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Blessing

This week sees me in the office only for a few hours. I decided to drive across the city yesterday to meet with supportive friends for lunch. All three of us are fully vaccinated.

Along the way in the suburbs there were still people parked at strategic barriers erected to prevent free movement into the suburbs. Some of the residents still stood guard. There was less traffic on the highway and very much less traffic in the suburbs.

Our lunch, the sharing of a simple meal, was punctuated with intense discussions about the ethics of what has happened to our country, and about the wisdom of the courts. Although we are close friends and understand each other, there were differing opinions. We are also generally a positive group, which is why we are friends. Somehow there was not the same energy of positivity amongst us this time.

Later in the afternoon after we had eaten and spoken, I drove to the nearby La Lucia Mall to see if I could get some grocery shopping done. The shops where I stay had been closed all of last week and I thought the upmarket area might have better stock.

The parking area was empty and there were no queues to get into Woolworths. Everyone, shoppers and workers, were subdued. I spoke to a lady shopping. We were in the meat and poultry aisle.

“Isn’t it just crazy?” I said to start the conversation.

She paused. I was still in my scrubs. She looked at me. “Hectic. I am Muslim and there is no chicken. The meat is not Halaal.”

“Get some frozen fish? I am not sure if there is any?”

“Have you just come from work?

“Yes, I closed the office. It is so quiet.” There are other reasons, like I am overstressed and have withdrawn to have time to myslef, but I chose not to tell her that.

“OK, be safe”. I echoed the greeting and moved on. I got most of what I wanted except garlic to ward off evil spirits and chicken.

On the way out I stopped talk to the manager. I asked about stock and staff, and he was positive. He stood in front of the empty in-house coffee shop.

Happy to have enough groceries for me and others that I could share with, I pushed my trolley out into the dusk of Durban winter. 

“Doctor, doctor” I heard a voice calling out. No one should know me around here as I haven’t lived in the area for five years. I turned. A young man was running toward me. He was small, and wearing a worker’s overalls with reflective safety strips.

I stopped pushing my trolley and faced him.

“I just want to thank you for what you do for people. I am so happy you studied so hard to do what you do. God bless you.”

I had tears in my eyes. I really did not know him. Yet I felt an instant connection.

He rolled up his left sleeve and pointed to a scar on the funny bone of his elbow. “I have had a debridement” he said and pointed to his elbow. “I have met doctors like you.”

Lucky Ndlovu had no idea I was an orthopaedic surgeon. Thirty years ago I would have treated young men like him for injuries with debridement, a French term for removing damaged tissue. I debride aggressively now, and then hand over big skin defects for my plastic surgeon to close.

Our country needs a debridement, I thought to myself.

Lucky was truly grateful. I was moved. I took his number. We chatted a bit. When things are better I will go back to the La Lucia Mall and have a meal with him and talk. He inspired me more than he knows.

He alone, with his open gratitude, has given me hope to carry on.

My cherished messages from a stranger.
Posted on by basilBLOGinc · 10 Comments

Broken

Thirty years ago I stood on the rooftop of Edendale Hospital in Pietermaritzburg where I had started my orthopedic training. 

I looked up the Sweetwater Valley. It reminded me of the  opening of Alan Paton’s book, Cry, the Beloved Country:

“There is a lovely road that runs from Ixopo into the hills. These hills are grass-covered and rolling, and they are lovely beyond any singing of it. The road climbs seven miles into them, to Carisbrooke; and from there, if there is no mist, you look down on one of the fairest valleys of Africa.”

I stood on the roof of the hospital watching a swathe of a Zulu men descend as an impi down the valley, over grass-covered and rolling hills that were lovely. The army of men moved toward a trading store and before they reached it, the occupants fled. It was as if someone had released a man-eating lion in the store. Then the impi engulfed the store and it burst into flames. The war machine continued on its path of destruction and killing. They approached homesteads, schools, clinics and the occupants fled. Then the buildings burst into flames. Later we would receive the casualties at the hospital.

Ten years later I was a qualified orthopedic surgeon in private practice in Durban. It was the 17th of July 2002 when I took transfer of a patient from the local provincial hospital further south from Amanzimtoti where I work.

