Freedom

Last Friday night I decided it was time to let my hair down; there was a huge concert playing in Johannesburg, aptly named the "Coke Fest" (I'm endlessly amused by double meanings...) and what better way to spend a warm evening than watching Korn and Muse play live in the company of 46,000 goth-influenced, strung-out-on-coke-and-what-have-you high schoolers? But, really, it was a blast. Apparently, plastic cups of warm beer and eardrum-piercing rock was exactly what I needed to smooth over the tensions of the past few weeks and remind myself that, after all, I don't always have to be the "doctor" - sometimes I can let go and just melt into the sea of punk rockers moshing away into the night. I went with Craig, a South African I met through friends; we both searched for Paris Hilton (though, really, with only the vaguest desire to actually find her), but settled for just seeing her boyfriend. Good Chariot is *fantastic*. At some point during the concert, I was momentarily startled by a young man (god, am I old?) with dark brown hair gelled into six foot-long spikes projecting straight up from his head. It could have been NJ.

As the days in 163 (the trauma unit) go by, I find myself settling into routine more and more, approaching the resuscitations with greater ease and peace of mind, taking on more difficult procedures and increasingly being able to work independently. In just three and a half weeks, I have placed seven chest tubes, countless drips and ABGs, set fingers and shoulders back into place (well...usually), and sutured everything from skin to - yes!! - a tendon. Of course, everything I'm doing is just a sampling of things to come, but spending long nights in the trauma unit has reminded me just how much I love this kind of work; despite the difficulties, I know that I am exactly where I've always wanted to be. Over the past three days I've been auditing an ATLS course at the Wits Medical School; it's an advanced trauma life support course for physicians, but medical students and nurses can participate fully (I'll just have to wait till next year to get my actual certification). The class was great, but most importantly, early this morning, something dawned on me. Yesterday was our "procedures lab"; we watched a brief video and then spent three cold hours in the animal lab practicing cricothyroidotomies, DPLs, thoracostomies, and venous cutdowns on euthanized pigs. Sometime in the middle of my second pericardiocentesis (you stick a needle into the membrane around the heart to evacuate blood), a thought suddenly struck me: just nine years ago, I first became an EMT, first became enamoured with the idea of jumping out of an ambulance, lights flashing and horns blaring. Just a short while ago I was a nervous teenager fiddling with suction catheters and oxygen masks, trying to look confident as I repeated the ABC's over and over in my mind. Now here I am, in Africa, practicing surgical airways! And, more importantly, this is just the beginning. I was proud for that moment, standing there, thinking, I set out to accomplish something - not anything extraordinary, but nothing guaranteed, either; and, I'm doing it. For a moment I felt the power of having direction, of having the will to chase dreams... is it really possible that my wildest fantasies could come true? Do I really have what it takes to make it happen? It was a great moment... and then the moment passed and I was left standing with a goofy look on my face, needle still in hand. People talk about doors closing as you get older... for me, I feel long hallways all around me; they're dark and sometimes lonely, but I can follow them anywhere. I can feel it.

Just a few years ago, I remember on one particularly dark evening telling my best friend Josh that I felt as though I was walking on a thin wire, surrounded by so much life but unable to reach out and touch any of it. I felt as though I was suffocating; I hated medical school, hated the mindless minutia drilled into us, hated the endless labs and lectures and obnoxious classmates who had studied biochemistry since they were two. I look back at those days and shudder; there was nothing overly dramatic about my words; I really did feel trapped. I realize now that my frustration wasn't so much with the curriculum, but with myself. I felt that I was following a path I didn't really want to be on, with no foreseeable way out. At that point, everything I had done in my life was more or less prescribed - high school, college, and now medical school. True, I had gone that way because of my own choices; no one forced me to become a doctor. I did however feel that I needed time - time to reassess, to see more of the world, to learn about myself; I felt rushed through life, as though I was running towards some goal in the distance that wouldn't wait for me... if I slowed down and took a breath, would everything fall apart? This year was about taking that time, learning and seeing what I felt I had been missing... would I come to regret my time "out"? Would I return disenchanted, bored, sick? My parents thought this was a terrible decision; my friends, for the most part, either thought it was dangerous or just didn't understand the point. But I went ahead anyway, because I knew I had to; over the years, I had allowed my soul to slip away from me, I had lost my muse and no longer remembered why I was doing anything. I took a stand and left... and now, standing in the trauma bay in one of Africa's busiest hospitals, ready to do the things I have only dreamed of... now I feel alive, now I feel accomplished, now I have remembered who I am and what I want. After all this time and hard work, I have finally regained the serenity I lost a long time ago. My dreams and ambitions don't make my life any easier, but at least I know that I have something to look forward to.

