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In a soldier’s pocket...

I am a soldier in this life. In the trenches, on the road.

In my pocket see what I carry

A token from my lover

Prayers from my mother

The pride of my father

An embrace from my brother

Grace from above

Upon my body I carry them close.

And onwards do I march.

[squeaktown-blog-blog]

YOU’RE breaking up with *ME*?!

I figure a train ride is pretty common place to muse over relationships and it was precisely on a blue Gautrain seat that it hit me that while I was hurtling towards my destination, I was also headed for a breakup. Let me explain.

Public sector medicine and I have a long and complicated history. Cut to the opening scene of our dalliance wherein a young medical student is gently introduced to the simple pleasures of immunizing babies and drawing blood at a local clinic. Fast forward a few years and her cheeks are flushed with excitement and intrigue on her first magic carpet ride through a night shift at a district hospital Casualty. Every new pathology or surgery or procedure was a whole new world. 28 hour dates would soon become the norm however, and she would find herself consumed by the mounting demands of her mercurial beau. This relationship took on a very serious and thrilling tone in its borderline insanity.

By the time I became an Intern the hospital needed me like a manic lover - relentlessly and with little regard for my safety. Let me stretch this metaphor even thinner by saying it was in bed with all my intern friends too, as one warm body was simply not enough to slake it’s demands. But we would never leave voluntarily. We had taken an oath to medicine and slipped our stethoscopes around our necks as surely as a bride does her wedding ring.

As a Community Service doctor my marriage to medicine settled into a steady routine. I was no longer a blushing debutante but a tough bird who could wrap up ward rounds with one hand and wrangle Casualty with the other. We were an old married couple - sniping at each other but still performing a tango with only the occasional stomped toe. So imagine my discombobulation that after all the years of becoming the perfect partner in this system I was about to get the boot without even so much as a ‘good luck finding your next job.’ My compulsory and gaurenteed time in the public sector was coming to an end.

Sure, there were CVs and interviews and future plans to remain in state service to pursue a position in a specialist department but none had come to fruition as yet. I couldn’t help but feel like the spurned lover of dimestore bum. How could this struggling system reject me while I was at the top of my game and in the prime of my youth? Where did it get the nerve? I had even attempted primaries and stood outside the window of a dozen Anaesthesia departments holding up my commitment and dreams like John Cusak. Say Anything? More like Say Unemployment.

Having secured a position outside of the public sector for next year I am better able to look upon my time there with fondness, gratitude and more than a little disbelief at the challenges we faced and overcame. It was always tough but hidden gems were sprinkled throughout in times of trouble. Like crawling through the desert on your hands and knees and stumbling upon a margarita station whenever you were about to expire in a *poof* of anxiety and chronic fatigue.

So if I must bid adieu to my first 9 years in the public health sector I would say this: You were wild, man. And I’m with Rachel on this one, we are just on a break.

[squeaktown-blog-blog]

A woman’s body

*in assimilation with Amanda Lovelace’s beautiful collection of work: The witch doesn’t burn in this one*

I am spending my community service year safely sequestered in the Internal Medicine wards. Now don’t think that safe means easy, it’s just that this specialty suites me. I get to solve puzzles and use my knowledge to fire perfectly aimed treatment arrows into the bullseye of a diagnosis. Often the target is moving or there are so many comorbities that clay pigeon shooting might be a more accurate analogy. But regardless of how complicated the medical conundrum, my brain loves the process - the systematic and finely calibrated takedown of a problem gives the old grey matter a victory smirk.

Every day I am grateful that the body that carries my brain is strong enough to keep me on my feet and perform diagnostic and therapeutic procedures. You have to put your back into it even though physicians are widely regarded as more cerebral than practical.

I don’t often think of it as a woman’s body because in the Medical wards I am a doctor and ‘The Doctor’ is asexual. There is a power in that asexuality. A strength in knowing that I am no less capable or deserving of respect than a man because of the shape and size of my body. This mindset helps me to personify a role that was traditionally exclusively reserved for men. It’s important that I see myself as an equal to my male colleagues because it sets the tone for how my patients and peers respond to me. I still get the occasional, ‘Don’t get ahead of yourself, little missy,’ or ‘Why’s a pretty little thing like you trying to do a job like this?’ but it’s easy enough to brush off. At some point every misogynist will be confronted by a woman who will grudgingly force him to admit that she’s a boss - and that accolade has no gender.

On a recent night shift I found myself mulling over the fact that the only specialties that remind me during each and every patient interaction that I am female are Psychiatry and Obstetrics and Gynecology.

