MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'other things amanzi' source. Thu, 08 Jan 2009 11:39:05 +0100 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/504639233/finalist.html i am a finalist in the literary category!! obviously capitals are not a prerequisite.but actually i'm honoured and inquisitive about how i compare to my very excellent co-finalists. now, believing as i do that the only thing worse than a politician is a lawyer, i morally can't campaign actively for my readers to vote for me. however, what i will say is that if you truly think i deserve this honour, please do vote.for those who don't know my writing, i have decided to select a few posts that i thought weren't too bad.how to wake up.what to wear.what not to do in front of the prof.an icu patient.a student's story.a south african perspective.anyway, please only vote for me if you think i actually deserve the award. if not, please vote for whoever you think does deserve the award. (Source: oth... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=2087539 Tue, 06 Jan 2009 05:00:00 +0100 2087539 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/501011660/tribute-to-friend.html rest in peace. (Source: other things amanzi) other things amanzi blogs http://www.medworm.com/rss/comments.php?id=2075667 Fri, 02 Jan 2009 05:00:00 +0100 2075667 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/500093599/new-year-triage.html triage is taught to us all, but unless you find yourself in a war, you don't use that skill too often. when it is needed, somehow all those lectures don't seem to help.i was working on new year's eve in casualties in qwaqwa. the local population was about one million and the average income was pretty much on the bread line. the bread line, for those who don't know, is way above the alcohol line and significantly above the knife line. there was no shortage of drunken stabbings.as can be imagined, that night was busy and the later it got, the busier it got. the early evening was only much worse than an average night. but by ten pm all hell had broken loose. the stab wounds started coming in. initially they came in at a rate of about one every twenty minutes, but soon they were walking or bei... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=2075668 Thu, 01 Jan 2009 05:00:00 +0100 2075668 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/499235130/breaking-news.html there is a fair amount of talk about how to break bad news. truth be told i think i'm fairly good at it. sometimes, however it can leave quite an impression.i was a community service doctor in qwa-qwa. i was working in casualties when they came in. two young children had been playing on the side of the street with a spinning top when a drunk driver came careening off the tar and ran them down. apparently in his drunken state he couldn't negotiate the turn.the patients were cousins. we shuffled them both into the resus room and closed the door. one was about four and the other was six. the bigger one was dead. the smaller one had only minor abrasions. we covered the body of the big boy and cleaned and bandaged the wounds of the little boy. then we waited for the family.a side story here was... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=2075669 Wed, 31 Dec 2008 05:00:00 +0100 2075669 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/498851564/beautiful.html another trip to the kruger produced a beautiful sighting of the above lion. her face is stained by the remains of a dead hippo that they were scavenging off. she walked so close to the car that i actually had to stop taking photos to quickly close the window just in case she decided to have my arm for dessert.the above picture is what remains of the hippo after two days. the lion still monopolised the carcass but the trees were heavy with vultures patiently waiting their turn. the maggots had also had a good innings.it is difficult to explain how cleansing for my soul a visit to the park is. suffice to say it is. (Source: other things amanzi) other things amanzi blogs http://www.medworm.com/rss/comments.php?id=2075670 Tue, 30 Dec 2008 05:00:00 +0100 2075670 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/493284743/it-flows-in-blood.html there is something about being african. there is almost a covenant between the land and the individual. it is not something you can avoid or ignore. it flows in the blood.true sometimes i consider whether i should leave, based only on the fact that i may one day pick up a not-so-stray bullet like so many of my patients, but somehow i know i won't. everything is messed up (thank you anc) but somehow i live under the delusion that staying may just be better for the country than leaving.the real reason i wanted to post quickly was just to link to a great post on a most excellent site that shows the beauty of this land that does indeed flow through my blood. (Source: other things amanzi) other things amanzi blogs http://www.medworm.com/rss/comments.php?id=2062179 Tue, 23 Dec 2008 05:00:00 +0100 2062179 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/487081945/best.html when i was a registrar i used to tell my students that all surgeons believe they are the best surgeon there is. with only limited logic one can clearly see this is obviously a load of rubbish. how can every single surgeon be the best there is...when i am the best!! for some reason they always laughed.there has to be a certain self confidence in a surgeon's work. and yes sometimes it does flow over into arrogance. i knew this before i really knew this. i was still in my community service year and had only just decided to do surgery. one of my old friends was a medical officer in the surgery program at tukkies so i went to pretoria to discuss it with him. to be honest he spent most of the time just speaking about the primaries he had just passed and was of little help to me. then he told a s... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=2040843 Wed, 17 Dec 2008 05:00:00 +0100 2040843 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/486287851/weblog-awards.html once again i'm humbled and amazed. let's face it i'm more amazed than humbled (i am a surgeon after all). but i've been nominated in two categories for this year's medgadget medical weblog awards. they are:Best Medical Weblog The Best Evidence in Emergency Medicine Investigator Group Edwin Leap, M.D. Ivor Kovic, M.D. other things amanzi Running a hospital Science-Based Medicine ScienceRoll Unprotected Text and:Best Literary Medical Weblog Notes of an Anesthesioboist other things amanzi Reflections in a Head Mirror Rural Doctoring Science-Based Medicinetake a look at the amazing blogs i have the priveledge of standing next to. to be honest i think the best blog award is a far cry for me. i semi-wonder if i have a chance in the literary category, but time will tell.i suggested they make a ne... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=2040844 Tue, 16 Dec 2008 05:00:00 +0100 2040844 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/476965385/textbook-case.html what the textbooks say and what happens in real life do not always agree fully. for one, the textbooks are seldom funny.i was on call. a slam dunk came in. he had a two day history of sudden onset severe abdominal pain. clinically he had a rigid abdomen and x-rays confirmed free air under the diaphragm. not that it changed the decision, but he was also feverish and his white cells were through the roof. it was clearly a perforated peptic ulcer with generalised severe peritonitis (his stomach had burst and everything inside was rotten). the only question really was how had he managed to survive two whole days without seeking medical help.i informed him he needed an operation. he said no. i was astounded. i pushed on his abdomen again. he went through the roof. i explained that there was cle... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=2018544 Sat, 06 Dec 2008 05:00:00 +0100 2018544 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/476094856/panel-of-experts.html my blogger friend enrico managed to hijack doctor anonymous's blogtalkradio show this morning. he invited me as a member of what he termed a panel of experts. i think i was there for the comic relief, but i was in the midst of giants. the other experts were ramona, dr val and mother jones. later vijay phoned in too. it was great fun. thanks enrico! (Source: other things amanzi) other things amanzi blogs http://www.medworm.com/rss/comments.php?id=2018545 Fri, 05 Dec 2008 05:00:00 +0100 2018545 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/474973019/doctors-for-africa.html a previous minister of health (who was then married to the present president of the anc and the future president of this country. can you guess who it is?) made the comment that she wants to train african doctors for africa. then she proceeded to degrade the degree. after all, life in africa is cheap and africans don't need quality health care. i couldn't help thinking back to my own experience of african doctors for africa.in the apartheid era russia was kind enough to train a few doctors up for africa. interesting to note that their qualification was not recognised in russia. they were only good enough to treat africans. i worked with a few of them. here follows one story.she was a russian qualified doctor. she had been chucked out of a surgical registrar post at medunsa (who gets chucke... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=2014073 Thu, 04 Dec 2008 05:00:00 +0100 2014073 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/464225946/out-of-benoni.html when charlize won her oscar, south africans weren't surprised that a fellow south african achieved such a great thing. what we couldn't believe was that benoni could produce anything even remotely worthwhile. having said that i actually know of the other good thing benoni produced (yes, there were only two).when i left school, my headmaster taught me never to look down on someone who actually might still achieve something in his life. the way he did this is that he wrote me a letter. in that letter he said;"you are a lout! your five years in this school have meant nothing and you will amount to nothing in life." just in case i didn't get the message (i think he thought i couldn't read) he wrote a letter to my father. in that letter he said;"your son is a lout! his five years in this school... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1985536 Mon, 24 Nov 2008 05:00:00 +0100 1985536 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/462072399/words.html as a rule i don't swear at people (not at people) but like every rule, there are exceptions. sometimes the frustrations of old were too much to take.i was working at 1mil (the military hospital in pretoria). because the calls were so light we were required to lessen the load of the guys at kalafong (hell). so on the day in question i found myself stalking the cold corridors of kalafong. to make it worse, my students made themselves very scarce despite numerous attempts to contact them.late that night a gunshot wound abdomen came in. now abdominal gunshots roughly fall into two categories. the first group are hemodynamically stable. that is to say they are not trying to die at that exact moment. usually they will deliver numerous bowel perforations that can be sutured at your leisure while ... