, Meryl and Ulysses…

 

Johannesburg...

Johannesburg…

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Meryl and I chilling. That's my post-call face on Friday evening

Meryl and I chilling. That’s my post-call face on Friday evening

If anyone asks, I’m off to go see about a girl… Those were my last words as I left Port Elizabeth for Johannesburg on Friday afternoon. For some odd reason I have had Matt Damon and Robyn Williams on my mind a lot lately. So come Saturday morning Meryl and I were at our favorite little DVD shop on Queens street in Kensington on a mission to fulfill my latest little resolution. Unbelievably they didn’t have Good Will Hunting… “It’s too old,” the lady said, “Too old?! 1998 isn’t old… and besides it’s a classic!” I said in exasperation. It was the second DVD place I had been to that morning that didn’t have it. The nice lady even called another branch but they also did not have the film, presumably for the same reason. “…Unacceptable!” I exclaimed, only half joking…

So we proceeded to choose another one, then two, then six movies, mostly because we couldn’t agree on what to get (we never do apparently, according to the lady that works there 😌) Walking out with that number of movies meant that it was officially going to be that kind of afternoon, which neither of us minded as that really is one of our favorite things to do together.

Getting breakfast at Uncle Merv's, Maboneng.  Highly recommended,  they have an awesome selection of smoothies :-P

Getting breakfast at Uncle Merv’s, Maboneng. Highly recommended, they have an awesome selection of smoothies 😛

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There was a rugby game later that afternoon, the Springboks are currently in Europe and were due to play against England. I was forbidden to take time out to watch 😓! “It’s just 2 hours I’ll be across the road at the Troyville Hotel and back here immediately after…” I pleaded. “So it’s QT vs the test match eh? are you going to defy your woman?” Rodney, my best friend over the phone, having a giggle at the tussle I was in. As a married man he has much experience in these delicate matters. I like to think I’m an intelligent man, so there was no rugby that day. My (subtle) sulk was met with a dismissive “You can always Youtube the highlights later!” Really…

 

Tha evening Rodney came over and he, Meryl and I hung out with a new acquaintance of ours, Ashley. She is an American living and working in Swaziland, who was passing through Johannesburg (as one does) on her way to Cape Town. We all got stuck into one of the most interesting conversations I have had in a long while; gentrification, reincarnation, heaven and hell, Anglicans and Catholics, and child rearing. How’s that for a list of topics? And all before any of us had any dinner! 😋

The next day I turned 31. Just like that. “Je ne sais pas comment j’en suis arrivé à ce point!” Me, in a conversation with my dad on the phone. Time really does just go on, regardless of and in spite of you paying attention. I mean I know exactly what I’ve been up to for these past 31 years and it’s not that I have any regrets or anything but jeepers has it been 31 years already?!

Just the other day I was like 19 years old! :-o

Just the other day I was like 19 years old! 😮

Not that I necessarily would have but there wasn’t much opportunity for any kind of celebration as I had to fly back to Port Elizabeth in the afternoon. I got what I wanted though, some time with my girl over the weekend, and seeing Rodney the night before. My mother, and both of my sisters also called, Muriel in particular sent me a video over WhatsApp of a bunch of little Smurfs singing happy birthday, which I quite enjoyed! 🙂 Henriette, a friend of mine, came over and she met Meryl for the first time. We all shared a quick lunch at Maboneng’s weekly Sunday Market. Then I was off to the airport, and back to PE.

Curiocity Backpackers

Curiocity Backpackers

A good place for a night or two if you ever pass through Jo'burg

A good place for a night or two if you ever pass through Jo’burg

The walls of Curiocity Backpackers, where we stayed over the weekend are adorned with words, parts of Lord Alfred Tennyson’s ‘Ulysses’ one of the greatest pieces of writing ever penned. ‘… I cannot rest from travel… How dull it is to pause, to make an end, to rust unburnished…’ Fitting, for a place continuously housing restless travellers but also I think, as the writer may or may not have intended, quite inspiring for a cerebral soul such as myself. Everytime I walked past a paragraph on a wall I couldn’t help thinking and imagining. I felt overwhelmed with a sense of possibility that the words seemed to suggest.