I have treated many psychotic patients in my time and this shift was no different. Of these many psychotic patients, the vast majority are men. I am completely aware that one cannot expect a psychotic patient to adhere to social norms or even feel regret over violating boundaries. But the unnerving sensation of eyes freely and unashamedly roaming over my body and lingering over the areas that make me female constantly reminds me that I am not as safe in this specialty as my male colleagues. It is a strange kind of sexual assault in that I am expected to brush it off to honor my duty and treat the very person who is undermining me. I won’t go into the obscene catcalling or attempts to invade my personal space. This specialty triggers the hairs on the back of my neck. I am not ‘The Doctor.’ I am a woman in a throng of unpredictable strangers so disconnected from reality that they cannot be held responsible for their actions. It makes me feel threatened and exposed and reduced to nothing but the body I wear. I never feel at my best with these patients because unsurprisingly, I cannot do my job well when I am afraid.

Obs and Gyane on the other hand gives me fear of a completely different flavor. During the call that inspired this essay I had just finished up admitting a few psychiatric patients in casualty before finding myself assisting a male doctor in four back to back Caesarean sections. I quickly noticed that he was an experienced surgeon who preferred to use his hands rather than a surgical blade to separate the planes of the abdomen and only utilized the knife when absolutely necessary. This technique causes less bleeding and allows the tissues to knit back together more easily. It also helps us to bust the baby out of its uterus jail faster. Sounds good, right? All I could think while I watched this excellent surgeon was that this must be exactly what it looks like when a butcher uses his hands to rough up a slab of meat. And how sorry I was for the woman whose body was being ripped apart. My own abdomen started quivering in sympathy - I saw myself and my own woman’s body on that table. Four times in a row.

This uncomfortable fear-tinged empathy started hitting me when I rotated through Obs and Gynae as an intern. Every miscarriage, breast/uterine/varian/vulva cancer, infertility or hysterectomy case would tie me up in knots and paralyze me long after the patients had left my ward. I’m not more special than these woman. I have all the same parts. I was reminded every day that I am also just a woman sitting at a cruel universal roulette table. You get drafted into the game as soon as you solidify your 46 XXs- the fact that I am ‘The Doctor’ doesn’t exempt me. My number could be up tomorrow.

I wasn’t initially sure why it felt so important for me to get these feelings down after that call. The Internal Medicine wards had protected me from this particular brand of uneasiness for so long that I felt guilty and soft shelled for even allowing thoughts of my gender to affect my performance at work. I realized that I was preparing a testimony to defend myself. As if a tribunal would be ready and waiting to lay down a sentence for my self-indulgence. And it wouldn’t just be men banging that gavel. The women who had fought so valiantly to secure my opportunities in this field would shake their heads and condemn me for my weakness.

The privilege of possessing a woman’s body is a complicated one. You could be lauded for your mind but still coveted for your form. Undermined for your sex and dismissed from hand as easily as an eyelash wish. Invisible in your details but cast onto a giant screen as a shapely silhouette free for anyone’s eyes.

I went to work the next day and forgave myself my trespasses. Because no matter how afraid I was I never turned a way from a patient. I was more than my weakness. And a woman is more than her body.

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The Goods and the Sass

My little brother is a 4th year medical student. He is scalpel sharp and bespectacled and adorable in a straight-laced, serious way. What you might not notice right away but soon becomes evident is that my brother has a honey comb for a heart - his care runs thick and sweet. It sticks to you. What my brother has is something I like to call the Goods.

Doctors with the Goods value human connection and overflow with empathy. They are founts of compassion. They have angel wings under their scrubs. They are as eager to please as Uber drivers and just as affected by their performance reviews. I have rubbed shoulders with students, peers and consultants with this wonderful quality. A memorable doctor I crossed paths with repeatedly as a registrar and then as an Obs and Gynae specialist once confessed that the Goods sometimes gave her the urge to practically move in and cook for her patients - placing a cap on her investment just didn’t feel right. I have often witnessed a lovely friend of mine compelled by the Goods to listen with boundless patience to complaints and winding stories even when she was 24 hours into a call and barely holding herself up. Doctors with the Goods inspire elderly ladies the world over to pat their cheeks and say, ‘What a nice child!’