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1981622 Sat, 22 Nov 2008 05:00:00 +0100 1981622 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/458666860/african-dream.html i had been working too hard and long hours. i found that i was a bit irritable on the whole. usually i enjoyed talking to people and hearing about their hopes and joys, but i found myself rushing through consultations. then an old couple came in. he needed a hernia repair but had no medical aid. they had heard i did some work in the state and wondered if i could help. i explained that i could not book my own patients there but would do operations at the request of the normal state staff. i was willing, however, to put in a good word for them. shortly thereafter i found myself waiting to get the relevant state doctor on the line. so we got chatting.they lived in a small flat and it apparently drove him mad. you see he was born on a farm and had farmed his whole life. he went on to tell me t... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1976337 Wed, 19 Nov 2008 05:00:00 +0100 1976337 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/456540886/faceoff.html in surgery you work with what you are presented with. sometimes you simply don't have a choice but to try amazing or ridiculous things. i have mentioned my weird sh!tometer (here and here) but this is another one that scored highly.he was mentally retarded, or so his siblings said. i actually thought he was just a bit slow of thought but had been rendered useless to society by years of being told that he was mentally retarded. he presented to us with a skin cancer (squamous) on the forehead. but it was no small thing.it had apparently been growing for a few years. his caretakers elected not to take him to a hospital for medical treatment because they felt that evil doctors would use him as a guinea pig because he couldn't "think for himself". so they left it to grow. finally when the smell... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1969858 Mon, 17 Nov 2008 05:00:00 +0100 1969858 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/446253623/i-am-not-special.html just when you get a lift life tends to slap you in the face again.the state hospital was supposed to get a surgeon. all indications were that he was supposed to start on the first of the month. the medical officers booked elective cases for him to do with excitement and anticipation. the first of the month came and the first of the month went, but no surgeon turned up. the poor medical officers now had the nasty problem of having a whole bunch of people needing operations with no one to operate them. they phoned me.i could not do all the operations. not even close. but i told them that i would try to make myself available on tuesday afternoons. they just needed to book the most critical cases and i would do them. they organised a typical state thyroid for the first tuesday. (not quite as b... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1945623 Sat, 08 Nov 2008 05:00:00 +0100 1945623 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/445793610/i-am-special.html sometimes it is good to get a bit of recognition. if you don't the job can sometimes slowly erode away at your spirit. so recently i got a boost and i think my spirit may be good for a few more calls.one of the state hospital doctors invited me out for a casual get together to celebrate his birthday. most of the guys i work with when i help out there would be attending so i thought it should be fun. the night started off slowly. i sat with the man of the hour and his girlfriend and two of their friends from the real world (not medical). i concentrated on their conversation, sedately sipping my beer. i was the outsider and i didn't want to draw attention to myself. then the doctors started dribbling in. the senior guys came over and greeted me. the house doctors would occasionally nod an ac... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1943783 Fri, 07 Nov 2008 05:00:00 +0100 1943783 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/437279440/rumours.html as i've already said, the small community of registrars in pretoria tended to lend itself to gossip. i had been the brunt of rumours and rumours of rumours a number of times so generally i just ignored juicy stories about other people, especially if they were friends.and this was what i did when rumours started doing the rounds about one of the registrars of urology. she was an enigmatic girl with a fast mouth and a vibrant personality. she also fell gently upon the eye. i counted her as a friend. so when someone let slip that she was having an affair with a registrar from another discipline i quickly said i was not interested in even listening to these stories. people stopped polluting my ears with this foul gossip.then one day someone came up to me."bongi what's this i hear about you?" i... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1921526 Thu, 30 Oct 2008 04:00:00 +0100 1921526 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/436319739/gossip.html the community of registrars in a university like pretoria is small. a small community is nice, but it is always important to remember whatever you say will probably find it's way back to the person you are gossiping about.i was rotating through orthopaedics. rotation generally is not too much fun and ortho was no exception. finally they allowed me to operate. they put together a list of wound inspections and secondary closures and the like, claiming they would handle the ward and clinic (later i found out they used the opportunity to take an early day and go and play golf). anyway, there i found myself all on my lonesome, closing some wound on a forearm in the company of a green anaesthetist that i'd never met before. i tried to be friendly and i thought it was working. i was making small ... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1918436 Wed, 29 Oct 2008 04:00:00 +0100 1918436 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/431592630/so-clever.html i'm not the brightest. pregrag took a lot of studying just to scrape by. surgery nearly caused pressure sores on my butt. so i always assumed i was fairly low down on the surgical iq pecking order. we at pretoria knew we could operate better than most of the other universities, but how could we compare to a place like uct (cape town). those guys we knew didn't nearly get our operative exposure. we just assumed they used all that extra time cracking the books.i remember a registrar's symposium i went to where they presented. at some stage a zim registrar asked a pretty poor question. the uct guys answered, but the zimbo wouldn't accept their answer (mugabe-like???). the uct guy calmly pulled the mike forward and said,"i suggest you go back to your books!" i was impressed. i knew the zim guy... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1908046 Sat, 25 Oct 2008 04:00:00 +0100 1908046 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/423061282/big-five.html unlike the perception that some first worlders have about south africa, there are not wild animals walking the streets and there are not attacks every now and then by said animals (except for my cousin who was eaten by a crocodile. that is a bit too close to be discussed on my blog though). however i'm starting to have my doubts too.quite soon after moving to the lowveld i treated a patient that was bitten by a hippo. let me assure you that that is no small bit. i think it is remarkable to survive something like that. then there were the two crocodile attacks. the one actually had a tooth embedded in the arm. it seems that crocodiles often loose teeth. to them it doesn't matter because they can replace their teeth right through their lives.but it seems recently we are working through the b... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1883902 Thu, 16 Oct 2008 04:00:00 +0100 1883902 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/418892211/i-smell-drunk-people.html it's funny how smells can be so emotive. i have spent a fair amount of time in the state hospital lately. and going through casualties the smells were so familiar. it is a smell common, it seems, to all state hospital casualty units that i've ever worked in. and somehow alcohol is the constant thread.i'm not talking about smelling alcohol on the breath of an aggressive family member, although that is also something one does see (or smell) a lot of. but it is so much more than that. i'm talking about the residual smell of alcohol laced bodily fluids after a busy trauma night. it is a smell that is resistant to being washed out.it's difficult to explain but the smell left me with a longing for days gone by when i was the surgical resident on the floor. i was the guy placing the nasogastric t... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1871340 Sun, 12 Oct 2008 04:00:00 +0100 1871340 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/416097354/tumble.html i know a bit about ballistics. it's more practical knowledge. i've seen enough gunshot wounds to pick up something here and there. the high velocity ones wreak havoc inside. the more usual 9mm doesn't compare but a well placed shot is still devastating. and then you get the exceptions. ricochet shots can be confusing. they tend to take strange paths through the body, sometimes following dissection planes (like surgeons) and causing less damage than you'd expect. and then you get the tumbler.i did a tumbler recently. it wasn't a particularly high velocity projectile. the bullet didn't even make it through the patient. the entrance wound was just below the rib edge to the left of the midline. i could feel the bullet under the skin just below the right arm (bullets that are palpable just belo... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1865952 Thu, 09 Oct 2008 04:00:00 +0100 1865952 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/410582371/kruger-weekend.html well i had a great day in the kruger park (also mentioned here and here). besides the Buffalo, elephant, rhino, leopard, crocodile, hippo, kudu, bushbuck, nyala, etc that i saw, i also saw wild dog. and not just saw but followed a troop with about 8 pups for about 30 minutes. what an experience. it was wonderful. (Source: other things amanzi) other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1851496 Fri, 03 Oct 2008 04:00:00 +0100 1851496 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/408997673/specialise.html recently i had two experiences which once again reminded me that the public and medical people have contrasting views of what a general surgeon is. most readers of medical blogs would at least have some idea of what it takes to become a general surgeon, but joe public out there does not.in the first post in sid schwab's series on deconstructing an operation, he mentions a light hearted exchange in the scrub room between an orthopaedic surgeon and a general surgeon where the ortho refers to the general surgeon as a real surgeon. in many senses this is true, not to detract at all from the other surgical specialities. but at least in my neck of the woods, when your chips are down and your life hangs in the balance, it will be a general surgeon trying to save you (severe head trauma is the exc... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1848347 Thu, 02 Oct 2008 04:00:00 +0100 1848347 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/405986485/where-in-world-is-dr-val-haunted-by.html ian over at wait time and delayed care asked the question on almost everyone's mind. where is dr val? i say almost everyone because i don't include myself. you see i know where she is. she is hiding out (cyber hiding anyway) in south africa but i have no doubt she'll soon be gone. so while she's here let us be entertained by yet another one of her guest posts. for those familiar with my blog, i did permit the great dr val to use capitals on my blog, so this is a first.Haunted By Inaction By Val Jones, MD When I was a medical student rotating at a hospital that shall remain unnamed, I witnessed a medical error that has haunted me ever since. I was partnered with a team of residents in the inpatient pediatric unit, and late one night a two month old baby was accidentally infused with an enti... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1837904 Mon, 29 Sep 2008 04:00:00 +0100 1837904 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/405407699/pseudoaneurysm.html there is nothing pseudo about a pseudoaneurysm except that it is not actually an aneurysm. where an aneurysm expands the wall of a blood vessel, in the pseudo variety the blood escapes from the vessel altogether creating a ballooning of turbulent blood flow outside the vessels constraints. both may burst, but, seeing that the one in a sense has already burst, when it bursts again it is not an understatement to say this is not a good thing. at that moment you hope there is someone who knows what to do. or in other words you are not in rural south africa.it was during my witbank days (way back when i started blogging). i was up in my office (a thing no self respecting surgeon should ever have) trying to fend off the boredom, probably by blogging, when the call came in. it was the radiologist... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1837905 Sun, 28 Sep 2008 04:00:00 +0100 1837905 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/403415986/byeboer.html my good blog friend ramona suggested i do a post about my other interest, beekeeping. one story immediately sprung to mind which sort of connects to surgery.i was in my vascular rotation. it was busy. we did 15 calls a month and the days were really full. yet, somehow, in my off time, i made extra money by removing wild beehives from people's houses. naturally most of this work was done after hours, when the sun had set. this is the best time to work with the somewhat aggressive african bee so it suited me fine.then one monday the theater list ended up being cut short due to a lack of icu beds (a common problem in our neck of the woods). this gave me a few hours off that afternoon before i had to be back for the m&m meeting (morbidity and mortality meeting). it seemed ideal to quickly ... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1829789 Fri, 26 Sep 2008 04:00:00 +0100 1829789 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/399110783/old-rural-surgery.html one of my friends was sent to a homeland hospital when he did his military service (the old regime bolstered the homeland hospitals with whatever doctors they had at their disposal, which somehow makes the present government's totally disasterous management of the department of health seem so much more ironic). anyway, having spoken about war doctors, albeit in a different context, and also about my anesthetic escapades, i thought i would relay this typically south african story. (to be honest, eish reminded me of it with his last post too.)the hospital was in the middle of nowhere (ok it was slightly to the left of the middle of nowhere, but you get the idea). when he arrived for his first day he was surprised to find that almost everyone was still on leave. only the superintendent was st... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1813032 Sun, 21 Sep 2008 04:00:00 +0100 1813032 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/398433575/cyanosis.html it has been a very long time since i gave my last anesthetic, but i still don't think blue is a good colour. i was reminded of this recently when one of my gastroscopy patients developed laryngospasm. he turned out fine but blue patients tend to age me quite a bit.when i was a student i found anesthetics boring. that is because i didn't really know what was going on. when i was a comm serve i started off in anesthetics and was soon the number three in the department in our small hospital. in fact for that entire year i was considered an astute giver of gas to my great dismay. i was on the wrong side of the action on all calls.i had been in anesthetics for not too long, but long enough to develop adrenal hyperplasia. i was on call and had to dope for a common or garden caesarian section, ob... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1811647 Sat, 20 Sep 2008 04:00:00 +0100 1811647 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/395591231/sign.html those of you who follow this blog will know that we had an interesting prof. some might say eccentric. others might say idio(t)syncratic. whichever, there were interesting stories associated with him.the prof demanded total silence during any operation. the silence was so absolute that the prof himself would not speak, not even to ask for instruments. he had hand signs which he used to request the next tool of his trade. his eyes never left the operation field and the sister had to make sure she palmed the instrument to him correctly if she didn't want to fall foul of the prof's sharp tongue. one incident delivered an exception.it was an auspicious occasion. the prof was going to demonstrate the correct way to do a haemorrhoidectomy. he insisted that the whole firm was there to see how it ... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1803237 Wed, 17 Sep 2008 04:00:00 +0100 1803237 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/389076747/last-goodbye.html this is a story i considered not telling. somehow it comes too close to how we deal with the constant tragedy of life we are exposed to, both positively and negatively. then a post by buckeye reminded me of it.the rotation through the military hospital was interesting in that the slog work was done by relatively junior doctors. that night one of them admitted a patient with abdominal pain. to be honest i didn't pay too much attention in the handover because he was admitted to another firm and that consultant would surely handle whatever the problem was.late that afternoon, when the relevant consultant was no longer available, the medical officer of his firm asked me to evaluate the patient. the first thing that struck me was that the patient was in excruciating pain, yet his abdomen was so... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1783247 Wed, 10 Sep 2008 04:00:00 +0100 1783247 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/386136001/injuries.html every sport has its injuries. so the saying goes. and surgery is no exception.it was a thyroidectomy for multinodular goiter. not like the monsters that the state was inclined to deliver, but a routine straightforward private thyroid. the only catch was that she was hiv positive and not on antiretrovirals. the cd4 count was low but acceptable so i went ahead.the operation went without any hitches. quite soon i found myself placing the last skin sutures. and then... i stuck the needle into my finger. let me assure you, that is not the greatest feeling.anyway, before the next case the first dose of antiretrovirals had passed my lips and i felt slightly consoled. only slightly.the month flew by quite quickly actually. the only side effect i experienced was diarrhea but, truth be told, that wa... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1773462 Sun, 07 Sep 2008 04:00:00 +0100 1773462 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/382733389/supplies.html i did my house doctor and community service years in a historically significant place. during the old regime the government deemed the area independent as part of the great apartheid madness. to maintain the façade the apartheid government ploughed money into this pseudo-country. even after all the officials had taken their cuts there was still enough left over to keep the hospital well stocked. when i worked there, after the fall of apartheid, all this had changed.this 'country' became a small region in one of the 9 provinces of south africa. provisions came from a central depot. they were trucked in and there was no exchange of money locally. the bribe industry really struggled for a while. but people are ingenious. soon the trucks started turning up with very little. apparently they le... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1764574 Wed, 03 Sep 2008 04:00:00 +0100 1764574 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/379575135/arte-y-pico.html ruraldoctoring has bestowed upon me the arte y pico award. she praised me with possibly the nicest words ever spoken about my blog. i quote:"One of the best writers in New Media Medicine, his posts are both gripping and intensely moving. He's like a blogging Joseph Conrad."the rules of the award are as follows.Here are the rules: You have to pick five blogs that you consider deserve this award in terms of creativity, design, interesting material, and general contributions to the blogger community, no matter what language.Each award has to have the name of the author and also a link to his or her blog to be visited by everyone.Each winner has to show the award and give the name and link to the blog that has given him or her the award itself.Each winner and each giver of the prize has to sho... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1750657 Sun, 31 Aug 2008 04:00:00 +0100 1750657 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/379961168/jelly-tots.html sometimes i just post funny stories. sometimes you think of the ideal punchline before the moment has passed. on both accounts this post represents one of those times.it was one of many morning meetings. usually they were not fun. almost always the prof would have a go at someone. most of the time if you weren't actually directly in his cross hairs, you would just keep quiet and nod at the appropriate moment. this morning was no exception.fortunately i hadn't been on call the previous night so i was basically a passive, occasionally nodding observer. the guy who had done the call was a particular target of the boss. the boss didn't like him, but, even worse, he didn't seem to have the savvy to present his cases in a way that avoided drawing fire. this day was no exception.my friend's first... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1750656 Sun, 31 Aug 2008 04:00:00 +0100 1750656 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/376584077/mobilization.html like most surgeons i can't overemphasize the importance of mobilization after an operation. it is good on so many levels. the lungs enjoy it. the vascular system enjoys it. the bowels sure do enjoy it.ironically smokers mobilize quickly. it seems after an operation the only thing on their mind is that first drag. unfortunately you must make it to the balcony to get that payoff. no amount of pain will get in the way of a fully fledged nicotine addiction. there are less common motivations to mobilize in south africa.it was a normal call. then very late that evening my pager went off. it was mamelodi hospital. as usual they were phoning about a gunshot would. actually there were two but they were exactly the same. both were through the right iliac fossa area and both turned out to be caecum i... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1739792 Wed, 27 Aug 2008 04:00:00 +0100 1739792 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/375599972/old-school.html sometimes old school surgeons are interesting to watch. one of my 'mentors' was a real study. he came across as hard and even cruel. and yet there was no one who truly cared for his patients as much as this man. you had to know him quite well to be aware of the fact that he cared so much. he usually hid it well.the patient had stomach outlet obstruction due to benign stricture. the consultant in question decided that a dilatation would be a better option for the patient as he could therefore avoid an operation with all its associated morbidities. he told me to get it done.the gastro unit at that hospital was not fully functional so it came as no surprise to me that they said they didn't have the necessary equipment to dilate a pylorus. i knew my consultant was not the type of guy to let tr... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1734629 Tue, 26 Aug 2008 04:00:00 +0100 1734629 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/369404143/collateral-damage.html i'm not a war doctor. well not in the truest sense of the word. but sometimes i think there are similarities between whatever it is i am and a war doctor. i'm not talking about the fact that i have operated more gunshot wounds than i can count because of the amazingly high crime rate in our country, although that is probably part of it, but i'm talking about being first hand witness to collateral damage.when the new government came to power they decreed that no state doctor could do private work. bearing in mind almost all state hospitals were run by private doctors, in on fell swoop they got rid of almost all their senior doctors. they realized their mistake, but it was too late. those doctors did not return. the next plan was to import doctors from cuba. but having doctors from a somewha... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1717971 Tue, 19 Aug 2008 04:00:00 +0100 1717971 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/364233593/aaargh.html some time ago i wrote a story about clothes (or the lack of them) we wear in theater. it was a strange post, stranger still because it was true and reflected something a bit too common in state hospitals in south africa. it is also one of my better posts (i think anyway). this is in the same vein.i was called to the state hospital. it was a gunshot wound through the liver. the patient had been transferred from another hospital and had therefore missed the so called golden hour. he wasn't feeling too spritely. my main problem, however (excluding the pringle maneuver and putting hemostatic sutures in the liver of course) was to find something to wear on my head. finally i found a discarded theater cap and, being in somewhat of a hurry, i donned it.as these things often go, i ended up packing... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1705203 Wed, 13 Aug 2008 04:00:00 +0100 1705203 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/362391223/swimmers-chest.html the following story isn't really mine, but because the meeting of the two protagonists happened in my presence during an event that i've previously posted about and because it touches on a very relevant south african topic, i thought i would pen it down.when i was in my training, a very good friend and i had the privilege of treating a pregnant woman with a gunshot abdomen (take a look at the incident here). when we took her back a private consultant who was associated with our firm offered to join us in theater. but he was no ordinary private surgeon. he was one of only a few hepatopancreatobiliary surgeons in town and a particularly good one at that. truth be told, the reason he offered to join us had to do with the fact that i initially thought that the hepatic artery proper had been sh... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1696704 Mon, 11 Aug 2008 04:00:00 +0100 1696704 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/356899506/aggression.html on a recent post greg p made the comment "this is a strange system of teaching over there. all stick, no carrot." this is true. those who have followed my blog will see that i don't have too many fond memories of my training. truth be told, most of us became punch drunk and developed certain survival tactics. most of these i look back on with regret. but at the time it was the way of things.we could do very little when we took beatings from our own seniors (except resign which quite a few did) but when attacked by other departments often all that pent up fury would come pouring out.i was in the boss' firm. i was the most senior registrar in the final phase of training. it was our call day which was also our clinic day. fortunately i had an orthopod rotating with me so we divided to be able... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1683772 Wed, 06 Aug 2008 04:00:00 +0100 1683772 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/353907409/surgexperiences-203.html welcome to another edition of surgexperiences!!!surgexperiences is a fortnightly carnival of surgically related posts in the blogosphere. so without further ado, let's see what's to be seen out there.t gives an absolutely brilliant piece about the effect of the inevitable on the treating doctors.We do feel it in the O.R., even after years in practice. A sad diagnosis cuts a wide swathe. Even with the patient anesthetized on the table, totally unaware of our presence and our sympathy, we express our pain and our care, in awkward murmurs and pregnant pauses. The dye seeps into our stories as well; the fringes touch and mingle. We are changed.t also gives us a more light hearted look at the 'scrubs' we wear.little karen brings back to mind the horror that is necrotising faciitis. as always we... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1677589 Sat, 02 Aug 2008 04:00:00 +0100 1677589 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/346170824/buff-and-turf.html the other day i read a post about the age old medical practice of the buff and turf. bearing in mind i also recently posted about icu, i was reminded of one of the worst turfs i ever saw.it was during my icu rotation. we were on morning rounds with the consultant when a medical technologist came running in."there is a major disaster in casualties. can someone please come as fast as possible to help?"naturally we all rushed over there. we were not prepared for what we saw.in resus was a patient in severe shock. he was extremely pale and had almost no blood pressure. his abdomen was severely distended and sported a midline scar which had been crudely closed with a running nylon suture. the picture that is forever impregnated into my mind is the blood squirting out between the sutures. there ... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1655928 Sat, 26 Jul 2008 04:00:00 +0100 1655928 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/345093679/im-on-my-way.html some lessons are learned the hard way. and it's no easier if you are thrown out to the wolves.i was in vascular, arguably the toughest rotation. i was doing 15 calls a month, most with little or no sleep. i was not having fun. so i was delighted when the powers that be (the general surgery prof and the vascular prof) made the decision that all stabwonds of the neck must be referred to the general surgeon on call first. if he made the assessment that it was a vascular problem then he would call the vascular surgeon. this would decrease the number of unnecessary referrals and slightly decrease our workload.so on a particular night when the casualty officer called me in the early hours for a stabbed neck, my first question was whether she had already spoken to the general surgeon. she informe... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1652921 Fri, 25 Jul 2008 04:00:00 +0100 1652921 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/344536359/surgexperiences.html once again surgexperiences will be hosted on my blog on the third of august. please get submissions in by the second of august. posts can be submitted here. also, for all those budding surgeons out there, anyone interested in hosting future editions of the only surgical blog carnival, contact the boss here.the theme is that there is no theme, so if you have a post that fits the theme, send it immediately!! (Source: other things amanzi) other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1649605 Thu, 24 Jul 2008 04:00:00 +0100 1649605 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/340152278/family.html my last post was about icu. while on the topic i couldn't help thinking about family and what that implies.i was the icu guy. as usual, late at night, i got a message from theater that i needed to make a bed available for a gunshot wound patient. as usual, i pretty much had to stand on my head to do this. as usual, it was a criminal that took a bullet through some organ that he probably needed and nearly died. and as usual one of my surgical colleagues pulled him through.he came in pretty messed up. he had lost a lot of blood and had gone into coagulopathy (the little bit of blood he had just didn't want to clot any more). then i heard his story.my patient and three of his friends held up and old couple trying to eek out a living as real estate agents. it was late one afrernoon when they f... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1639571 Sat, 19 Jul 2008 04:00:00 +0100 1639571 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/336386320/captive.html icu is icu is icu, but some icu stories could only happen in south africa.i was doing my icu rotation. the work wasn't so tough but the hours were long and we did one in three calls, so it became a bit tedious. part of the job was shuffling patients to make space for the next critical patient coming in. bed occupation was always 100% or more (makeshift icu beds were often created in side wards). so late one night i get a call that they are operating some guy the cops winged in a shootout. apparently he lost quite a bit of blood and would come in intubated. great, i thought. probably a bad man and i needed to perform almost a miracle to create a bed for him.sure enough, after transfering our most stable patient to another hospital, which required speaking to their superintendent, no small f... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1625988 Tue, 15 Jul 2008 04:00:00 +0100 1625988 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/319478469/pointless.html i've put off posting about a patient i once had in paediatric surgery because my writing could never justify how i really felt about him, but i suppose i should at least try.when i rotated through paediatric surgery, there was a memorable patient. let's call him k. when i knew him he was 2, but his story started long before that.k was one of a set of twins. for whatever reason his mother favoured the other one. this means she lavished what she could on his brother. what she could lavish was nothing more than food. k became very malnourished. around roughly their first birthday the mother decided she was tired of k, but how do you get rid of a baby? she decided to poison him. she gave this poor malnourished child something to eat that was supposed to kill him.i still don't know for sure wha... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1544535 Wed, 25 Jun 2008 04:00:00 +0100 1544535 http://feeds.feedburner.com/~r/blogspot/wuOP/~3/318704196/boere.html i love history. i am fascinated by where we come from and its influence on who we are today.from 1899 to 1902 two small boer republics held off the onslaught of what then was the local world power, britain. they had no standing army. they were basically a group of farmers fighting for their freedom. but they could ride and they could shoot. these days most of their descendants live in cities and have lost most of the skills of their forefathers.last week i went hunting with one that hadn't lost this connection with his past. he was brought up on the back of a horse and his father had taught him to place a bullet exactly where it needed to go from very young. to top it off, he lent me his 100 year old mauser, the same make of weapon that the boers had used in that war against the british so... other things amanzi blogs http://www.medworm.com/rss/comments.php?id=1544536 Tue, 24 Jun 2008 04:00:00 +0100 1544536