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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 There are other reasons, like I am overstressed and have withdrawn to have time to myslef, but I chose not to tell her that.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.
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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.

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The Tree of Life

I had been searching for a year. Because of the pandemic, in spite of the pandemic and to heal from the pandemic. Finally in May this year I was gifted what seemed to have become an impossible task.

I messaged the hospital manager : “the trees have arrived. I’ll come by later in the week to chat about where to plant them.”

“Excellent” was her answer.

We have a garden of remembrance as you enter our hospital. It has two benches, three tall aloes and a variety of African indigenous lilies. There are two glass walls with stainless steel plaques for anyone to pay homage and remember the departed. One wall has become the Covid-19 Memorial.

A few days later I popped into the manager’s office. 

“Hi.”

“ Oh hi Dr Stathoulis” . She always calls me that. We asked about each other. “Can we do a walkabout to see where to plant the trees?” 

“Sure”. She always makes time for me.

We walked into the sun of autumn, a warm day, with the trees huddled in their black plastic uterine bags.

Ziziphus mucronata. The tree of life. That’s what the Zulus call it. uMphafa. If someone dies  in the hospital they bring a  branch from the tree of life and reverently capture the spirit to take it home. They even pay for an extra bus seat on the way home. The branch that has captured the soul of the person who has died is tucked into the eaves of the roof of the homestead to rest. 

I have a plaque in memory of my father’s passing in 2008 on the first glass wall. It reads in Greek: “Η αιωνιότητα είναι ποιότητα, δεν είναι ποσότητα, αυτό είναι το μεγάλο πολύ απλό μυστικό” from Nikos Kazantzakis, who wrote Zorba the Greek. Translated it means “Eternity lies in the quality, not the quantity; that is the great secret.” When I finished school in 1980 I planted a  Ziziphus in the garden of our family home. After my father was buried in Johannesburg I took a branch from that tree and left it at my grandfather’s house in our village in Greece. 

It was difficult to find the trees. I had asked far and wide of nurseries and tree growers and finally a friend of mine, Jane Bedford, who had trained as a traditional healer with the Zulu’s, gifted them to me. A few days later the local nursery found another three small trees for me.

Jane delivered the first three trees as soon as  she got them. The thorns tore at her car seats. He forearms had bright red spots where the thorns had drawn blood.

The tree of life has a straight thorn that points to the future and a curved thorn that connects us to out past. The branch has a zig-zag pattern, much like the path we follow in life.

I had a dream in the beginning of the Covid-19 pandemic. I was moved by the pain of families who could not visit their loved ones in hospital. I thought of these trees after my dream, and knew I should plant them in our Garden of Remembrance. I finally found them. Rather, they found me. So Rachel the gardener at the hospital planted them. Three in a row. The other three small trees were planted in a group a but further away.

This weekend I mixed some concrete and planted a sign to remember the reason we planted the trees of life.

A sense of peace descended over me. Now my soul can rest a little easier.

Rachel, our gardener planted the trees of life.
The tree of life….
The Garden of Remembrance

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Some Good News

I have been distracting myself since the second wave. Our hospital has quietened down as far as Covid-19 cases go, and we started doing limited planned surgeries. After my last post which detailed the overwhelming and horrific difficulties we faced during the second wave, a friend of mine suggested my next post should be about some good news.

So I thought of telling you about a touching visit by a medical student to her grandfather. He had been admitted with Covid pneumonia and is now recovering at home. I also thought I would write about how we have resumed planned surgeries, and how it feels different to when we resumed after the first wave. In the background I have been working on a document detailing how Covid-19 has affected me as an orthopaedic surgeon. I think the latter post would not be good news.

But there is good news for this post: I received my Johnson and Johnson vaccine on Friday. It was injected into my left arm by a community clinic nurse at Prince Mshiyeni Memorial Hospital, a provincial general hospital in the south of Durban, KwaZulu-Natal.

There is so much to say about the vaccinations for Covid-19. The scientific endeavour and ultimate production and licensing is nothing short of miraculous. The first time use of mRNA vaccines in the Pfizer and Moderna vials is science exploring the envelope . The Pfizer story is worth reading. It details a humble event. Albert Bourla is a Jew born in Thessaloniki, northern Greece, who steered Pfizer as CEO to be the first to release and use a vaccine for Covid-19. The story of who was the first person to be vaccinated in Greece is where much respect goes to Mr Bourla. Mrs Despina, 95 years old and also of Thessaloniki, is a Jewish-Greek holocaust survivor. She received her vaccine in early January 2021.

The Astra-Zeneca and Johnson & Johnson vaccines both use the older technology of inactive adenovirus with the DNA of the Corona virus incorporated. Unfortunately the Astra-Zeneca vaccine gave less protection for the new variants of the Corona virus, including the variant which caused South Africa to explode in the recent second wave. The adenovirus DNA vaccines are more robust than the modern mRNA vaccines, whose cold chain storage at -70 degrees Celsius is difficult in a developing country. South Africa had already taken delivery of one million doses of the Astra-Zeneca vaccine as the studies unfolded about it not being as protective as we had hoped for. It was an disheartening blow to the nation’s health care workersw who were relying on a vaccine to give them real protection.