I’m not sure I have ever had the Goods. Or perhaps I did early on and it morphed into something else entirely. What I have is the Sass. Now, don’t feel let down if you find yourself under the care of a doctor with the Sass. We are charming and charismatic. You will identify us quickly and find our energy and self-possession reassuring. When you are scared and in pain, no-nonsense from a straight shooting doctor can sometimes be more helpful and sweeter than a spoonful of sugar. Doctors with the Sass are fun to work with and practical to a fault. They are goal-orientated and purpose driven. They are nonchalant superheroes. I have experienced the Sass as the motivation to execute plans pristinely and in the most efficient time frame. The minds of these doctors are filled with grids and checklists and the greatest satisfaction is found in winning the running competition against the clock and whatever disease you are protecting your patient against that day. Whether the patient enjoyed the ride or would come again of their own volition is considered important but not as sweet as victory. A win is a win.

But here is the rub. Doctors with the Goods can struggle with burnout and find it difficult to stick to time frames because every patient wants to monopolize all their energy and attention. When you have 50 patients waiting for you there are simply not enough RedBulls or hours in the day. Doctors with the Sass can struggle to gain their patients’ cooperation because they may come off as callous and unsympathetic in their zoomy attempt to cross another item off their neverending task list. And without the patient’s cooperation you have about as much a chance of success as an intern trying to boss around a nurse.

The key is to find a team that can utilized both goodness and sass in equal measure. Like firing a hug from a cannon - still comforting but with the added benefit of a cleverly calculated trajectory and a little oomph behind it. Allow those with the Goods to temper your briskness with empathy. And allow those with the Sass to inject a little backbone into your commiseration.

At the end of the day not everyone will appreciate the Goods or the Sass that you bring to the table. But hey, you gotta work with what you’ve got.

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I’m so sorry and thank you for the plums

A while ago I was transferred to the male medical wards. I wouldn’t say that I had any particular opinion about treating men rather than women but I had grown comfortable on the other side of the corridor. I wasn’t sure what to expect and the unknown made me nervous.

I quickly realized that the common pathologies I would be treating every day were very different. Women tend to be admitted to the medical ward for control of chronic diseases like hypertension, diabetes, obesity and heart failure. I would optimize their treatment and they would take note of how to follow the new plan at home. We would part with satisfaction on both ends of the stethoscope. There would be a sprinkling of parasuicides and the psychotic patients were manic but mostly not dangerous (exceptions to this rule were alarming and memorable). Illicit drugs were mostly popped or smoked, not injected. Lower respiratory tract infections were often community acquired and those that turned out to be TB were treated successfully the first time around. I found that even if my female patients didn’t know exactly what medication they were supposed to be taking I could guestimate most of it due to their desire to help me and my skills as an amateur sleuth (sometimes you have to rifle through a purse or two to find the pill boxes).

But the men. Let me tell you about the men. Many of the male patients I came across were slowly dying due to a refusal to stop smoking or drinking or engaging in unsafe penis activity. They had little to no interest in health education and laughed in the face of my warnings not to default their treatments. The TB ward would invariably have 2 or 3 MDR or XDR patients who had defaulted both their TB and HIV medications many times over. The psychotic patients were aggressive and dangerous and mercurial. They would pace and prowl around me while I worked until security had to restrain them. Young men addicted to IV drugs would arrive every other day, their hearts failing and septic and full of poison.

These men. It was only really at the end when their bodies were crumbling and ruined that they truly wanted my help. That I truly had their attention. And at that pit stop all I could really do was attempt the best medical care while watching them slip away from the life they had valued so little. They resented me for my inability to reverse the irreversible damage and I resented them for not heeding the warnings in time.

I would walk to my car at the end of the day shaking my head at the futility of my efforts and the knowledge that I would probably see many of the patients I had discharged admitted again with the same problems. I felt like I wasn’t making the kind of difference I had made with the female patients and my body would sag with frustration and my mind would rail against their arrogance and apathy. You only get one body in this life, I had promised. They did not and would not listen.

Then I met an elderly male patient who was admitted due to difficulty breathing, confusion, loss of weight and general body pain. He was the father of one of the hospital employees and his daughter would come to visit him every day. She was clearly afraid of the worst and I woud choose my words carefully when she would ask me about his condition - I didn’t want to instill hope or insight panic before I had made a definitive diagnosis.

Within a few days tests confirmed that the patient had lung cancer. It had spread to every nook and cranny of his body. There was no option available to him other than palliative care. I made an appointment with his daughter and scheduled a family conference. She was devastated but not surprised at the diagnosis and shouldered her own pain with profound strength so we could reveal the poor prognosis to her father.

I held his hand and explained the results of his tests with a nurse and his daughter as a translator. I was dreading the conclusion of the conversation when I would have to announce that I could do no more and would discharge him soon. I expected denial and anger and resentment. I expected him to blame me. I expected him to banish me from his bed because I had failed to save his life.