Just for fun, as long as I'm going on and on about dreams, I'm going to import my list of "greatest dreams" from Facebook... I'm posting it below. Dreams, of course, are fluid, and I'm sure that this list will change over time; also, it is by no means all-encompassing or in any particular order. But, it's on my mind, and since the point of this blog is to share whatever randomness my neurons come up with, here it is.

Greatest Dreams/ Ambitions:

- Spend a year driving across Africa, stopping to do medical work and photography and following the trail of Dr. David Livingstone. Maybe write a book along the way? Or at least take lots of pictures.
- Become a photojournalist for the New York Times... alternatively, freelance for Reuters.
- Move to Israel, live on a kibbutz in the Galilee, and work for an activist NGO promoting human rights and providing free medical care to immigrants, refugees, and Bedouins.
- Spend a year living in the Australian outback, working as a flight/ emergency doc in the bush
- Come back to South Africa and work as a flight doctor/ ATLS/ paramedic instructor for Netcare 911, the largest air rescue service out of Johannesburg
- Adopt a dog
- Become fluent in Spanish and Hebrew
- Put together a photography exhibit on the melting of cultures and religions in Jerusalem, my favorite city in the world (hmm... maybe this is something for next year?)
- Learn to drive stick shift... on a Land Rover... in Africa? Well, ok, at least learn to drive stick, damn it.
- Let myself fall in love again, even if it hurts... at some point I have to be willing to open up my heart again, right? Still waiting on that one...

Ok, that's it for now... more updates and, yes, photographs! to come soon. For now, it's raining, and it's Saturday, and that means I should be putting on gloves and a gown upstairs in the trauma ward. I'm ready.

You just can't make this stuff up.

I decided to take note of the particularly absurd occurrences in the Joberg trauma department... this is just from Friday night:

Psychologist: Hey, we're looking for a medical student to watch the psych patient while he has a cigarette outside
Me: You mean the violent one who tried to kill himself?
Psychologist: Yeah, him... we just need someone to watch him and make sure he doesn't do anything, because he still has his knife
Me: What?! Why don't you just take it away?
Psychologist: We're afraid he might be violent... anyway, is there a medical student around?
Me: No.

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Woman: Doctor, doctor, I have a baby
Me: Alright.... is something wrong with the baby?
Woman: Yes, i've had him for one month
Me: And.... is there a problem?
Woman: Yes, he's dead now.
Me: Uh, dead? Now? Since when?
Woman: Since yesterday, he has died. Do you want to see him?
Me: Uh... dead babies, right. That's pediatrics. I'll walk you over.

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Claire (resident): I went to get coffee out of the pantry, but someone stole it.
Me: Someone stole the coffee?
Claire: No, the pantry.

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Me (to a very intoxicated, bloody woman): Hi, ma'am, what happened to you?
Woman: I don't know
Me: What do you mean, you don't know? You have stab wounds all over you!
Woman: Then I guess I got stabbed

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True story: A woman came in, a transfer from a private hospital, with an external fixation (large screws) bolted to her tibia (long bone in the leg). It was nicely done, and there would have been no problem, except that it was actually her ankle that was broken. She was being transferred for "further management".