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That is what was on my mind as I got onto the plane. One could go anywhere (in the world) if one wanted to really…

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Surviving sepsis and the rugger

‘After that magic run in Port Alfred a few weeks ago I was on call on the Monday, we had a heavy one, admitting over 40 patients. There was a public holiday on the Wednesday Heritage day, or braai day as South Africans prefer to call to it. The weather was not conducive to braaing, I spent it indoors studying. The next day after work I managed to drag myself out for a lazy 16km run, then I was on call again on Friday.

At the end of my call on the Saturday I went across to Seaview, and after a couple of hours of sleep at the flat I went to Kim and Bennie’s. The Springboks were playing against the Wallabies (Australia) that afternoon. Being able to kick back and watch a test match is one of my favourite things, even better when it is with friends. Bennie fussed around outside, making a fire for the braai, and Serina and Dean were in and out of the house the whole time. It was a tense game, the Boks trailed by 2 points (10-8 to Aus) for much of the game, only going up to a one-point lead (11-10) sometime in the second half. In the last 10 minutes of the game in a flurry of inspired activity they scored a couple of tries to end the game as winners 28-10. After the game I found myself apologising to everyone (much to Kim’s amusement 😛 ) for having gotten so excited (I had been shouting wildy at the screen at one point!). We then shared a delicious supper (chops cooked over the braai by Bennie and veggies and a salad prepared by Kim). I retired to the flat after we watched a movie (I watched, Kim and Bennie dosed off on the couch 🙂 )

 

I spent most of Sunday studying and getting to grips with a topic that had been on my mind quite a bit. That being sepsis. A little while before on call I had looked after a patient in sepsis. Sepsis is as bad as things can get for the body. It describes a continuum from systemic inflammation to multiple organ failure.

 

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The underlying cause in most cases is an infection (bacterial, fungal or viral although we always look for bacterial first). At the mild end of the spectrum is the systemic inflammatory response syndrome (SIRS) where one can find a very high or very low white cell count (WCC) (WCC >12 or WCC < 4; normal range is 4-10), fever or hypothermia (body temperature >38ºC or <36ºC), tachycardia (an increased heart rate) and tachypnoea (an increased respiratory rate). Moving up the spectrum (with increasing severity and mortality) there is hypotension (a decreased blood pressure) and some form of organ dysfunction (kidney failure for example). This is severe sepsis. When the hypotension is refractory (not responding to treatment) this is referred to as septic shock. Multiple organ dysfunction syndrome is at the extreme end of the spectrum.

 

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On 16 September we saw a patient on call that I assessed to be in sepsis or some degree thereof. He was a 47 year old man HIV positive with a very low CD4 count, clinically wasted, confused and incoherent.

The intern started seeing him as I was busy with another patient at the time but I looked over and heard the details of the referral as the casualty doctor wheeled him in. I immediately had patient envy…

The intern reported that the blood pressure was 80/40. “Put up a second IV line for fluids and draw blood for blood cultures” I instructed. I also thought that by the looks of him that he would possibly need a lumbar puncture. We also started him on antibiotics.

After an hour or so the blood pressure had not improved. With the accompanying tachycardia and his generally poor state although I didn’t have any blood results yet I started thinking about sepsis. I wanted to use a drug to help increase his blood pressure but wasn’t sure exactly how to. I had prescribed dobutrex (dobutamine), an inotrope (increases strength of contractions of the heart) for refractory hypotension before but that is a drug used in cardiac cases.

