What Nobody Tells You About the Free Services We Provide

For all sakes and purposes, the hospital I work in, is truly a free hospital. That means that, technically speaking, the patient doesn't have to pay for anything at all ranging from investigations, medication or necessary surgeries to actually staying in an ICU ward. There is, however, a catch to all of this. Several catches, actually. Let me shed some light on them, and go into detail on one of them that particularly bothers me.

• First of all, we will run all the necessary investigations to help reach a diagnosis, so long as our shit works. If you frequent this blog, you'll know we have an especially troublesome CT machine that tends to 'stop working' quite often. That's not all. Certain blood tests too, aren't readily available either. By readily available, I mean immediate. Let me give an example. In the Emergency ward in Pediatrics, it's a 24 hour shift. Now in the morning the main labs are open and stay open until about 2 pm. Now, if the main lab is open and you submit a sample at 8 am in the morning, they will not hand you the results until 2 pm in the afternoon. Protocol and beauracracy at its best. That means if a patient comes in at 8 am with severe anemia and you want to find the hemoglobin level not just to confirm the anemia, but to order a blood bag, they're going to have to wait until 2 pm. It's unfair too because if a patient comes in after 2 pm, then the emergency labs are open, and that only takes an hour for the results to yield. So if you ever need to go to the emergency department in a free hospital, fucking come late because coming early isn't worth the effort. Keep in mind that this isn't what bothers me.

• We will give the medication for free, only if we have it. Some medication is simply not available in our hospital or requires a special order (that must be filled in only in the morning). Either way, if we don't got it, your best bet is to go buy the stuff outside. This is normally okay because even in the worst case scenario, most medication isn't that expensive. However, sometimes it can truly be heartbreaking. We had a patient that needed cyclosporine (a drug we did not have) and it cost them 1,200 Egyptian pounds to go buy. That's alot of money for the type of people we get in our hospital. It also becomes even more annoying when they end up spending money for investigations outside(to speed things up) and find themselves spending more money for medication. Alot of departments thankfully do get around the money issue by giving out donations courtesy of the older professors in each department. Sadly, not all departments have a heart. As sad as this is, it's also not what gets to me.

• ICUs are readily available too, but only if they're empty obviously, and the problem with ICUs is well, patients tend to stay there for a while. So having to tell parents that they need to bust their asses looking for an ICU for their very sick child can suck at times but again, this is one of those things that is out of our hands. Again, as much as this sucks, this is not what gets to me.

• Above all else, our hospital, is a teaching hospital. We have students readily coming in and patients regularly get examined by these students. Exams and classes with patients are prepared by the residents when the need arises and so on and so forth. It can genuinely be a bitch to find certain patients too. For example, neurology week would need different neurological cases. Cases we might not have, so we go around bargaining with other departments to give us their patients just for a while until the class ends. By bargaining, I literally mean bargaining. Usually, other departments also want other patients so we switch for a few hours until the classes are over. Just a few days ago, I had to go to the other Pediatric hospital across the street (we have two) and bring a patient for a class. It was especially difficult, because the mother was being difficult. Her kid had just had 7 samples taken out of her; she was tired and she wasn't ready for a class full of students palpating/groping her child. The mother had a point obviously, but she didn't have the right however. All patients admitted to our hospital sign an admissions form explicitly stating that we can do whatever we want and we have the right to use them for tests, classes etc. Now, I felt for this mother. Her kid was especially in high demand because the manifestations of her disease were easily shown to students. So this was her 5th day in a row. I managed to coax and convince her and she tagged along.  Now this may not sound so bad, but it gets much much worse when it comes to exams, especially Masters or PhD level exams. Higher level exams require complicated patients that fulfill very specific criteria according to the examiner (our professors) and they can be ridiculously anal on what they want. Our professors also will not take no for an answer. Again, let me clarify with a better example. We had a kid (who I'm going to call Adam) with Rheumatic Fever in our department. He was a really nice 7 year old with a great and understanding mother. He got on the medication, got better and we told his mother that come Saturday they'd be going home and continuing their evaluation at a clinic. They were ecstatic because let's face it, a hospital is not a cheery place. The Friday before, a few professors came in and asked us what our cases were and we told them. They looked at Adam and heard his heart (he had Mitral Regurge, a complication of the disease that reveals a certain sound on the stethescope known as a murmur). They came back to us and told us, "Keep Adam for a week. He's going to be in one of the exams." We argued back and told them that we told the mother he was leaving. Their response was simply, "Doesn't matter. Make something up and keep them for a week."
  