She was eighteen years old. Her orthopedic injuries included fractures of one arm and leg and traumatic amputations of the other arm and both her legs. She had been attacked, raped and left on railway tracks for the cold steel wheels of a train to slice her up.

Three days ago I received news that my late father’s youngest grandson had died of Covid, leaving behind his partner and two small beautiful little boys. Yesterday I was told that  a close friend of my brothers had died. He was my friend as well. The lives of our families had been intertwined from the beginning.

Today my cousin called me from Australia to commiserate.

“Every time we get news from South Africa, it’s bad news.  How are you holding up? Are you ok? Look after yourself.” I was touched by his concern. He is  compassionate and cares for many people. We joked about Australia being a “nanny state”.

Afterwards I thought about what I am writing today and was thinking of a title. 

“Bad News” did not make as much sense as when I wrote “Some Good News” when we started our vaccination program,

I write not only to share what I think are lessons and insights.   I write to help me cope. Sharing the narrative in medicine has been shown to reduce burnout. 

We were already burnt out like those buildings in that lovely green valley. Facing the third wave of Covid seemed an impossible task.

Now after last weeks event’s we are broken.

Things are broken in South Africa.

People are broken in South Africa.

The corruption that has drained resources from our country continues unabated and the only prison sentence that was upheld was for contempt of court. Not for corruption.

This imprisonment was followed by a systematic attack on the colourful fabric of our society. Joseph’s Technicolor Dream Coat is in shreds.

We all face these events which, like the impis burning in the valley, or the thugs raping and leaving a young girl on a railway line, scar us.

These recent events have brought previous trauma to the surface for me. I had never buried those disturbing events I had witnessed as a young doctor,  and then again as a young orthopaedic surgeon. I hoped  that theses  atrocities could be healed by the miracle of our inspiring path to democracy.

They were obviously not healed.

Now I know our democracy  is broken, and it is time to move on to heal.

A priest on Durban beach.

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Breaking Point

It was a cold day in Durban. Sixteen degrees Celsius is cold for us on the East Coast of sub-tropical Africa. 

I had made a trip through the suburbs to drop something off for my theatre scrub sister.  The roadblocks are manned by community commandos, most of who are my patients and it’s easy to pass through. 

On the way back to the hospital I passed a que of cars more than two kilometres long. They were on the road to the Galleria Mall or maybe just the filling station. There was an air of dejection and desperation hanging over the cars waiting. Ordinary South Africans waiting to get food or petrol. I was disheartened to see lone drivers trying to push into the que of orderly people.

I parked at the hospital. The doctors parking area was at about 30% full today. The last few days it has been at 10%. The faster cars don’t seem to be able to make it to the hospital.

I walked from the parkade toward the tunnel that goes under the medical centre to the hospital. I hate wearing only scrubs in winter. It is way too cold for sleeveless bravery. A striking young woman caught my eye as I laboured through messages on my phone. She was bald, well dressed and made up. Vibrant. No hair.

She was clutching a form and stopped me.

“Excuse me, is Ampath closed?”

Trying to wrestle my attention away from the little screen, I stopped to talk to her. “Yes, we didn’t have any lab service yesterday, and today we have one technician for the whole hospital. I am sorry” the famous South African refrain. “The lab is closed. Why?”

I glanced at the laboratory request form in her hand. In orthopaedics we keep it simple and don’t really ask for all the  tests after which  Elon Musk might name his children. This list was for things that scared me. Cancer markers.

“I need to have these tests before my chemotherapy tomorrow…”

I felt like crying and giving her a hug. Neither were an option. So I excused myself while I scrolled through my messages looking for something about laboratory closures and openings. In the end I called one of the doctors who knew how to work the system. In seconds my unknown patient took a photo of my screen and left to get her blood tests done in the nearby industrial area. 

I went into my office. It is a safe place that is more of an art gallery than a doctors room. That’s the way I like it. We have been closed to the public all week. I am not sure I like that. I had the tedious job of completing a report of a patient whose lawyer was suing the province for negligence. In this case there was no negligence. She just had bad luck. 

Instead of going home I went and did rounds in the hospital. Not the surgeon rounds where I check a patient’s limb  and movement. A round where I chatted to nurses and tried to understand their issues.

I ended up in the trauma unit. Luckily the first patient I saw had an undisplaced fracture of the wrist and I knew what to do. I showed a keen student how to apply a cast and explained the care to the patient, the father of a neurologist in another city.