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I called the consultant on call and when I mentioned sepsis he said we needed to do blood and urine cultures (this is to find the source of the infection) and give a broad spectrum antibiotic. We had given a stat 2mg dose of rocephin (ceftriaxone) already but he suggested adding flagyl (metronidazole). Regarding the haemodynamics we needed to be aggressive with intravenous crystaloid fluids via two IV lines he said. We had two IV lines up but they were both peripheral, we needed at least one central line. We had already given him 2 litres of ringer’s lactate IV, and “I want to step up to a vasopressor maybe” I said. A vasopressor causes constriction of peripheral blood vessels (vasoconstriction) increasing the pressure against which the heart has to contract. “The first choice in a case like this is noradrenaline, but we don’t have that you’ll have to use dopamine” he said, and he quoted me the dose. “Keep me updated of any further changes” he said before we hung up.

 

We got the patient’s blood results back from the lab not long after that phone call. The white cell count was 41 (😱!!) which all but confirmed sepsis, he had a very low platelet count (50) which ruled out the idea of putting up a central IV line (the risk of excessive bleeding is very high with low platelets). He was also in quite severe kidney failure. It takes a couple of days before we get blood culture results so we wouldn’t have those back by end of the call…

 

Dopamine is a catecholamine, it has the effect of increasing the strength of contraction of the heart as well as the heart rate, and it also causes peripheral vasoconstriction, all of which help increase blood pressure. A 10mcg/kg/hour infusion had his blood pressure up to a much better 110/70 eventually. The goal is a mean arterial pressure of 70mmHg or more. It remained good, as long as we kept the infusion going. The reason one fusses about the low blood pressure is that at such a low level the heart is essentially failing to get blood (with oxygen and other essential nutrients) to the organs around his body. This is the definition of circulatory shock.

 

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The Surviving Sepsis Campaign started in 2002, is an international initiative that provides regularly updated evidence-based guidelines on how to diagnose and manage sepsis. We go according to these, or as close we possibly can in our approach to sepsis. That is what I spent that Sunday 28 September pouring over.

 

 

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With all the work that we put in for this patient the numbers looked to be improving in terms of his blood pressure and fluid output but he still looked in a terrible state.. with a decreased level of consciousness and bradypnoea (decreased respiratory rate). He had a very poor prognosis the consultant had explained. I was happy about the fact that he survived the night but I knew that further than that it would be touch and go once he was in the wards. Sepsis is bad news under the very best of circumstances. Patients generally have poor outcomes. According to the National Center for Health Statistics between 1999 and 2005 the sepsis mortality in the United States was 66 deaths per 100 000 people and in a study published in Clinical Microbiology Reviews in 2010 sepsis was found to be the tenth leading cause of death in the US causing 6% of all deaths. The same article mentioned that in Europe an estimated 135 000 people die of sepsis every year. These are statistics from first world settings where one has everything necessary to look after patients as well as possible. Cross over to a resource poor setting such as ours and add to that the poor health seeking behaviour of our population (people seem to only go to the hospital when they are at their very limit of tolerance) and you have a very bad picture. Importantly, sepsis is best treated in an intensive care setting where you have specialised staff giving what is almost one on one care to a smaller number of patients. Compare that to the situation in our medical admissions where we have 6 beds and one professional nurse who may or may not be assisted by a staff or student nurse, trying to make sure that every patient gets everything they need. There is a medical ICU at Livingston Hospital but there are criteria for admission (again due to limited resources) and an HIV positive patient in what is probably advanced AIDS, with multiple organ failure has too poor a prognosis to be admitted unfortunately…

 