  Let me clarify what "Make something up" means. Make something up means going to the mother and telling her that we just need to make SUPER sure Adam's okay so we'll run a few more tests on him, JUST to be on the safe side. It's all bullshit of course just to keep him there. THIS IS WHAT I HAVE A PROBLEM WITH. Thankfully, the specific scenario of Adam ended on a happy note with one of the more senior professors deciding he wasn't fit for an exam (not because of his health, but because his case was too easy for Masters students)
  
  This sort of shit is what ticks me off. It gets much worse as well. A few professors had entrusted me to find cases for a PhD exam in a few hospitals, one of them being our own version of a Cancer Hospital. Their criteria was simply, "Try to find a super difficult case so that more people fail than pass." So not only did I have to go about finding patients with rare fucking findings, I had to do it so that other fellow doctors would fail their PhD. This story got much worse because when I got to the Cancer Hospital and spoke to my contact there (Yes, a fucking contact established through the professors) she showed me an especially hard case (that had cancer and rare findings) and then she told me to let her know if they'd want her because if they did, she wouldn't have to start the next dose of chemotherapy on time and delay it for a few days until after the exam (because the findings would subside after a dose of chemo)
  
  Not only was I dealing in patients but I was sometimes prolonging treatment. Now, to be fair, we're not monsters either. I mean, the 'delay' isn't going to harm the patient and everything is looked after so as not to deteriorate the patient's health.
  
  But goddamnit if it doesn't make you feel like an asshole.

So the next time people talk about how free hospitals really are free, always realize that nothing in this world is for free. There are consequences and repercussions to everything no matter how great it sounds on the outside.

G6PD aka Favism aka What do you mean he can't eat Ful (mashed beans)

I'm about to get scientific on all your asses right now so please bear with me.

There's a disorder out there called G6PD deficiency. Now G6PD is an enzyme called Glucose 6 Phosphate Dehydrogenase. It's an enzyme that protects the Red Blood Cells against oxidative damage. Now you might not know what oxidative damage means but all you need to know is that there are certain food items and medications that have molecules within them that can essentially destroy a red blood cell. G6PD is an enzyme that protects the red blood cell from this destruction.

The deficiency is pretty common especially here in Egypt, and it can be quite disastrous for the parents. Why is that you might ask? 

Well, remember when I said certain food items. By certain food items I mean Ful (http://en.wikipedia.org/wiki/Ful_medames).

Looks appetizing no?

Ful is the commonest and cheapest dish prepared here in Egypt. It's basically mashed beans along with some olive oil and garnish. Suffice to say, many people of a lower socioeconomic class have designated Ful to be their prime nourishment throughout their life. It's cheap and it's satisfies the hunger more so than any other meal I've heard of. 

Having a deficiency in G6PD means you cannot eat Ful, forever.

If a person with a deficiency eats the beans, his or her red blood cells start getting destroyed (hemolysis) and the person presents with a case of acute severe anemia that cannot be corrected except with a blood transfusion. The destruction can be so severe that it can cause death in some cases. 

There is no cure or anything like that. The only cure is to stay the fuck away from all food items, including Ful, that may induce hemolysis.

Now as far as enzyme deficiencies go, this one is awesome. Most enzyme deficiencies are fatal and severely affect a person's lifespan because they're involved in vital functions of the human body. G6PD is just a 'protective' enzyme and so all it does is protect the cells. So, whenever a kid comes with this condition I usually tell the parents that it could've been alot worse.

Problem is, parents don't quite see how it could be alot worse. 

As I said, people of a lower socioeconomic level depend on Ful for sustenance. They can have it for breakfast, lunch and/or dinner. And in a country where more than 50% of Egyptians are on the poverty line, they try to be as economically wary as possible. 

To them, it's a death sentence. Reactions I've had from parents who were told their kids had the deficiency have ranged from sheer disbelief to just mental breakdowns and tears. I remember laughing a little on the inside when a certain family just broke down into tears about the subject. I thought they were being dramatic. After all, they came to us in the ER and there were kids dying everywhere, so just needing a blood transfusion and staying away from the stuff, to me, was a win. After going back home and talking to my friends about it, we realised they were crying because they literally had no idea where or how they were going to get enough money to feed their kid something that doesn't contain beans. 

We've had parents come in over and over again, because their answer was "We have to feed him something! He's going to die anyways if he doesn't eat, so we get him to eat the Ful then take him to the hospital for a blood transfusion." 