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In the trauma bays, we no longer have ANY functioning manual blood pressure cuffs or working batteries in the portable monitors. I went upstairs to ask Vascular to borrow one of their monitors so that we could take our patient to the CT scanner, and they just laughed at me. I guess it's funny if it's not your patient...?

Sigh. This is Africa.

Bed Days

A pounding headache shook me awake from the deepest of nightmares... I only remember gunshots, and then a steady pounding at the back of my skull, drowning out any further thoughts of sleep. I sat awake for hours, trying to breathing deeply, willing myself into a meditative trance... willing the pain to stop, praying to sleep, to pass out, anything... but there was only the pounding, waves of nausea, and a steady, pouring rain storm that shook my window and made the wind chimes scream. By six AM I found my migraine medicine, a dark green bottle I had left in Colin's room the night before; I swallowed more pills that I should have and crawled back into bed with strong tea and dark rye bread, vowing to hide under the covers for the rest of the day. That was lucky, because Colin's car died in the middle of traffic on his way to the hospital, forcing him to wait amidst angry, honking drivers and bone-chilling wind for AAA to jar it back to life. I woke up mid-afternoon to shower and register for next year's clerkships... the bathroom was flooded and the server was down. My scrubs are still soaked, waving pitifully on the clothesline after four days of rain; a long-awaited friend hasn't called and I have allowed my mood to darken inconsolably. There are days when we should all just stay in bed... though I do plan on getting up tomorrow.

Rain Dreams

There is a tense, distinctly palpable feeling of dread in South Africa, emulating the calm before a storm... serene, but teetering on the edge of chaos; you don't have to go out of your way for the experience. For the past week, the residence hall where I've been staying has had no electricity, and the (cold) water only came back on Tuesday. The toilets wouldn't flush, trash piled up, and, most disturbingly, security gates didn't lock. One of the orthopedics registrars (residents) offered to let me shower in their on-call room, but the idea of lathering up in the hospital wasn't the most appealing... I joked about setting up a basin in one of the trauma bays just before morning sign-out... "excuse me, guys, could you please get my back?". Well... it was funny, maybe you had to be there, but after three days of, essentially, camping, I decided it was time to move out. Colin's landlady, Michelle, offered me a room in her house and, after some confusion (and a very upset black Labrador retriever), I packed up my things and, with Colin's help, moved over. Michelle is South African and her husband is Greek, a fact that's confirmed by the myriad of aromas steaming (yes, literally) out from the kitchen. The house is beautiful... small, decorated in an eclectic Afro-European style, and complete with a sweet, hyper sausage dog and a very fluffy, horribly allergenic cat. My room looks out into the garden with a small, oval swimming pool tucked between an exotic collection of trees and plants... I'm in heaven. I have already been spending a lot of time at the house, hanging out with Colin on evenings off, so being able to stay here overnight is just an added bonus.

Work is more of the same... so much more that I'm shocked at my lingering empathy. Some stories look like they could have been plucked from season premiers of Grey's Anatomy, except that the drama seems secondary when you're dealing with real human beings laying out in front of you. A 35-year-old woman, Thembe, came in yesterday, hit by a car speeding along a side road... she had just turned 35, it was actually her birthday. Although she was "stable", her c-spine x-rays showed suspicious shadows and markings... a reconstruction CT demonstrated a c4-c5 avulsion that severed her spinal cord... in other words, in all likelihood, she'll never walk again. I assisted the orthopedic surgeon as he screwed calipers into her skull, attaching 7 kg of weight for spinal traction. She moaned quietly and asked me repeatedly to reposition her legs. I would have, except that they were already lying flat... she just didn't yet realize that she simply couldn't feel anything. I swallowed hard, and for once was greateful that I don't speak Zulu, that I had a convenient excuse to not explain the details. Her family came and left, obviously upset but not hysterical. This is Africa, this is what happens in Africa. It happens everywhere, really, but here it is so commonplace that the senselessness seems to be more the rule than an exception to it. I gave her 3 of morphine and her vital signs dropped... 115/70, 103/65, 92/55. I was nervous, watching the monitor, but held back on giving epinephrine.... after all, with her spine paralyzed, she had a diminished sympathetic tone... in other words, even her body was struggling to understand what was going on, struggling - and failing - to maintain her vascular tone. She was eventually moved upstairs to the ICU, and I pasted her ID sticker into my notebook, vowing to check up on her in a few days. Thembe's scenario disturbs me, as she is living out my worst nightmare.... just an innocent bystander, just walking, for god's sake, and now paralyzed. I think that I would rather be dead than paralyzed.