“Why internal medicine?” an interns asked me the other day. “It suits my brain” I replied. I like to think my way through problems, slowly. Internal medicine is complex, all the systems affect one another. What’s happening in the lungs has an affect on the function of the heart, and cardiac dysfunction affects the kidneys. You can’t consider a patient’s liver function in isolation, and similarly kidney disease can cause changes in the blood pressure. All these systems and the different ways things could go wrong and what you need to do to help the patient I find really interesting. There is a hec of a lot to know, it is a vast field but I am super keen to get into it. I get ‘patient envy’ when I hear of an interesting case that another doctor has seen, I sit at the weekly internal medicine meetings at LVH and I’m in awe of the registrars and specialists because they know so much, and are so capable of making real change for sick patients. I am still at the beginning of my journey, I have been qualified for less than 3 years and there is a lot I don’t know yet. I definitely want to take it as far as I can. The CEO of our hospital has agreed to let me do the full year of my community service in internal medicine, I won’t have to change departments after the end of this month (this is my sixth month) I’m really happy about that. It will mean more time and exposure to the discipline.

 

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Onto more important matters, that of the rugger! 😛 The New Zealand rugby team (the All Blacks) is the best in the world, up until 2 weekends ago the last time they had lost a test match was in 2012! The South African rugby team (the Springboks) are ranked number 2 in the world. The All blacks are the only team in the world against whom South Africa has a negative win-loss ratio and conversely whenever New Zealand loses a game (this doesn’t happen very often) it is more likely to be against the Boks than anyone else. So this is a serious rivalry.

The All Blacks perform a what is essentially a war dance 'The Hakka' before every game. I'm pretty sure that uf the Springboks ciuld bring themselves to perform some sort of traditional African dance before games we would also start with some sort of psychological advantage :-P

The All Blacks perform a what is essentially a war dance ‘The Hakka’ before every game. Imagine if the Springboks could bring themselves to perform some sort of African traditional dance! 😛

The two teams played other on Saturday 4 October at Ellis Park stadium. Ellis Park is about two blocks away (a ten minute walk maybe) from my apartment in The Maboneng Precinct in Johannesburg CBD, but here’s the thing: I am obviously in Port Elizabeth. The game was televised obviously, but here’s the thing: I was on call on Saturday… I don’t know why the universe does this to me!! ☹ This month’s roster was such that I couldn’t swop out that call with another doctor. I was absolutely miserable about the prospect of not being able to see what would be the final game of this year’s Rugby Championship. One of the interns was kind enough to bring me a walka (mobile TV thingie) but the signal was poor on the day, so I had to put the game out of my mind and concentrate on the call and having to look after sick people (it was really difficult!) The Boks played an awesome game and won by 2 points I found out later. This means that they are actually able to do well without my watching and supporting. Who woulda thunk?! 😲

South African wing Bryan Habana running rampant!

South African wing Bryan Habana running rampant!

 

The call was not too busy on that Saturday we had 24 admissions, none of whom were in sepsis thankfully 😛 There was one lady that was very distressed, in congestive heart failure with pulmonary oedema. This is when the ‘left heart’ is failing to pump blood out to the body, there is a build up of pressure in the pulmonary vein and smaller vessels feeding into it from the lungs. Simply put, the pressure pushes fluid out of these vessels into the lung tissue. Oxygen by facemask and large doses of IV diuretics are the way to go about managing these patients. I was quite worried about her but she pulled through. I saw her during the week as she was in my ward, she became less oedematous (fluid overloaded) with the diuretic therapy and I discharged her after a few days. It was nice to see her get better.

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Cheap cars, romcoms, kizomba and iron, lots of it!

I spent last weekend up in Johannesburg. My cousin got married on Saturday. I seem to be attending weddings relatively often, this being the fourth in about the last year, and there have been numerous in the last few years. I suppose at my (ripe old age) of 30 years it is about that time… Weddings also seem to be the only reason I travel back up to the Highveld these days. There are a couple more still to come in the next few months so this blog is going to start to resemble the screenplay for some predictable romantic comedy 🙂

Speaking of romantic, while the family nuptials where the official reason for my making the trip, being in Jozi meant that I got to be with Meryl. I took leave on Thursday, Friday and Monday, so it was 5 consecutive days of catching up. Definitely the best part of the little holiday 🙂

And speaking of comedy, I rented a car for the duration of my visit. Much to the amusement of my friends I went with the same company I rented from the last time I went up for a short visit. I got an old Mazda 323 and I uploaded a picture of it to show a bunch of friends. The guys were in hysterics, as I knew they would be 😀 over the first day or 2 there was absolutely no end to the abuse that I copped. ‘Learn to love yourself’ one of the guys said.