These are parents who are willing to take the risk of their child dying because they can't substitute Ful with anything else.  

Fucking crazy.

All in all, it's a sad disorder to have if you're living here in Egypt. Ful has seeped its way into culture even and many (myself included) are not considered full blown Egyptian if they don't eat Ful at least daily. 

I'll end this post on the funniest line I've heard from a patient's dad when I told him his son couldn't eat Ful forever, if only to document the mindset and to alleviate the sad tone of the post.

"Is this some sort of conspiracy? Is there going to be a Ful shortage so you're being forced to tell me that my son can't eat it? No, its impossible! God would not do this to the Egyptians. He can't! He knows how much we need Ful!"

It's funny, but also sort of sad.

Stupid Things I've Heard Mothers and Fathers Say (Part 1)

Here's a list:

• "NO! You will not take another sample from my son's precious blood! You're draining him away!" -Scared woman who was pissed off at us for taking a few samples for reports. I think she also said something about selling her baby's blood in the black market. 

• "I don't know why I didn't bring him sooner Doc. I just thought that his head growing faster than his body and that's where the brain is right? So he'd be getting smarter too!" - Mother who brought in her hydrocephalic child after months of leaving his head to grow in size. (Google hydrocephalus if you want, but I must warn you, it's pretty disturbing.)

• "Listen Doc, I know he had a seizure and he needs to be under observation for a few hours, but I have work in the morning and his mother's tired. Can't we just leave him here and come back to pick him up in the morning?"  -Father after realizing he was going to have stay 5 extra hours with his child that had a convulsion.

• "Can't I just give him my blood Doc? Yeah I understand it has to be a match but I'm his daddy and I know MY blood will specifically save him." - Father upon hearing it's not like the movies and that it  actually takes an hour for a kid to receive blood from the hospital.

• "I'm worried about his poop Doc! It's brown and it smells nastier than usual. What do you think it could be?" - Mother discovering that poop is actually brown and smells pretty bad.

• "So.... You're saying we SHOULDN'T feed him to the point of vomiting? But that's what my mom did and look at me! I'm fine!" -Mother reveals her wonderful technique for feeding her baby that is also, a family trade secret

A New Start.

So it's been a long time since I've posted (4 months and then some) so I figure I should update you on what's been going on.

Country's in shambles. Islamophilia and Islamophobia are on the rise all at once, and it's not looking good for anyone who's living here. However something monumentally life altering has happened:

I've finished my internship.

Now this might mean that the blog is done and dead. No more wacky stories from the intern who gave you a peek at an Egyptian Government hospital. Don't fret! For I have bigger news:

I start my Residency in a month (hopefully less), and it's going to be in Pediatrics, but for now I'm volunteering every now and then at the hospital so that I'll know my way around when it all becomes official.

Now, I know what I said before about me not being able to post that many stories when I was interning at the Pediatrics hospital, but, after much thought and exposure to both stupidity and mind altering moments of clarity, I've decided to keep posting about the stuff I'll be seeing. Keep in mind it might not be funny all the time, and sometimes, it's going to get a little dark and depressing. Anyways, let's get started.

A few days ago, in the Pediatric ER department we had a patient that went into shock.We stabilized her but she needed to get into the ICU. Luckily, the resident at the ICU department said there was a free space available (a rarity in its own self) but we'd have to wait a while until the patient using the bed previously actually got discharged i.e: her parents would come and pick her up. So we comforted the mother and told her, and needless to say, she was ecstatic (she knew about the difficulty in actually finding a free bed available) After a few hours and dozens of patients we'd realized that the resident in the ICU hadn't called us back to tell us to bring her in. So I went to go talk to him about it.

"What happened? I thought you said it was a done deal and your patient would get discharged."
"Yeah, about that, the patient's parents aren't picking up their phone."

"What do you mean they're not picking up their phone?"

"I mean they're not here in the hospital and I can't just kick her out into the street now can I?"

(Keep in mind the soon to be discharged patient was 4 months old)

"Well, keep calling them. They'll have to pick up eventually right?"

4 hours later.....

"What the fuck man? It's been 4 hours. Did they not pick up?"

"They did but we have a bigger problem.They don't want her."

"What?"

"Like I said, they don't want her. It turns out they weren't the ones that brought her to the hospital. That was her uncle. Her parents don't want to have anything to do with her."

"I don't understand. What do you mean they don't want her?"