I pushed more morphine into her veins before they took her up, wishing her a drugged, dizzy sleep where she would dream of anything else. Then I went home, to my new, comfortable bed, and fell asleep nestled in a thick sea-green comforter. I dreamt of merciless rainstorms, pounding down on the earth, flooding it, drowning everything. I woke up, shaking but still dry; outside the ground was soaked, naked branches swinging in the passing wind. I shut my eyes for a few more minutes, willing Africa out of my nightmares.

Light Heart, Dark Tea

Dark, blue, sterile. You gingerly unwrap the tightly sealed package and the thin sheets come apart slowly, neat and elegantly balanced on a wheeled metal tray. You touch only the outsides as you pull on gloves; Snap, snap! Powder and latex cover your hands, too long at the fingertips, but you push them down, then ignore them. You glance up; the patient breathes rapidly, looks away; periodic cries from the monitor remind you that it's probably not working again, but you look anyway, hesitate. Back to the patient; jugular notch, three fingers down, nipple line. 4th intercostal space, just anterior to the midaxillary line... is that it? You palpate the ribs, push hard, run fingers along their smooth, dense bodies, rigid underneath the leathery skin. Is this right? Is it here? You pierce the skin with a thin needle, anesthetic seeping under the skin, fuffing it up like an enormous goose-bump. The skin swells, the patient moans, you pull back. Small scalpel blade, the length of a thumb, thin and razor-sharp. You hold it like a butter knife, loose gloved fingers pressing tightly against metal. Right here? You breathe, you cut. Pale, pink tissue gives way under darkest brown... you run the blade along slowly, smoothly, then press harder. Once centimeter... two... four. Crimson drops obscure the view, but that's it, the blade is nearly through. "Forceps!" You're handed a needle driver. There are no forceps. You breathe again and push the blunt metal hard against the incision, pushing through, pushing further through. The patient moans... more anesthesia? No, he's supposed to scream. You push again, then remove the driver and feel with a gloved finger... there is only muscle, so much of it, so thick, hard, nearly inpenetrabale. You push again, harder this time, putting your entire body weight into a trembling hand. You feel as though you're going to fall into his chest, fall into the tiny cavity made larger by the brutal dissection, and still, you're not through, there's more muscle. Deep breath, push again. And then, ah!! You're in, your wrist collapses against his chest as the blunt dissector finally punches through; there is blood, dark, deep, running over you, over the bed, onto the already darkened floor. Quickly, reach a finger in... clots, strings, ribs... you feel hard pulsations reverberating through the lung, barely palpable at your fingertip... it is partially collapsed, and there's blood, so much blood. You pull back, and a thick plastic tube replaces the digit; you release the clamp and blood is allowed to run through, bubbling at the base of the collector. Crouching down, mesmorized by the swinging indicator, you watch the water seal closely. You're in, you're through. Several sutures in, and you're on to the next patient... another chest tube, another ABG, another line. They come through like soldiers in an inexplicable war without a front line, leaving their scent, parts of themselves. Blood, sweat, saline, everything everywhere. You come home to wash but it's still there as you try to sleep... there are dreams of blood, dreams of dark raptures circling overhead. We are like scanvegers, competing for procedures over prematurely slaughtered flesh. We joke, drink coffee, retreat but always come back to chaos. This is emergency medicine, this is trauma. This is real... it is the most real thing I have ever done.