Before the dust had settled on the unused Astra-Zeneca vials ( which were sold to other African countries) South Africa took delivery of 80 000 doses of the Johnson and Johnson Vaccine. This is a single dose vaccine as opposed to the others which rely on two doses, given at an interval of a few weeks to a few months. Over the last week the Department of Health co-ordinated the distribution of the Johnson and Johnson vaccine under the umbrella of a trial for health care workers called Sisonke. Sisonke in Zulu means “together”. It is a Phase 3 (b) clinical trial which is pragmatic and set in the real world. Perhaps a little more real in Africa.

The Department of Health distributed the 80 000 doses between 14 state hospitals and used these initial doses to protect frontline health care workers. Their EVDS (Electronic Vaccination Data System) website allowed me to register as a health care worker. My hospital then stratified staff into risk levels, and then I was able to register on the Sisonke website to be part of the trial. Besides entering personal details this also involved digitally signing an informed consent. After this I received a voucher number and a booking to get my vaccine on Friday 26 February 2021 at Prince Mshiyeni Memorial Hospital. It was not all as simple as it sounds. 

The logistics of the vaccine delivery process has been difficult globally. South Africa has discovered the limitations of the public-private health care system. Some provinces allocated appointment times. When I received my invitation it was open ended: from 8 am until 4 pm. My heart sank as I thought of my visit two years ago to the Department of Home Affairs to apply for renewal of my passport. For that I arrived at 5 am to be close to the front of the queue. It could not be that bad, so I arrived at Prince Mshiyeni Memorial Hospital, 10km away from Netcare Kingsway Hospital, just after 7 am. I was relieved and reassured to see our nursing manager at the entrance welcoming and directing me. I was number 184 in the queue. Two hours later I received my injection. Then I had to wait the obligatory 15 minutes to ensure I did not suffer an adverse reaction.

I walked out feeling empowered. I had survived a mild dose of Covid-19 at the end of last year,  and now with the vaccine I was protected. As data comes in I will in turn protect others. But until a significant proportion of our population is vaccinated I will continue applying the appropriate precautions. We should all continue to wear masks, wash hands and maintain social distance. In the hospital and my office the minimum requirement remains a mask, visor, plastic apron and gloves. 

We still have a long way to go with this pandemic, but the vaccine is the most significant step in our battle to gain control of this novel corona virus.

I am grateful to the scientists who developed the vaccine and the South African government for choosing to protect us. Special thanks to the manager of Netcare Kingsway Hospital, Mrs Demetriou for her efforts to get her staff vaccinated.  Health care workers have seen a different reality to the rest of the population.

Thanks to Sister Nompumelelo Molefe
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In Their Memory

I cannot find a title that encapsulates what has happened at my hospital without being alarmist. This is all about death. 

In early January 2021 my hospital was overwhelmed with Covid-19 cases as the second wave of infections hit our coastal holiday town with devastating force. 

The senior emergency doctor contracted the disease and was unwell. The remaining doctors were stretched to cover the extra load. Our infrastructure was stretched. My measure of how we were coping was based on a few rough gauges: 

How many people were lined up outside the emergency department on oxygen? 

How many people were in the emergency department waiting for a bed at my or another hospital? 

A few weeks later I added another measure: how many people were waiting for ICU? 

We were stretched, no doubt. So I went to see how I could help. 

The nurses and doctors knew what they were doing, but it seemed chaotic just because of the sheer deluge of ill patients. We had a ward that was empty and accessible to those needing urgent care for Covid-19 symptoms. But we did not have the staff.  

As I walked through the ward I discovered the real measure of how overwhelmed my hospital was. There was a dead body in each of many rooms. Out of respect for the departed our staff were leaving the dead alone in a room. Their desire for those in the afterlife was to rest in peace with space. 

I am not at liberty to give the statistics as they are part of the information that the Department of Health disseminates. But I can tell you how it affected us. 

To make space for sick patients I seconded a porter and we started moving all the dead bodies into one room. A holding area. As we did this I met some of my operating theatre staff who were delivering a shrouded body to the new holding area. Beds in the ward were at a premium so it was more efficient to move the body to a holding area where the many professional undertakers have taken them away timeously. 

4180. 

That is the switchboard extension the ward staff call to get the RIP (Rest In Peace) team from theatre to prepare and move the body.  

The RIP team is made up of skilled theatre nurses, scrub sisters, recovery and anesthetic nurses. Once they get the call on extension 4180 they go to the ward where the patient has demised. They check the paperwork. They ask the family if they want the clothes left on or removed.  Then they wrap the body in two layers of plastic, each layer with three patient stickers identifying the body. Then they shroud the body with a white bedsheet. The remains are respectfully transferred to the holding area. 

