9:15 AM on a Tuesday morning, a man in his mid 30’s is brought into casualties on a stretcher by 4 paramedics. Victim of a mob attack, he’s unconscious, has multiple laceration to the face and torso, possible damage to his cervical spine and a fracture on his right leg. There’s no registra on duty, she left 5 hours after her shift last night because of the evening patients influx after an accident on the M1. The other registra has been called off to another hospital for the week. There’s only two doctors in the wards; one is a second year intern who is now 3 hours post-call and the other is first year intern who started her rotation two weeks ago. A third intern has been called in from the surgical unit but he hasn’t arrived yet. There are too many casualties coming in that no one notices the 10 year old child who’s having a seizure in the corner or the crying mother with the 3 months old baby who has now become unresponsive. Sounds like the introduction to a Code Black episode right? sadly this is more or less an ordinary morning in the trauma and emergency unit at any large public hospital in South Africa. The lack of resources and the shortage in medical staff in comparison to the patients that require help becomes a reality you experience upon the early days of clinical exposure. It’s not a story that is told to scare us, it’s a reality. There aren’t enough healthcare professionals in the country.
But back to this ordinary Tuesday morning, a sigh of relief as the Nurse in charge notices us, “students, great.” She quickly calls us over, “Hi guys, as you can see we’re having a busy morning” she said before she started instructing us on what to do, “Can the two of you go help in administration and triage patients, can you follow this doctor and assist her” she instructed my friends. She then turns to me, “bad day to wear a white shirt my boy, follow those paramedics and assist the doctor with that man they’re carrying.”
Now I’m also thinking that it was a really bad day to wear a white shirt. I run off after the paramedics. “Here help us get him on the bed on the count of 3. Careful with his neck. Hi sir, can you hear me?” said the doctor in charge, let’s call him Dr. X. “What’s your name?” He says, looking at me, “okay, Yannick I need you to get me two bags of Balsol, ask the nurse over there to show you where to get morphine.” I did not completely understanding what he said, it was hard to concentrate; there was a lot of blood, I had never seen so much blood before. I run off to the nurse who helps me find the Balsol and morphine. As I return, Dr. X says, “pupils are reactive to light, he opens his eyes to and flexes away from pain stimulus, his speech is slurred and inappropriate. What’s his GCS score?” before he goes on to insert the drip. “GCS score, uhm I should probably say a number, any number” I thought to myself before guessing 7/15. “He saw right through that, he knows I guessed”, still thinking to myself. “No, it’s actually a 9/15, you need to revise your notes. A fifth year student should know these things” he says, looking rather disappointed. “I’m actually in fourth year Dr.” I corrected him, but deep inside I still felt as though I should have answered that right. He pauses for a second then says “Oh my bad, well today we’re going to treat you like you’re in fifth year. I’m gonna need you to draw blood, syringes are in the orange basket, after that you’re going to need to put a cast on his right leg, I think he might have fractured his tibia. I’ll suture his face while you put the cast on. I’ll talk you through it.” Now my mind is racing and my heart is pounding, I’m feeling dizzy and a little nauseous but I can’t differentiate between a hypoglycemic attack because I had skipped breakfast or a panic attack. I’ve drawn blood maybe a handful of times, I have sweaty hands now, what if I puncture right through the vein, what if I get a needle stick injury, what if I precipitate the formation of a thrombus and kill the patient. Seeing the look on my face he says “You’ll be fine, I’m right here to help now get going, this man needs your help doctor”
I had been called doctor by my family members and friends, since before I had ever filled out my application form to med school. Somehow it felt different having this tired intern call me that. I followed his instructions, spoke out when I needed help and the rest is history.
I had learned two important lessons on that ordinary Tuesday morning; never ever wear a white shirt to a Trauma/emergency unit (I mean why would you?) and to always be prepared. That ordinary Tuesday was my first day of fourth year, I didn’t even know the ward we had been assigned to and while I was still on holiday mode, the patients I was suppose to serve that day needed the best version of me. There’s no days off, there’s no excuses, you can’t be slacking off; if you’re going to show up, you’ve gotta be ready, you never know when you’ll be the deciding factor between life and death.