The days are long because they are quieter; the nights run by in a flash of needles and scalpels, splints, drips, and stretchers. I am working nearly every day... tonight will be my ninth shift in less than two weeks and the weekend is yet to come. Sometimes it really is like a war zone and you wonder how people find the money for drugs, weapons... there is so much of it, there seems to be almost nothing else. There are the patients that make you laugh... there was a car accident victim on Saturday night who had suffered a TIA whle driving; we couldn't clear his C-spine right away and so he had to lay on a stretcher for hours, large orange headblocks tightly strapped to his chin and forehead. In a delerium, he would continuously sit up, entirely compromising the immobilization, looking around with a bizzare resemblance to an enormous teletubby. It wasn't funny, but yet it was hysterical... in the middle of the night, i wished for my camera as much as I wished for a faster radiology service. There was a man with a "broken penis" who I was lucky enough to suture... he was stoned out of his mind, and all the better. I think of the patient whose chest x-ray showed possible bowel in his chest, cringe at the battle over whether he would be allowed a CAT scan... back home we CT everyone; here, it is a rare luxury. I have begun to hoard supplies... a small vial of antiseptic cream is tucked into my pocket, several ABG tubes stuffed into another... there is always a shortage of something, monitors breaking, gloves for tourniquets and dirty plastic instead of biohazard bags. It has become a joke - lazy nurses, incompetent technicians, medical students who disappear and cabinets that are never stocked. I ask the residents how they deal and they reply with weary smiles that they know no other way... but then, I do, and that stays with me. Unstable patient? Directly to the OR? No, there is only one OR, and it's booked straight through... just how unstable is he? A young woman was hit by a bus, run over as she was crossing behind it; The stringy, pulpy muscles of her left leg reminded me of cadaver lab as I held it for bandaging, and my stomach turned. Six hours and the vessels are gone, all muscle compartments turned grey, necrotic... when you wake up, you will not have a leg, and your life will be forever changed... i'm sorry, there was only one OR, they know no other way. I do.

They say that there are no atheists in foxholes, but either I am yet to be fully entrenched or "they" are wrong. I don't see god in this work, and I don't see god in the situations that makes it so plentiful. I see predjudice, bitterness, stigma and greed spilling over. I spoke to a patient as I was suturing him, a 37 year old man pushed off a train. Yes, it happens all the time. He has a daughter and works six days a week to make forty dollars. I hesitantly approach two refugees from the Congo, and they eagerly tell me about their dead fathers, about being illegals. I say that I hope we can help, I hope they will be healed, will get asylum. They say it is in God's hands and smile patiently, wearily, but still smile. I look around but I don't see God in these hallways. A petite, white 75 year old woman was turned away by the nurses because she needed a referral first... a referral from an inner city clinic where she could not go because she is old, and she is white. Racism? Realism. I would treat her, and I would treat a little old black lady just the same. But the nurses scowl, speak Zulu, and we turn away... white doctors, asian doctors, not black and not them. Us and Them. Is there racism in my country, a resident asks me. I'm not sure what to say... I shrug and reply there is injustice everywhere. So many patients, so much suffering, and hope? There is hope. I'm looking for it. Elizabeth is still barely responsive, moaning gently to pain but otherwise restless on her startched ICU sheets. I wonder what her morphine dreams look like. I continue to check on her, keep watching the respirator, keep waiting for God to decide.

I am working tonight. I drink dark Rooibos tea and try to lighten my mood, lighen my heart. Perhaps we can make a difference, even if it's just bandaids. If God is indeed here, then I hope he will lend a hand instead of only watching from the sidelines.

Bloody Hell, Mate, Bloody Hell.