We managed to staff and open the ward the next day and take patients from outside on oxygen and put them inside in a bed on oxygen.  

The odd thing is the number waiting outside remained the same for many days.  

It was sobering that number of dead arriving in the holding area was much more than we ever anticipated. 

The Holocaust Memorial in Berlin

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Sometimes I Think

Sometimes I think and nothing happens. That seems to happen a lot during this period of the second wave of Covid-19 that has hit my hospital. Netcare Kingsway Hospital is a community private hospital and has been overwhelmed in caring for patients with Covid-19.

Sometimes I think and something happens. That’s when a story takes shape and I wonder how I will tie it together to make it work.

Sometimes I think about the pandemic. I focus on the problems we face and work out solutions. I reflect on all we have done. I reflect on what we have learnt. Although we were all tired after the first wave, at least for the second wave we had systems in place. Systems to protect staff with PPE, systems to control the flow of patients and systems to deals with patients waiting outside and waiting for an ICU bed.

Sometimes I think that it is affecting everyone. It is affecting every nation. Uniting some and dividing others.

Sometimes I think that it is not only about the nurses and doctors and first responders. It is about the cleaners and security staff, about the porters and the kitchen staff. About the switchboard operator and the admission clerks. They are the ones that make up the scaffolding from which the nurses and doctors flesh out their caring and compassion. Without them risking close contact with sick patients health care workers could not do what they have had to do. 

Sometimes I think about the undertakers I see moving around the hospital. Death certificates in hand if they are lucky, otherwise their unfazed search for the source of that important document. I have seen families cry as a body has been transferred to the undertaker’s van. It was eerie to see a full length leg prosthesis pushed like a spare part above one body.

Sometimes I think about all of these people. I just have not written about them. Now I will write about them.

It may look like it’s only sometimes that I think about them. But today I walked out of my office holding a tray doughnuts. A patient brought them yesterday to celebrate his birthday with us. I didn’t save his life. I am just an orthopedic surgeon. I only fix bones as my clever anesthesiologist insists. I was grateful my patient thought of us but I never got round to having the doughnut.

Sometimes I think clearly. This time I took the doughnuts to the security guard that directs people in crisis to the back of the hospital for them to be triaged. He remains calm and polite and cares as much as any nurse or doctor. I know that because I see him every day he comes on duty. I wave as I drive in and he salutes me.

Sometimes I wish I could do more for them. The doughnuts for the security guard were a start.

Moving mannequins at a Durban outdoor market
Posted on by basilBLOGinc · 8 Comments

Superlatives

I could use superlatives to describe our nurses at Netcare Kingsway Hospital.

There are fancy words like  unprecedented, incredible, amazing, unbelievable, conscientious and self-sacrificing.

But I will not.

I will just tell you what they do:

Our nurses work twelve hour shifts. They arrive early and leave late. They wait in line to  sign in with a thumb print for work. Then they log in on their cell phones to be screened for Covid-19 symptoms and checked for fever. They queue up to sign in. Then they wait to be screened. 

From there they walk to their ward. There is not as much noise as before. It is quiet as they put their bag and food in their locker. Before they used to leave their phones in the locker. Now the phone is a vital tool to connect. Not to social media, but to hospital and doctor groups. Orders, stats and death notices fill the small screens.

They don PPE to start work and care for their patients. They wear a mask, visor, gown and gloves all day. It gets hot. Their throats become dry.  Tea and lunch breaks are short and sometimes missed because they are busy. They cannot sit with friends. The tea rooms only allow two nurses at a time. I see them walking to their cars to eat lunch. There is no life in how they spend the time which is meant to recharge their soul.

The wards are full. We can give each patient an oxygen mask or rebreather. Not everyone can get high flow oxygen because our oxygen supply system will fail. This even after we installed a huge tank and free flow piping that we hose down every hour to prevent the freezing of the pipes. I do not need to explain the cap we face if we need to escalate breathing support. There are a fixed number of ventilators with a waiting list.

As I write this, the words seem without aim.

I have chosen my words to reflect the staccato world of talking through masks and behind visors.

Yet somehow richer words appear. The intensity of the ICU’s is cloaked in an almost church like peace as these highly qualified nurses work around the clock to save lives. When I talk to them all I see are tired eyes above the mask line, yet there is a gentleness and concern that pervades their every action.

My theatre staff have lost all sense of stability. They have to work in wards, ICU, the emergency department, triage or screening. They also call the families to update them of the loved ones condition. My theatre staff have another duty: they care for those we have lost. They do this with great dignity.

This week I got some grass cutting helmet visors (I am holding two in the photo) for some of the theatre staff. We all know they are the most comfy and safe as well. They are bulky and ugly. One of the nurses put her visor on and walked as if on a catwalk. She was showing off her new visor as if it was a designer handbag.

As she walked she tilted her head to show the large blue helmet with clear plastic screen and said “fabulous!”.

Now that is a superlative I did not expect to hear.

Holding the grass cutting visors in a stainless steel hospital lift. See my phone in a plastic bag.