Then they called me to see another patient. I am not an experienced general doctor. I decided soon in my training, after realising internal medicine was not for me, that I would concentrate my energies on the simple and straightforward subject related to bones. This lady was bleeding from her flank. I could see the bump on her tummy that meant she was pregnant. She was stable, fortunately. Her abdomen was soft and it seemed she and the five month old foetus had escaped major injury. I numbed the bullet wound with local anaesthetic to relieve her pain. The student put up a drip. I called the obstetrician and general surgeon. Their movements were hampered by riots. The patient was admitted to the maternity ward where the loving maternity nurses would care for her.

My day ended with humanising visits to friends to feed me and charge my emotional batteries.

I am very blessed to have such friends and to be associated with a medical team that cares so much. But we are all at breaking point. Remember that.

Baptism on Durban beach… praying for the rebirth of South Africa.
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Another Stray Bullet

I had an uneasy weekend.

One the one hand I was watching the Covid-19 figures around the country and in my region of KwaZulu-Natal. We are waiting for the third wave to hit our hospital. Last week we stopped planned surgeries and reviewed our planning and capacity to deal with the surge.

On the other hand I had been sunk by the images and reports of violent protests related to the imprisonment of our former president on the charge of contempt of court.

Last year the local provincial department of health closed my hospital following an early community outbreak of Covid-19. The bottom fell out of my practice. I had obliquely thought about the chances of this happening but the scenario where my patients would dry up and there would be no work seemed impossible. But it happened. I still don’t think that should happen to an orthopaedic surgeon, but it happened again this week.

I had a small case planned for surgery on Monday. The patient was supposed to have had the procedure three weeks ago but she tested positive for Covid-19 at the time so surgery was delayed. She remained asymptomatic and was booked for surgery on Monday without needing another test. There is a lesson in that for people and companies who expect a negative PCR Covid-19 test for return to work (or to attending mass parties or sports events) after a positive Covid test. My patient called the hospital early on Monday morning to cancel surgery as the road she needed to travel was blocked by protestors. Violent protestors. My adjective. I have seen the damage to the roads with my own eyes. I have been too scared to risk driving up to a protest. I want to keep safe.

I had consultations booked after my Monday morning surgery. As news filtered through the hospital group and patient grapevine ( I do not use social media), all my patients who were booked for consultation were postponed. The next day I decided to cancel all consultations for the week.

Monday was the start of my week of orthopaedic call for my community hospital. We are not a level one trauma unit so we deal with community accidents that often stay overnight and have planned surgery the next day. I don’t work at night except before Covid when I had big operating slates that took 12 or 14 hours to finish.

My first and only patient in my office on Monday was a local carpenter who had broken his toe while fishing the night before. He was a pleasant and polite man. He was very happy when I reduced the fracture under local aesthetic and sent him on his way.

Then I did a ward round. I have a patient who is lingering for medical reasons, but whose hip replacement is fine. Then I was called to see a new admission. At 830 am. A 24 year old smartly dressed lady who had been involved in a motor vehicle collision at 2 am earlier in the morning. Remember, we have a curfew from 9 pm to 4 am. So I asked why?

“I was at an after-tears funeral party”. I have an ounce of Irish blood in me, so I understood about wakes but was not in the mood.

“Were you drinking and driving?”

“I only had one drink.”

I examined her. She had minor injuries but needed a CT scan to exclude anything major. So I said we would book it and that I would order some standard blood tests.

“I will also do a blood alcohol level. I am asking you for your consent to do that.” She was stunned and said nothing, so I walked off.

An hour later the laboratory technician called to say the patient had refused the blood alcohol test. I did not need the result to know why she had the collision.

At home later on Monday afternoon I took two calls within thirty minutes of each other. The apologetic trauma doctor was referring a patient who was shot in the leg. And then another who was shot in the thumb. Stray bullets. They were both admitted on antibiotics and pain killers and had a Covid test. I made a few calls to book surgery for them the next day. No answer at the hospital. I called the manager.

“We don’t have staff. I don’t know when you can do them. All the other hospitals are in the same situation so we cannot refer out.”

