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My Elective - Blog 4

By Alice Gwyn-Jones

My Elective - Blog 4

Sat on the plane leaving Johannesburg airport I feel it's finally safe to say that we didn't get shot, stabbed or robbed; I'd say that was a success. There is a part of me however that can't help but wonder if we didn't do Cape Town right, but anyway grateful that we are now sat on the plane with no trauma and not taking a lot of PEP (post-exposure prophylaxis) for HIV exposure.

The last month in South Africa has been a whirlwind of hiking, wine tasting and of course helping in the trauma unit in any way we could. More hectic shifts in the Tygerberg trauma unit as Youth day in South Africa meant a bank holiday Monday, so a long weekend of drinking and violence.

I was seeing more and more assaults that were labelled "community assaults", initially I presumed these were assaults that took place within the community however it soon became apparent that this is where gangs decide to take the law into their own hands and punish those that have stolen or committed other crimes and punish them with a mob attack. It turned out justice wasn't always the incentive of these mob attacks, sometimes it was just because someone had taken a disliking.

After a horrific morning, that started of as normal as you could imagine, the ward round was as eventful as usually with one patient getting intubated and many more ready for discharge. I was carrying out some jobs for the day when one of the patients in a chair waiting to be discharged collapsed. She'd lost control of her bladder and had a reduced GCS. We managed to get her on a bed and wheeled around to the resus area when she went into cardiac arrest.

Commencing CPR, obtaining a gas and realising she was in a non-shockable rhythm we discussed the reversable causes. Recognising this patient as a young woman that had been in a road traffic crash and was due for discharge with orthopaedic follow up for a fractured clavicle. The only reason that we could think of was a pulmonary embolism from being stuck in the department for 4 days on a chair.

Now with a bradycardia of 26 and a gas incompatible with life, it seemed an alien concept to me when they disconnected the ventilator. The only explanation being that they'd given the max dose of atropine to bring her heart rate up and there wasn't anything else they could do. We were all just left baffled to how a woman about to be discharged with some tramadol suddenly deteriorated to this level. 

Trying to carry on the rest of the day completing the jobs that were still left to be done. I felt more than ever any job that meant a patient could be discharged was of increased importance. One young 18 year old boy was waiting for the past 3 days in the department. Reason he was waiting - so a bullet could be removed from this thigh. Past medical history "kidney issues" written on the clerking form.

Turns out this patient was post kidney transplant and hadn't been having this immunosuppressants whilst in the department. Searching desperately for a place to remove this bullet so he could go home and have his medication; carrying it out in the treatment room which had now turned into a mortuary with our two patients that had passed away just felt wrong and soon definitely wasn't an option when the family showed up. 

So I was instructed to remove the bullet in a store cupboard. We turned the room filled with bags of clothing, a plaster trolley and neck collars that would make any emergency doctor have a fit into a mini operating theatre. Bullet removed, now time to nag the doctors to complete the discharge paperwork.

After the intense 4 weeks in Tygerberg it was time to start our journey home. Opting to drive from Cape Town to Johannesburg rather than do the sensible thing of flying. 6 days and 2346km later we made it to the airport. Of course, this wasn't just for the sake of driving.

We hiked up to the 2nd tallest waterfall in the world in the awe-inspiring Drakensberg mountains, across suspension bridges along the coast and of course we needed to say goodbye to the elephants before we left Africa so took our Hyundai i10 rental car around a games reserve on an interesting and bumpy self-drive. So many lifelong memories created and a life lesson of not to hike up to 3100m with a cold, unless the view is as incredible as the amphitheatre in Drakensberg mountains.

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