As mentioned before, being newly single, I seem to find myself at home on the couch on a Friday night more often. The fact that our hospital has only 4 doctors for the month of July is not helping either! I'm on call so often, that when I'm not on call, I'm too tired to do anything else
but sit on the couch!
I've decided that the characters I dislike most on TV are the doctors! Because:
- They're always perfectly dressed with perfect make up on even after a 48 hour shift!
- They send patients for MRIs (a high tech investigation, not readily available in the average South African hospital) when they present with a one day history of uncomplicated headache!
- They always know what to say to patients and their family! I never know what to say.
- I don't know what to say to the 23 year old girl who's pregnant with her first child and has HIV. She's come to see me because her CD4 count is 79* and she needs to start antiretrovirals (ARVs). She hardly understands what's going on and why I've ordered an FBC, U&E and LFT** on her. She's tired, she's been at the hospital all day. She gets her blood results after 16h00 and I see that her Hb is 6.7^. I tell her I can't prescribe the ARVs now, she has to stay at the hospital overnight and in the morning she will have to give sputum to test for TB and do a CXR^^. It can't be done now, because it's after 16h00 and the Xray department and lab are closed. She's come to the hospital alone, she's waited all day and she still hasn't gotten what she came for. She just starts crying. I have no idea what to say to her! I just sit there and look at her and watch her crying for a while. I pass her a tissue and tell her she can wash her face at the basin. And I watch her crying some more. I can hear the other people outside the door in the queue, complaining about how long they've been waiting.
- I don't know what to say to the man who wants to kill himself because he found his fiance with another man. He works in the hospital mortuary and he thinks that death is better than his life right now. He is the sole breadwinner in his family, meaning he has to support his mother and alcoholic father and other siblings besides his own children and cheating fiance. She's been admitted to hospital because she attempted suicide, he has to pay for her care at a private institution! He can't afford private care for himself, he's come to me for help.
- I have no clue what to tell the old lady who comes to me because she's having bad dreams. She think it's her treatment she's been taking, she says the dreams started when she started taking the pills. None of the medication she's on is known to cause bad dreams, at least not according to the South African Medicines Formulary.
- I don't know what to say to the 8 year old who's been raped by her brother.
- I don't know what to say to the 6 year old girl who's got HIV and TB, she's been on treatment for the TB for the last 3 months but it's still not getting better. She now has a hole in her neck draining pus (for the medics: a draining sinus from her TB infected lymph node) and she weighs around the same as a 2 year old. She's on antiretrovirals for about a month, but her baseline CD4 count was 3,3%*! She's not really eating anything and everytime anyone who works in the hospital comes close to her bed she says: I want to go home, please can I go home! Maybe it would actually be better for her to go home to die.
I have no idea what I could tell all of these people that would help to make it better. I am struggling to sort out my own life, what qualifies me to be able to fix their lives?
Last night, however; I actually discovered something that I
do like on TV: James Bond!
Now, I've never been much of a Bond fan, I find the action genre of movies mentally unstimulating and somewhat far-fetched. I think I've watched 1 of the newer Bond movies and it definitely didn't excite me. But being at home on a Friday night and all that, I watched Dr No and part of From Russia With Love.
To my surprise, I found that the idea of what constitutes a sexy woman has DEFINITELY changed over the years. The Bond girls had curves! Bond bumps into a girl called
Honey Ryder on the beach in Jamaica, she's wearing a bikini and she has meat on her bones. I definitely thought she was attractive, and Bond seemed to think so too.
I think the problem is, that these days the entertainment and fashion industry is run mainly by homosexual males and women with low self esteem!% Because I'm sure the majority of straight men don't find the stick insect, Calista Flockhart look-alike, breath takingly attractive, but it's the image we're seeing and being told to aspire to.
I've decided that I like the old James Bond movies! The women were gorgeous and don't look like they've got drug habits, the fashion is almost exactly the same as what's in magazines now just 2 to 4 sizes larger, and the young Sean Connery is not at all bad to look at!
*CD4 cells are a type of white blood cells in the body important in fighting off disease. In HIV these cells are depleted. In South Africa the criteria for starting antiretrovirals is having a CD4 count of less than 200 or stage 3 or 4 HIV. A healthy person has a CD4 count of above 500. In children we use a percentage instead of an absolute value; children 1 year and below with a CD4 below 25% should start on ARVs, children from 1 to 12 years with a CD4 below 20% should start on ARVs or any child with Stage 2 disease or worse.
**Blood tests: FBC- full blood count, counts the red and white blood cells and platelets
U&E- urea and electrolytes, an indicator of kidney function
LFT- liver function test, self explanatory
^Hb- haemoglobin, part of the FBC, it's often low in HIV positive patients, but if it's below 8, we have to look actively for TB before starting antiretrovirals. In healthy people the Hb is always above 10.
^^CXR- chest xray
%This is obviously a general statement, I have nothing against homosexuals and I know some people in the fashion industry who don't have low self esteem!