These guys are just a few minutes walk away from my place in The Maboneng Precinct in Johannesburg CBD. Their rates seem to have made them my go-to guys for my short visits :-P

These guys are just a few minutes walk away from my place in The Maboneng Precinct in Johannesburg CBD. They have become my go-to guys on my short visits 😛

I thought the car had a lot of character actually 😛 and it got me from A to B, which is all I want really. It did make getting up and down in Jozi quite interesting. For example, I usually like to open the car door for Meryl but this car had a funny alarm system that I’m not used. Whenever I opened the passenger side door for my lady the alarm would go off and I would have to then run around to the driver’s side, put the key in the ignition and turn it in order for the alarm to stop ringing. I eventually devised a little routine to avoid this, I would open the driver’s door first, turn the ignition and scuttle around to open the door for Meryl who was (patiently, I think? 😏) waiting on the other side. This probably made for quite a comedic little scene to anyone watching but hec, the alternative is to let her open the door for herself, which is just not on!

The trip was also good for a bit of family time. My father picked me up at the airport, I hadn’t seen The Old Gentleman for almost 4 months so it was nice to reconnect a little. I spent the first night at my parents’ house in Centurion. This is the house I grew up in, mostly. I identify myself as a Jo’burg boy, which after 4 years at Wits University, then 6 years at Wits Medical school (all the while slumming it in student residences) then a further 2 years living and working in Jozi I suppose I can? but suburban Pretoria is where I spent my adolescence. It is always nice to go back to Centurion, I don’t get around much when I’m there, being at my parents is a very comfortable, catered-for experience. Having said that, after a certain age time with one’s parents should only be done in doses I think… So I spent the rest of my time at my apartment in Maboneng, in Johannesburg. Our whole family was re-united that Saturday at the wedding. My sister Muriel made the trip out from Secunda where she works for Sasol in occupational health. She too is a medical doctor, along with my dad. Before you start thinking we’re one of those families there is my other sister Benita, who studied psychology. She is the only one in the family capable of any original thinking. She and her husband Hendrik live in Mondeor, Johannesburg.

Because we’re all off in different places each doing our own thing, having all of us together in one place at the same time is something quite special. This along with seeing everyone else at the wedding (extended family and others not seen in years) and finally seeing my cousin Patrick, a couple of years my junior getting married, all has the effect of making one want to stop the inevitable wheel-turn of life for just a few moments to appreciate it all. At events such as these I always feel an acute sense of “where am I in life?” or “where will we all end up?” I can’t help it…

Added to all of that, this was the first time Meryl was meeting my mother (having already met my dad and sisters at my 30th last year). My mother is like me, she doesn’t open up and warm to people without quite a bit of work having to be put in, from both sides I would say. I will say no more than that about their first encounter. I was tempted to call this blog post ‘The awkwardness that was…’ 😛 I suppose we’ll give it some time.

Meryl and I at the wedding

Meryl and I at the wedding

The wedding aside, there was kizomba, an Angolan genre of dance that Meryl is quite into. We went to a kizomba event in Illovo on the Friday night. I found it quite challenging. I’m definitely an advocate of the standard one-step, two-step. “Rythm, rythm!” Meryl kept saying. Where is it, I thought. What is this rythm thing she keeps on about… 😮

We hung out in Maboneng for the rest of the weekend, not doing much. We did watch a romantic comedy, ‘2 days in New York’ I recommend it, Chris Rock and a lovely French actress. Lovely because she is French… 😉

#maboneng #jeppestown #jozi #cityart #graffity

#maboneng #jeppestown #jozi #cityart #graffity

I flew back down to PE on Monday night. It was an unexpectant pleasure getting into my own car after getting off the plane. In comparison to the vehicle I hired in Johannesburg, Elizabeth (I know I haven’t mentioned it before but that is what I call my car, Elizabeth the First, she is absolute royalty!) provides a very smooth responsive drive, and I had to stop myself from speeding all the way home to the flat in PE Central.