" I mean they don't want her. They said something about worrying she was going to die if she left the ICU but from what I gathered, they just don't seem to want her back."
"Did you tell them we're not a fucking orphanage and that bed's needed."
"Yeah yeah, all that, they still don't seem to give a shit though."
"What am I going to tell the girl's mother upstairs? We practically promised her the bed."

"Well, she's going to have to leave eventually. When she eventually leaves the bed's still guaranteed to your patient upstairs."

So yeah.. 

Now, it's not relatively uncommon for parents to not give a shit about their kids. If I keep posting, you'll soon realize how frustratingly apparent and common it's become.  What ticked me off, was that there was a bed that was available that could have really helped another patient, and it was being wasted on someone who didn't need critical care. 

And that. Fucking. Sucked.

I went upstairs and told the mother. She was amazingly decent about it. She kept asking me one thing though:

"What sort of mother would do that to her own child?"

My first OB/GYN shift, in which, surprisingly, I don't see any lady parts.

Okay so maybe I hyped up OB/GYN a bit more than I'd hoped for. 

It's actually not as hilariously insane as I might have expected it to be. 

I mean, sure I had to carry a bunch of samples, which included urine and tissue from an ectopic pregnancy (or a wannabe fetus as I like to call them) in a carton that was once a carton used to store a crap ton of eggs (there was no other medium of transportation).

Sure the sample with the fetal tissue was exposed and there was a big gaping hole in the bottle, which was ultimately worrying because I kept envisioning myself being drenched in, ummm, 'embryonic tissue'.  

Which , BY THE WAY, totally DIDN'T happen thank God, much as it would have been entertaining I'm sure.

Yes, my first day was disappointing. 

But then something awesome happened near the end of the shift. The resident, who I'd known from my previous stint in the resuscitation room (he was serving time there as well) came up to me and asked me who was covering the mid shift (I was in the morning shift).

"A reliable guy, don't sweat it."

"You don't understand, I need a man's man to get something done for me. Do you mind doing it and staying a bit later?"

"Sure, no problem."

Little did I know, that he wanted me to do something totally and utterly illegal..............

There was a patient that was due for a C-section the week after and she had mentioned a heart problem that she had when she was 6 years old. She didn't know the specifics but she remembered having had an operation. Now, the resident, ordered an echocardiography but it came up inconclusive. The problem was that no cardiologist would see her unless she had a chest X-ray. 

So the resident wanted me to get a Chest X-Ray done, on a very pregnant lady, in a hospital that has a protocol of not doing X-Rays on pregnant women. Not only that, but he wanted me to do it in the ER (because any other way would take forever)

Now a few notes I have to mention here, just in case people reading this think I'm some sort of reckless doctor with absolutely no ethical background whatsoever. 

• It's alright for a woman to get an X-ray during her pregnancy. It's not routine, but if it's necessary then it needs to be done.The few rads of radiation won't hurt anyone. The problem lies in multiple x-rays and so, just as a precaution the hospital banned all sorts of x-rays on pregnant women.

• Now, there is a way to get around this, ahem, legally. You get a radiologist to sign in on the request, and he sets up an appointment for her to have her x-ray. That's a totally doable situation but there's a problem with this scenario. It takes fucking ages. As I mentioned in a previous post, the bureaucracy in our hospital is maddening, and shit tends to take a while. Time was not something we had.

• She really did need an X-ray. A C-section is , for all means and purposes, an operation, and having an operation with undetected heart problems could lead to disaster for both her, and her unborn child.

I was up for the task and told him I'd do it. So I went to her and explained the situation clearly to her. After she agreed, I told her to get dressed in her normal clothes and we were on our way to the ER. Now the only way we'd get the technician to do said X-ray was if we lied our asses off. So for 20 minutes, I had a brand new cousin who needed a Chest X-Ray. I told her that if anyone asks about her ridiculously swollen belly, she'd tell them she had ascites ( fluid in the peritoneal cavity). After getting our stories straight we arrived at the X-ray room. 

I'd love to say that I had to convince the guy to do this one favor for me. I'd love to say that it took me ages to persuade the technician to perform the X-ray. 

In reality, it took me all of 5 seconds. It went a little something like this:

"Hi, I'm an intern here and my cousin wants to get this chest X-ray done because the doctor at the clinic said she needed it done."

"So she's a relative, sure man no problem. Consider it your machine!"

God bless favoritism. 

God bless corruption.

God bless Egypt.