Instead he shed two slow tears and thanked me. He was thankful that he finally understood the cause of his pain. The specter that was stealing his body had a name now and he could face it head on. He was thankful that I would ensure that he would go home armed with analgesia and that he could share his remaining time with his family.

I shed many more than two tears and thanked him in return. I thanked him for his grace. Even though I couldn’t cure his illness, he felt that I had still discharged my duty as his doctor. Before I left he asked his daughter to give me two plums that she had brought to cheer him up. He thought I could do with it.

I have relived this experience many times over in my mind. I remember the surprise and fulfillment he gifted to me. That patient lifted away all the frustration and resentment that has been crushing my drive to connect to my patients. If I work my entire professional career in that ward with its male inhabitants who never quite meet me eye to eye but find one more patient like him it will be worth it.

I’m so sorry sir, and thank you for the plums.

[squeaktown-blog-blog]

A series of unpopular opinions

*before reading this please remember your pinch of salt. If offense is still taken, enjoy chomping on that tasty outrage 😏

1. The hospital is not more important than my personal life. I am providing a service for a living and am entitled to clock out.

2. If you want an unjustifiable sick note just get to the point. If you come out and say it, you have a 50% chance of success (depending on my mood). Trying to manipulate me with a roundabout, time-wasting tale will guarantee failure.

3. I am a vagina person in that I have one. I am not a vagina doctor because I prefer treating patients whos vaginas are irrelevant to their diagnosis. This does not make me unfeminist. Having said that, please be kind to vagina doctors - delving into those dark depths is not for the faint hearted.

4. The nurse is right. Yes, more right than the doctor.

5. Calling an ambulance to transport you and your hangnail/boil/rash to the hospital at 2am to avoid cues in a clinic is a crime that should be punishable by electrocution to either your ears or genitals. You can pick.

6. When I ask you to lie on the bed, please sit on it and then lay down. Do not mount it on all fours and then look at me for confirmation that this is the correct position. It is not. We are now both uncomfortable.

7. Dear colleagues, please don’t assume I will write you a prescription for anything you like. I am not a drug dealer and this is not Tijuana.

8. Dear security guard searching my car, I am not stealing those 10ml syringes/adhesive stickers/jelcos. It is necessary for me to stash and stockpile because running around trying to find these essential supplies is exhausting and time consuming. I am ensuring that my patients will get their IV lines placed and blood drawn in a timely manner. It’s called distributive justice. I took an oath.

9. Sometimes drug addicts are really nice people and it throws me off when they politely ask to be excused so they can get high.

10. If I am determinedly not making eye contact in the corridors of the hospital at 2am, please don’t step in front of me to compliment me on my appearance and get offended if I respond with a curt nod and brief smile. You are a stranger. Stranger danger still applies even though I am a doctor.

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My stethoscope is strangling me: a post call vignette.

Sometimes when I’m driving home post call I like to save the delicious release of crying for when I’ve actually reached my own shower. It’s akin to trying to beat Google Maps and shave off 2 minutes from the time you were supposed to arrive. Ultimately worthless but super satisfying.

I like to dump all my things in the kitchen, grab some clean clothes and hop in the shower for what would be an Oscar worthy emotional outpouring. Imagine Anne Hathaway in Le Miserble - shot in a tight angle and with bad teeth because I too hadn’t brushed in while (don’t judge, there aren’t a lot of clean sinks in public hospitals).

What I’m trying to get at is that it feels dramatic, people. Mainly because you spent the last 24-30 hours trying to pluck people from the jaws of death but all you have to help you is one of those grabby tools that have a plastic dinosaur head on the end of a stick. And all the people are trying their best to fall into the well/step on the crocodile/discharge the gun into their foot.

As I get out of my shower, all squeaky clean and cried out, I think back to the patients I scanned over in the morning in the wards after my casualty call. You would think that appearing in the same scrubs I wore yesterday and a general air of desperation to blow this joint would inspire them to take pity on me and let me quickly get my work done and slip out of the ward. You would be wrong folks. It is always on my weakest post call days when my stethoscope acts like a homing beacon and I am treated to every inane bump and bruise story that has little to no effect on the working diagnosis or treatment of any of the medical patients admitted in this district hospital. ‘Why, WHY, Mrs X, was it necessary for you to bully the nurses into calling me back from my car for you to tell me that you started to bald in 1987 when I am trying to control your diabetes? Also, drop that white bread!’

Anyways. To all the post call people out there. You survived and well done. Have your shower, cry, treat yo’self, take to your bed, take a walk, get to Stranger Things, enjoy your people. Recharge however you like and be strong.

Your stethoscope will be waiting in the morning. May the Force be with you.