The week back has been work as usual. I have had iron on my mind. Specifically iron sulphate, really how much is too much? A few weeks ago my HOD had asked me to put together a presentation for the weekly physician’s meeting on Thursdays at LVH. I was to talk about a young lady who we had admitted a while ago (I wrote about her in a previous blog post ’12 phone calls’). After an argument with her mother she had swallowed 120 ferous sulphate tablets. Acute iron overload.

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Having brushed up on the 5 stages of iron toxicity and the management thereof I put the finishing touches to my presentation after I got back from my little break. On Wednesday my HOD told me that he would instead be presenting at LVH on Thursday. A different case, a teenager seen at our outpatients’ clinic with hypogonadism, low testosterone and underdeveloped secondary sexual characteristics. He thought that this case was more interesting and a better option for presenting at LVH, representing our hospital and all of that. The young man in question has a pituitary adenoma (tumour). I was in attendance at LVH when my HOD did his presentation. “Break a leg” I said to him just before he was due to speak. He didn’t get it…

The lady who had overdosed on iron tablets remained as an in-patient at Dora for 8 days, on admission we had given her copious IV fluids and an IV deferoxamine infusion. She had remained clinically stable and her blood results (particularly her liver function tests) had improved significantly by the time I discharged her home (on the HOD’s orders).

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We have a patient in my ward now who was admitted a couple of days ago with an assessment of symptomatic anaemia. Her haemoglobin level was 3.7g/Dl (normal is approximately 11-16). Her blood results show above normal iron levels and her ferritin is sky high. Chronic iron overload. Being a newfound expert on iron toxity I have her on a daily deferoxamine infusion to get the iron levels down. She has also received a blood transfusion to increase her haemoglbin levels. However she has obviously been bleeding for a long time and taking iron tablets to compensate for it. We will need to find the cause of the chronic bleed before we discharge her.

On Wednesday night I ran an 8km time trial at Charlo running club, 36mins 46secs. Happy with that. Nothing like getting a bit of speed work in, and a bit of lactic acid in the legs. This morning (Saturday) I did a 15km road race in 1hr 10mins. Happy with that too. On Sunday I am on call. While a I’m not unhappy about that I am not overjoyed either…

 

 

 

 

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There comes a time in every man’s life…

I spent last Thursday afternoon frantically scouring Port Elizabeth’s malls (both of them! 😛 ) for a clothing shop that would have a french cufflink shirt. Having finally found it (Edgars, Walmer Park Shopping centre. They saved my life!), I spent Thursday evening ironing said shirt. Anyone who knows me knows I’m a T-shirt, shorts and slops kinda guy. Outside of work, it takes a lot to get me to wear closed shoes or anything resembling formal wear. This however, was a special occasion, Rodney my best friend was getting married the next day! I packed a bag for the weekend and having taken leave for that day, got on a plane to fly to Johannesburg early the next morning.

 

Friday morning was frantic,  8.15am landing time, getting into town, getting to the car rental company, and being very disappointed with the service-“What?! ’95 Ford Tracer, ok fine! You want it back by tomorrow morning?! Jeepers, I’m here for the whole weekend… fine then!” (Never using that company again!) then going to pick up my girlfriend, and date for the big event. While all of this was happening, 2 phone calls from the best man very calmly saying (while probably visciously swearing under his breath!) “Pascal, how far are you? …alright see you in a bit”, and a third phone call unbelievably, requesting that I drive to Melrose Arch and purchase 2 bouquets of flowers. All of this before having to get onto the road to Haartebeespoort,  for a 14.00 start of the ceremony at the venue! What I would give to be just slightly (read: a lot!) more organised (insert emotive AAARGH!!)… All of that sorted, I finally got us onto the R512 to Haarties,  arriving at Red Ivory Lodge, the venue for this much awaited event with barely an hour to go before the scheduled start of the ceremony.