It's hard to believe that less than a week has passed since I landed in Johannesburg... so much has happened already that it's difficult to keep track, even in my own mind, and harder still to reiterate it all on paper. For starters, I'm working crazy hours... this, of course, is mostly my own doing (we're required to work a minimum of 3 shifts per week, while I'm working 5-6), but although it's nearly impossible to roll out of bed in the morning (I swear, I don't sleep, I hibernate), once I'm actually at the hospital it's *fantastic*. As of this post, I've worked three 12 hour shifts so far... Sunday, Monday, and Tuesday afternoons. I took today off, and am going to be working Thursday, Friday, and Saturday nights this upcoming weekend (that's 6pm-7am). Since I'm only here for two months (well, working for two months, anyway!), I want to put in as much time on the trauma unit as possible to get the most out of it... though, honestly, even one day in Johannesburg is equivalent to about a month back home... the learning here curve is steep, but the rewards - skills, confidence, and of course adrenalin - are second to none.

The emergency rooms here are set up differently than in the US; due to the enormous volume of severe trauma (gun shot wounds, stab wounds, MVAs, train crashes, etc), the "major accidents" division is separate from the medical and pediatric units, which means that the only thing we see (non-stop), all shift long, is serious trauma. And although places like Camden, NJ and the Bronx boast high patient volumes, they don't even begin to compare with the insanity of Johannesburg. Even though apartheid ended over a decade ago, the terrible social and economic situation hasn't really changed for most black South Africans... if anything, because of the mass emigration of whites out of the country and re-distribution of jobs into not-so-competent hands, a great deal has gotten quite a bit worse. Widespread unemployment is contributing to social unrest, alcohol and drug abuse, and, inevitably, to violence (in poor areas like Soweto and Alexandria, unemployment is as high as 50%, and even higher amongst young adults). It seems that there's an ever-growing culture of violence... young men (and, occasionally, women) come in with brutal injuries from stabbings, shootings, beatings... there are constantly reports of random violence around the city, and the entire population seems to live in fear. Driving around, there are walls everywhere - 10 foot walls with electric fences and barbed wire, fancy surveillance systems, and guards. The poorer neighborhoods are a no-go for anyone not from there (and frankly I don't think the residents are particularly thrilled about it either); the culture of violence is driving a culture of fear and distrust, which, of course, perpetuates itself in a predictable cycle. Johannesburg is one of the worst cities in the world for all of this... which, I suppose, is exactly why I came here... so, to begin...

I was only scheduled to start this Monday, but after settling in on Saturday (I bought an electric tea pot and some local tea, called 'Rooibos', so I'm set :), I decided to go in for a few hours on Sunday to get oriented. Well, about 15 minutes in, my "orientation" was cut short by - what else? - a major trauma. Any time a seriously injured patient is brought in, somebody yells "resus!" (resuscitation), and everyone rushes over to one of the trauma bays in anticipation of their arrival. Although the physicians here are generally very well trained (and obviously, quite experienced), things don't always go smoothly, mostly due to equipment problems... for starters, most of the monitors don't work, there's only one (poorly) functioning manual blood pressure set, and supplies beyond the basic bandages, tapes, and tube sets are nearly non-existent. Just to give you an idea: the other day, we applied traction to a patient's femur fracture using several saline bags in a plastic garbage bag, tied to the end of his splint! And this is a level one trauma hospital in a major city... and apparently, things used to be even worse. Anyway, so getting back to this patient... as this was my first resus, I stood back to watch the flow of things... another elective student, Colin (a Scotsman from the UK) started an IV drip while the two docs intubated the patient, drew gases, and started a central line... all in minutes. It was honestly kind of like ER but, well, real. Very real. Unfortunately, this patient actually had to be resuscitated in a procedure cubicle instead of a major resus bay... why? Because the resus bays were all being used to monitor post-op ICU patients! That's right folks, critical ICU patients - on vents and all - were being monitored in the emergency department by a skeleton nursing staff... and displacing the trauma patients coming in to surrounding bays and, well, the hallway (The ICU - and the entire hospital in general - is terribly overcrowded and patients who need intensive montoring are constantly spilling over into the ERs...) In any case, halfway though the resuscitation, the physician placing a chest tube suddenly got a massive shot of bright red blood all over his scrubs... all was quiet for a moment, and then the startled doc shrugged and said "oh, bloody hell, mate!" and continued on. To survive this place, you have to be laid-back about pretty much everything, or else you just won't make it.