PS: In case you were wondering, the X-ray revealed ridiculous cardiomegaly, which did in fact mean that there was something wrong with her. She's now being treated by the cardiologists and she's on the proper medication and hopefully, everything will work out fine.

Obstetrics and Gynecology. Fuck Yeah!

That's right folks.

For the next 2 months, I'm going to be talking about pregnant ladies and vaginas.

Now before you perverts start thinking,
"You lucky sonofabitch, women will strip down and show you their lady parts for free for 61 days"
let me just illuminate your perspective.

You're absolutely right. Women will strip down and show me their lady parts for free...

Let me just add a few more words to that last sentence to show you why you're wrong.

EMOTIONAL, HORMONE PACKED Women....OF ALL AGES.....will strip down to show me their SICK lady parts for free.
Here's a list of bullet points ( because you all know how much I love bullet points ) to illustrate my dismay:

• OLD WOMEN.......(In case you haven't been following my blog or you have no idea what I'm alluding to I urge you to read this post http://hospitaldelerium.blogspot.com/2011/05/my-first-clinical-exam-or-day-i-became.html so you can clearly understand how ridiculously disgusting this can be)

• SICK lady parts: Women, don't get me wrong. You're beautiful in every way. All of you. And I'm sure that your lady parts are perfect just the way you are. But like all other organs and body parts, when you get sick, they start looking less, how you say, perfect. I won't get into specifics, but fucking trust me on this one perverts, no vag is better than sick vag

• EMOTIONAL HORMONAL women:  Now hormones are a double edged sword. With them come all the wonderful things that make women women. Compassion, understanding, affection, love and all that. But when the hormones start working in overdrive you get all those other traits: Bugfuck Insanity, Absurdity, Illogicality ( I know its not a word but stay with me here) This becomes especially evident when a woman is pregnant, because according to her, EVERYTHING THE DOCTOR DOES is harmful to her baby, like say, take her god damn history and do an ultrasound.

Now the non-perverts (or perverts in hiding) are probably thinking , 

"But Dr. A, you're going to see the wondrous miracle that is child birth. It'll change your life every single time you witness it."

....................WRONG AGAIN!

Now don't get me wrong. I'm sure child birth is a beautiful process that brings a brand new human being into this wonderful happy planet (I hope to God you're realising the subtle undertones of sarcasm here)  but let me explain why it's not as 'life changing' as one would hope.

I once saw a doctor go in....with BOTH HIS ARMS.....to properly position a baby. 

That image is seared onto my brain, and is just a precursor to what sometimes happens in the 'Birth Kiosk' . Yes that's right, it's officially called a Birth Kiosk.

Now I'm sure its a beautiful process and all but witnessing this:

coming out of a uterus that was once the size of your goddamn FIST

can be quite disconcerting for many.  (The pictures aren't to scale I realize, but I'm too lazy to look for more appropriate pictures)

All in all, I'm sure they're going to be an entertaining 2 months, more for you than for me. So sit back, relax and enjoy the endless, and hopefully hilarious torment, that I'm going to have to endure.

Let Me Explain My Absence (Or At Least Make Something Up So You Can All Love Me Again)

Alright, so I guess I have some explaining to do. It's been a whole month and a half since I've updated this blog but there's a reason for that. Here it comes. Are you ready for it?












I was in Pediatrics.





Yup.

That's my excuse. Now let me explain why it's a valid excuse because I know what you're thinking. You're probably thinking,

"But Dr. A, Pediatrics must have been hilarious. Crying kids, crazy mothers; a shit ton of hilarious stuff MUST have happened to you!"

The real answer is no, not really. I mean sure you've got the crazy mother who's worried about her crying child, but that's because most of the kids had serious afflictions, and try as I might to spin dead babies into something funny, I just couldn't. It was harsh, it was brutal and I had the world's stupidest resident for a superior (which meant more kids weren't getting the attention or treatment they properly needed). I have however, come to an epiphany of some sort.

I want to be a pediatrician.


Specifically, a pediatric oncologist.


Yes, ladies and gentlemen, I've decided to pick the world's most depressing field when it comes to medicine. Do not ask me why ( I don't know myself ) . All I know is that it's something I want to do for the rest of my life, for now.  But again, I doubt any of you really care about what my goals and achievements are. This was just merely an explanation for my absence.

Does this mean I'm ending my blog?


Fuck no.


Why?

Because I've still got one more field left, and judging from how things are going from day 1, it's hopefully going to be the funniest field yet.

To quote one of the great philosophers of anyone's time:


I'm back bitches.