 

I walked into the Alexandra suite to find a dazzling collection of groomsmen, all dappered up and putting the finishing touches to their outfits-a final polish of the shoe, an adjustment of the tie etc. Ngoni, Rodney’s brother and best man handed me my own groomsmen suit. I was dressed in a few minutes (my shirt did have to be re-ironed, having not quite survived the trip) and there we were, tailored suits, cufflinks and the distinct feeling in the air that a chapter was about to come to a close, and our friend was about to embark on a new journey… There comes a time in every man’s life when he must forgo the things of youth, the frivolousness and abandon. He must take the plunge, make a commitment and choose a partner for life. Rodney had done this a while ago (their relationship is about 6 years-strong), but this would make it official.

 

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Rodney and I first met when we were both first year students at Wits university, we stayed at the same residence. Our first few encounters consisted of heated arguments about rugby, specifically that year’s Tri-nations tournament. That was 12 years ago. I don’t have another friend that I have known for that long. Despite my somewhat selfish nature (I spent most of the time during our varsity years buried in my books trying to become a medical doctor, and although I have come out of my shell somewhat since qualifying, I’m still not really Mr Sociable and Out-going) when I wasn’t stressing out about the next exam or just the sheer workload of the course I could always go and see him, or during the tough times I could always count on him for an encouraging word. He’s a really good guy, of strong character and he places a high value in his friendships. I have never been part of a bridal party before, never been asked to be one of a few to stand next to someone as they tie the knot with their chosen one. So this event was quite special to me, almost overwhelmingly so. It’s a good thing he didn’t ask me to make a speech or anything as I would have gotten quite emotional!

 

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I first met Mandisa, Rodney’s girlfriend-now-wife not too long after they started seeing each other. Attractive,  intelligent, also of strong character I noticed that she quickly became very important to him. I felt she challenged him somehow.  All these years later here they were, about to be married. It absolutely warms my heart to see my friend so happy and about to take this big step. The ceremony was something quite special, Red Ivory has a chapel, the front of which is open and looks out over a picturesque veldt area that provided a beautiful backdrop to the scene of the blessing of their union. The reception afterwards was a good, fun party. I was horrified a few weeks previously when we had been informed that the groomsmen and bridesmaids would have to  do a procession, consisting of synchronized steps during the reception. This is because my coordination is somewhat lacking, tending towards non-existent! Thankfully though the steps were pretty simple, dumbed down I think quite possibly because I was part of the bridal party! 😛 That part of the evening went off relatively smoothly, I think (and I stand to be corrected) that I may have only missed a step or 2 during our 10 minute performance,  no more or less than any of the other guys…

 

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Rodney’s brother Brian, and also Rishon, a good friend of his each said a speech about the man of the moment, and Jacqui the bride’s best friend also had a turn at the podium. None of the speeches were as embarrassing for the groom and bride, as one would have liked for the sake of entertainment but there you go,  you can’t have everything in life! 🙂 Good times were had by all. Friends and family had come from far and wide, as people will do for such an event, and everytime the dance floor was opened there was no shortage of bodies moving and swaying in merriment.

 

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Let me not to the marriage of true minds, blah blah blah… I could go on, I am a hopeless romantic, but that weekend came and went, and what a great couple of days it was. Definately worth the trip! You haven’t travelled I think, until you’ve travelled for friends. Sunday evening came and I was on a plane back to PE, to have to face work at the hospital again the next morning. For my friend,  Sunday and Monday both came but he wasn’t the same. No longer a single man but now half of a newly married couple. Ain’t life (and love) grand? 😉

 

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