My 36 hours of work have been busy, incredibly rewarding, and, admittedly, a bit sobering. I'm doing my best to cope - the long hours, wide array of accents (I think I'm starting to sound a bit British?), different culture, city, names for things... and, of course, the ever-present undercurrent of tension that is steadily, constantly palpable. So far, I've placed a chest tube, assisted with a central line, set up countless IVs and drawn more ABGs than I can count, and sutured like crazy. Yesterday I had a marathon suturing session - an hour and a half of standing, straining, and threading, with a woman named Elizabeth. Elizabeth is a black maid from Soweto who works in an upper-middle class suburb of Johannesburg. She was on her way to work yesterday morning when she was hit by a speeding car, apparently flipped over the roof and was thrown down onto the pavement. She was airlifted out and brought to our trauma bay in severe hypovolemic shock, with a broken femur, head injury, and massive degloving injury of the scalp. Once she was stabilized (somehow, amidst the chaos, we do manage to save some people...), I was given the job of suturing her. Now, I can't stress enough how difficult it is to neatly suture up a degloving injury, particularly one in a highly vascular area like the scalp; back in the US, even a senior EM doctor probably wouldn't do it, instead leaving it to an experienced plastic surgeon. But, of course, this is Africa, and I was the best we had. Elizabeth was heavily sedated, but sometimes patients can hear what's going on around them anyway, so, I guess for lack of any better ideas, I spoke to her while I sutured. I told her what I was about to do and why, explaining the procedure and promising to do my best. The longer I stood there, the more, well, human she became to me... even with all of those tubes, bandages, and bright lights, even with the swollen face and broken teeth, she somehow reminded me of, well, any middle-aged woman... it could happen to anyone. I thought about my family - what kind of care would I want my mother to get in such a situation? I spent a lot of time suturing Elizabeth, thinking... when the orthopedics intern introduced her to the attending as an "unknown female", I hastily corrected her; It became important to me that she was recognized for who she was - Elizabeth, a maid from Soweto, with a husband and two young children. Probably because she wasn't just another gangbanger or thief, but just an ordinary person trying to go about her life, I was willing to see her as more than just a body to resuscitate... it's dangerous, perhaps, to get attached to patients, but I think it's also what makes you a good physician. I checked on her this afternoon, looking a bit better and now in a proper ICU bed upstairs; She'll live (though the extent of her brain injury is still unknown), and, hopefully, she'll like her forehead when she finally looks in the mirror. It's a small thing, I know, but then it's the small things that, bit by bit, make me feel that - at least once in a while - I can make a difference, and perhaps through that contribution, make sense of the chaos that is otherwise overwhelming in its senselessness.

I'm learning so much here - about medicine, people, politics, and, as always, about myself - I made friends with Colin (who happens to have a car! yay :), and his landlady's dog, so I have company... we're spending our days off exploring the city; I went out to dinner in Melville yesterday, walked around the Johannesburg Zoo today, and am working on organizing a walking or cycling tour of Soweto for next week. The next few days are going to be hectic, but I will definitely update the blog again on Sunday, once i've caught up on sleep... and, as always, I will continue to post up more photographs! Below are three from the safari days... my god, that feels like a lifetime ago...


Relaxing at Lake Manyara, Tanzania


Photographer on assignment! :)


Photographing up close (I need a longer lens!) in the Serengeti... this bird wandered around our campsite, scavenging for food...