I'm So Sorry You're Dying, But I'm Going To Need The Pink Form First.

Bureaucracy.

Just the word alone makes me cringe.

I think, that one day, way back when man created government and government procedure, some smart ass said .
"Well if the process for applying for any documentation is easy, we'll be working every [insert deity being worshipped at the time]damn minute , every day. Here's an idea. Let's make it complicated, perplexing, and best of all, soul numbingly time consuming."

The hospital is government run , which means bureaucracy is effervescent within our halls. You're probably thinking, hey wait a minute! What if the patient's dying? Are they really cruel enough to let the family go through the unbearable torture of paperwork as he's slowly drifting off of this world into the next.

Yes. Yes we absolutely are.

Here's what happens so that a patient , let's say he's been in a car accident, can get admitted into a ward. This is assuming his only problem is , a broken hip for instance.

(Get ready to be BORED OUT OF YOUR MIND)

1. The family goes to the window and gets a pink slip and records his name.
2. The pink slip is given to a doctor in the triage who then gives them a white slip to go to the Orthopedic ER.
3. The doctors there send the patient back to the ER because he needs to go to Resuscitation first (to make sure nothing else is wrong with him).
4. The doctor in the Triage gives them another white slip to go to Resuscitation.
5. The doctors in Resuscitation need a CT of the brain to make sure there's no injury as well. 
6. A CT request is obtained.
7. The CT request is stamped.
8. The patient goes and gets the CT done (and if you've read any of my posts, you know this can go on for fucking hours) then goes back to Resuscitation.
9. The doctors declare he's alright and he needs to go back to Orthopedic ER.
10. The doctors in Orthopedic ER order an X-Ray.
11. The X-ray is done and the doctors decide he's worthy enough of an admission and consequently, surgery.
12. The doctors need the white slip to be signed by a Neurosurgeon AND a Surgeon so they can declare he's alright.
13. The family goes to look for said Neurosurgeon AND said Surgeron.
14. They wait a few hours until they find the doctors and they get the papers signed..Possible ending to this step: The family lose their shit over waiting for the doctors and decide to threaten and hit doctors, OR they just leave with the patient. After Step 14, life is relatively easy. It can seriously take 4-5 hours until they find a Neurosurgeon AND a Surgeon free enough to sign a piece of goddamn paper.
15. They go back to Orthopedics, where the doctor tells them they need to go back to the window so they can sign and get an admissions form.
16. The window tells them to go back to Orthopedics and have the doctor sign on the white slip saying it's okay for him to be admitted.
17. They go back to the doctor. Just before he signs it, he asks the family whether or not he's gotten the blood samples and test results.
18. They shake their heads and say no.
19. The doctor doesn't sign and tells them they need to get a nurse to get the blood samples and send them to the lab for any diseases.
20. They go back into the ER and wait for said nurse or intern to take the samples.
21. The samples are taken and sent to the lab.
22. They wait another hour.
23. They get the results, show it to the doctor who decides to sign off on it.
24. They go back to the window, exchange the white slip for an admissions form.
25. They congratulate themselves and pat themselves on the back for a job well done.

25 FUCKING steps! I want to tell you I'm exaggerating. I want to tell you I'm embellishing, but I'm not. It's fucking ridiculous. Bear in mind this is all necessary paperwork, and if any of them is stopped, FOR ANY REASON, odds are the patient will have to wait until it's all done. Now we're not monsters. No, we don't let the patient do any of this. If the patient is in a critical condition, we'll treat him right away but someone's going to HAVE to do the paperwork in order for things to go smoothly. I've been with families throughout this procedure. It's relentlessly exhausting, and this is from someone who knows where to go and how to contact the doctors. Most of the times, they're just left there to do this ALL on their own (with the exception of the few obvious steps).

It's enough to drive any sane man crazy. 

I'll end this with a video of a cartoon I once loved as a kid: Asterix and the 12 Tasks. One of the tasks was for them to get a specific permit from a building, without going crazy.
I urge anyone who's ever had to go through government bullshit to watch this. You'll get a kick out of it, I promise :

I hope to God that smart ass is stuck in Hell for eternity, doomed to look for a permit (that doesn't exist) in a building of gargantuan size and unbearable heat.

My First Clinical Exam or The Day I Became a Man.

Let's go back. Back to a time when I was just a young naive student, eager to learn, hopeful about my future and just ecstatic about choosing medicine as a viable career option.