I swore to myself. I was angry that I had to deal with a drunk funeral reveller and people shot by stray bullets. South Africa has a problem with stray dogs too, I thought to myself.

Then a general practitioner who is close to me called. His wife had just fallen and she had broken her wrist. It was deformed.

Normally I would say and organise at the same time: “Let’s get her admitted. Take her to the trauma unit. Get an x-ray. They can put a splint on and elevate it. She can have morphine overnight and I will operate in the morning.”

Instead I had to apologise. “We don’t have capacity at the moment. No-one has. Can you put a splint on her and keep her comfortable at home? If you need morphine call me and I will arrange with the night super. I am sorry”.

It was not even the end of the first day of the week and this is what had happened. My hospital has been closed again. Not by Covid, but by violent protests in a young African democracy that should have grown wiser by now.

Cheetah kill in the Kgalagadi. No stray bullet.
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The Naming of People

T.S. Elliot wrote a collection of poems on cats. One of the poems is called “The Naming of Cats” and it starts like this:

The Naming of Cats is a difficult matter,

It isn’t just one of your holiday games; 

You may think at first I’m as mad as a hatter 

When I tell you, a cat must have THREE DIFFERENT NAMES.

Luckily I am not a cat and only have one name. However there are more than three Basils in my family. I am one of six first cousins named Basil after my maternal grandfather, the late Basil Moutsatsos, who had come to South Africa from Greece. His legacy was one of love and generosity. He also loved to watch his children (he had five daughters and four boys) perform Greek dancing.

So Basil is from the Greek word meaning “Kingly”. In Greek my formal name is Βασίλειος (Vasileios). The shortened version is Vasili. When I was at university I liked Vasili. Many years later a Rumanian colleague would call me Vasili. He would also call on every 1st of January to wish me for my name day. 

In Greece the villagers who had been to the United States called all the Vasilis “Bill”. So I became Bill, Billy or Billaco in Greece. Bill came from their arrival at Staten Island in New York City. The immigration officers spoke no Greek, so they asked with which letter of the alphabet the name of the immigrant started. Vasileios starts with a “B” in Greek. So they were all called Bill. 

The seven cousins needed to be distinguished from each other. So we had Big Basil (or Sili) and Little Basil, who was the youngest Basil until two younger ones came along: JB and Sil. In the middle was me and cousin Basil, son of my Uncle Basil. I had a few nicknames besides the Bill derivatives: Budgie, Charlie and maybe a few others I cannot remember.

Oh , and my cousin Big Basil married Athena whose brother Basil shared my birthday, along with JB.

Names are important. Sometimes they make who we are. A name can mean recognition and connection.

When we were in the second wave from December 2020 to February 2021 at Netcare Kingsway Hospital, the hospital was all Covid except for one small ward. We all wore full PPE including visors all the time. Everyone looked the same in gowns and visors. Everyone was tired.

“Hey you” was not a polite way to address nurses when at work, and patients had no idea which angel was caring for them. Remember, as a doctor during the Covid wave I was working with teams I had not worked with before as an orthopaedic surgeon.

I decided that we should label everyone’s visor with their name and position in the hospital. So even the head of the gastroenterology unit in theatre got her label: Sister X, Theatre Gastroenterology Sister. She ended up heading up the Rest in Peace Team, so her patients did not see the name on the visor.

My receptionist used my label machine and five cartridges of labels supplied by the hospital to make labels for the whole hospital nursing and administration staff and the doctors. Each cartridges has a ribbon that is twelve meters long, so she printed sixty metres of labels.

Covid-19 has presented like a cricket game with the statistics. All sorts of useful numbers have been extracted and then equally so, misinterpreted and used as a foundation for some outlandish conspiracy theory.

We are now preparing for the third wave at our hospital. Many of the staff have new visors in preparation for the battle. Most have been vaccinated. My labelling machine is doing the rounds as people print their name to stick on their visor. 

What the label does not say is that these nurses are angels. They are the ones sacrificing themselves and their families as part of their calling to care for the sick. The sick are arriving again at our hospital with Covid pneumonia, grey skinned with wide-eyed white eyes searching for oxygen and help.

Thanks to our nurses they will receive more than just help. They will be cared for and connected to their families by these superheroes with names we should remember.

Grass cutting visors from the local hardware store have become the preferred from of protection globally.