Me with Maureen in Tanzania (the daughter of the teacher/ ice cream maker)

Photographs!

I've been trying to upload my photographs to this blog, but that feature doesn't seem to be working at the moment (or it just doesn't like me - hard to tell). Instead, i've uploaded some of them to my account at pbase; you can access it by following this link: http://www.pbase.com/quideam and then click on "Travels Through Tanzania". I'm going to be posting a lot more photographs in the coming days, so stay tuned!

A Johannesburg welcome, ay

Although my flight into Johannesburg arrived 20 minutes early, it by no means set a precident... actually, it probably set the bar a little high. During the 3 hour flight, I met a really nice (though slightly bitter?) South African businessman, Shamus (yes, he's also an Irish national...). He was so friendly that the spent the entire flight telling me about anecdotal rapes, muggings, stabbings... you get the picture. I also got a healthy dose of pro-apartheid era propaganda... although even I have to admit that some of what he said seemed to ring true. I'm going to delve into this topic (inevitably, i suppose) more and more as I adjust to South Africa, so I don't want to start off on a tangent now. However, the consensus amongst white South Africans seems to be that there's now a great deal of reverse-racism, which, in addition to being frustrating, has also resulted in a gradual weakening of institutions, deteriorating infrastructure, and overall incompetence as the previously educated (and white) leadership has been mostly replaced with hand-picked blacks who, in a lot of cases, aren't qualified for the job. A prime example of this would be the minister of health, Manto Tshabalala-Msimang, who in February announced that HIV patients don't need anti-retrovirals, and can instead be cured by using a combination of garlic, olive oil and beet juice (http://www.voanews.com/english/archive/2007-08/2007-08-14-voa19.cfm?CFID=23414950&CFTOKEN=65465016). Aside from frustrations, these issues bring up another question worth a good deal of consideration: How do countires that have been ruled by colonialism transition into effective self-rule? Is rapid modernization even possible in these circumstances, or are such societies inevitably going to descend into (hopefully temporary) chaos? I'll write more on this later... for now, back to my flight...

When the plane landed, Shamus called my contact at the university to make sure that he was already at the airport... ha, yeah, I guess we all knew that it was a long shot. Nicholas, the driver, was nowhere to be found and said he would "call me back"... yikes. I retreived my bags, and Shamus offered to drive me to the Wits campus. Well, his wife (whose accent I could barely understand, ay) met us... in a Porsche! I have to say, that ride was much better than a beat-up minivan would have been :). The were incredibely nice to me - they drove me to an ATM, a restaurant to pick up dinner, and helped carry my bags upstairs to my room. My room is a single (yay!), though with a shared bathroom down the hallway... I have yet to see anyone else using the bathroom, however, so either this particular wing is nearly empty, or there's a second magical toilet I don't yet know about... either way, everything is clean and fairly new, so no complaints.

After moving in (read: randomly throwing clothing around the room), I had one more small matter to take care of. About a week ago, my sandals caused a cut between my big and second toes on my right leg... by Thursday, the cut had mostly healed, but a small abscess had formed in its' place. I had been waiting to see if it would resorb on its own, but by the evening it was slightly painful and the area around it was red and tender... so, I decided, time to break out the first aid kit and do a little self-surgery.

The procedure: draining abscess, maintaining as much sterility as possible under the circumstances
Equipment: safety pin (to puncture the abscess), lighter (to sterilize the safety pin), not-so-sterile tissues, and a small tube of neosporin.

I won't go into details, but it went well... it's Saturday night now, and the cut has dried up and is healing pretty well. And yes, i'm still wearing the sandals! It's hot here, damn it.

Alright, i'm off to sleep... it's been a long day, and i'll write more tomorrow. I start my first shift at 8am, and I still need to go and "iron" (read: flatten out and pray) my scrubs and find my stethescope...