It was the day of my first clinical exam. Now let me just offer a quick explanation on what a clinical exam entails. It's a test (that you're graded on) that includes you, the patient and the doctor grading your performance with the patient. Bear in mind that the doctor doesn't care about how difficult the patient is, or how nice you might be. All the doctor wants is proper examination skills and a diagnosis plus or minus a management plan.

Oh, and you have to wear a suit. With a tie. Not a white lab coat. A suit. In the summer. With a tie. While examining a patient. Something about respecting the fact that the senior professor actually had to get off his or her ass and grace you with his/her presence (I was never too sure about the details).

Anyways back to the exam. There I was, nervous, anxious and ready to go. The patient was an elderly woman who looked like my grandmother (sweet and adorable old, not gray and senile old). I took it as a sign and went straight to work.

"Hello, my name is Dr. A. What's your name?"
"Zaynab, but you can call me Sayyeda Zaynab." (Sayyeda Zaynab is a district here in Cairo hence the humor)
"Ah. Ha-Ha. Okay well what brought you to the hospital Mrs. Zaynab."
"SAYYEDA"
................
"Right, sorry. Sayyeda Zaynab."
"Well, I've had this cough for a while and I decided to finally go and have it checked."

After I took the history it was time for the ............................examination... (You'll understand my hesitation to continue with this story in a bit, I promise)

I got the stethescope out and decided to auscultate her chest. Now she was wearing a gown so I tried to get the stethescope through but I failed. So I asked her .....nicely......... to unbutton her gown a bit. (We're almost there. God no. Please don't let me relive this again.)

"Why should I unbutton? Here, let make this much easier for you Doc."


She...
She........
She.


Took off her clothes.
She was 73.
She wasn't wearing a bra.
She was 73.
You know what happens when you're a woman and you're 73.
You..
You..


You Sag.
Alot.
Like touch the floor sag.

(Excuse me while I go puke again)


I was 20 years old! My eyes lost their virginity. I was like a deer, caught in the headlights of a speeding car. I wanted to look away. I swear! But I couldn't. Apparently I stared for a while in silence because the doctor decided to interject.

"Well, aren't you going to palpate?"
"Excuse me? Palpate?"
"Yes! Palpate the chest!"
"Um. With my bare hands?"
"Yes! You've got to palpate supra mammary, infra mammary AND mammary!"
"............................"

To this day I do not remember what happened. I get visions sometimes, late at night when i'm asleep. They wake me up. I'm getting better though so help me God. I remember how it ended though. Sadly my brain decided to leave me that memory.

I remember her wearing the gown again. I remember the doctor telling me to leave. But right before I left, Sayyeda Zaynab grabbed me by the arm, winked at me and said





"You've got great hands Doc."





I'm not a dirty whore. I'm not a dirty whore. I'm not a dirty whore. I'm not a dirty whore.I'm not a dirty whore. I'm not a dirty whore.

That was and is my mantra every single time I shower.

Doctors Striking: Outrageous, Yet Very Necessary.

Today there was a nation wide strike calling all Egyptian Doctors working in any public hospital to simply stop working.

I know what you're thinking:

That's insane! So they're just going to let the patients die simply in a bid to garner media attention for themselves and ride off the coat tails of the revolution to spark some interest just so they could increase their salary?

No. That's not it.

As far as I can tell, the main reason behind the strike (read here if you're Arabic inclined http://www.edraab.com/?page_id=2) was simply a response to the incredible amount of corruption all public hospitals have to endure. Let me explain a few things in order to illuminate your perspective.

First things first, it's not a complete strike. The Emergency Wards, Intensive Care Units, Neonatology units and Renal Failure units are still fully operational. That means any case that's at an immediate risk of dying will be looked after and resuscitated. This is a pretty big fucking deal. Almost all the wards in the hospital are full of stable patients, that, for lack of a better term, can afford a day of not receiving constant attention. Also, understand that not 100 percent of the doctors are participating in this strike. Most residents I know can't afford to not go to work because they're going to get in trouble with their superiors. So, although there might be a 'strike' to not work, it's not really all that effective because let's face it, doctors can't really stop practising even if for a day. I am 100% sure that if I were to talk to every single patient staying at the hospital and ask whether or not they'd support the doctors' strike in a bid for increased government spending, they'd agree and tell me that they'd join the protest if they could.

Now there's a whole lot of fuss about how ethical it is to simply stop working in an attempt to prove a point. Surely there must be another way? Let me tell you a little story that happened in my days in the ER ward. The ER ward has its own CT machine. Now for those that don't know what a CT machine is, it's a souped X-Ray  Machine. It can diagnose things better and sometimes even differentiate between different afflictions. It's a basic, fundamental and ESSENTIAL part of the process of reaching a proper management plan for patients.

The CT machine has been offline for more than 6 months now. That means for example, that whenever a patient undergoes a head trauma and needs a CT asap, they have to go up to the 2nd floor use the ONE CT machine for the entire hospital. And you better hope to God that that machine is working because otherwise, the patient would have to get into an ambulance (that takes about 20 minutes to show up) and go the Internal Medicine Hospital (that's about 20 minutes away in rush hour) and wait for the elevator so that they can do it on the 2nd floor there. This is of course, assuming that the elevators are always working (...they're not.)

This is one example. Others include, lack of proper intubators (for introducing a tube into an arresting patient's trachea) , lack of AMBU bags (which said tube then connects to for a proper supply of oxygen). Syringes, gloves, medication, even fucking saline are always deficient all the time.

Now I know what you're thinking:

But Dr.A, doctor shit is expensive yo!

True. However that's not your problem. That's the government's problem. Fact: Back in the 60s and 70s Kasr Al Aini was an incredible and prestigious hospital. People flocked from all over the world to see this magnificent hospital at work.

But we had more money back then!

No, we didn't. It's just that corruption wasn't as fucking rampant as it is now.

The worst part of all of it is that it reflects poorly on the interns and rising doctors as well. Imagine always being told there's nothing you can do because you lack even the most basic of facilities. That can jade anyone and turn them into a cynical asshole. I for one haven't escaped that mentality. Watching a mother's newborn die, just because there aren't enough incubators can darken even the brightest of souls. ( Here's another fun fact about that. The mother and father actually have to sign a paper that says the hospital isn't responsible for the inevitable death of their unborn baby due to there being no incubators. This is done before she gives birth. Imagine, signing a death warrant for your unborn child.)

But surely the strike is a drastic measure? Why not goad the deans? Talk to people? Let the media in on the travesties that occur. Been there done that. Not much happens because the public hospitals are always taken for granted. And the important people don't ever get to go to public hospitals because why go to a public hospital when you can go to a  much better private one. My friend personally tried to get them to repair the CT machine for months and gathered petitions and went the decent and righteous way, only to no avail.

So yes, this is a drastic measure. However, I'm hoping it garners enough publicity so that the appropriate pressure can be put on the appropriate people.

I'll end this with a joke. I'm a foreigner, which means I needed to pay for the entirety of my education in Kasr Al Aini. Now there's about 200-300 foreigners maybe in each year. So that's about 1,200 foreign students EVERY year. Each one has to pay 15,000 Egyptian pounds every year for 7 years (it's 6 but the first year they have to pay double so let's just say 7 for ease) . That's 18 million Egyptian Pounds a year.

Fucking Hilarious.

Niqabi Doctors: Oxymoron

Now this is just a disclaimer to remind everyone reading that this blog obviously reflects my own opinions. I'm not an expert. I don't claim to have a degree in studying human relations or human psychology. I do however, have something I like to call , "common sense" and it with that sense that we come to this blog post.

Let's just get it out of the way then.

Niqabi women cannot and should not be doctors.

I don't need to be saying this for fuck's sake!

Let's break it down into bullet points because I seem to love making them:

• Doctors don't just cure people. They need to offer ease to the patient. They need to relate, understand and emote themselves to the patient. Notice how I put the word emote there? How in God's name is one supposed to emote with a fucking black curtain covering their face.  It's impossible. I've worked with Niqabi interns and I can't even tell them apart. I can't even begin to imagine how a patient would feel talking to a Niqabi doctor. It just makes no sense. There's no trust because the patient can't see the doctor's face and therefore, expression. Suppose a doctor's giving a terminal diagnosis to a patient. I'd at least want to see the sorrow in their face. Not just because we are, whether we like it or not, governed by human empathy, but also because she could be smiling under the niqab. I know it's not plausible but hey, I don't fucking know that for a fact now do I.

• They're not 'big' on touching the patient. Now I might not be the smartest person in the world but last I recalled, being a doctor requires a 'hands on' approach. You must not be afraid to touch the patient and palpate for any abnormalities. You have to be comfortable feeling up a person from head to toe. I say feeling up because sometimes it does feel just like that. Now Niqabis are usually a conservative bunch, which means that they're not quite so adamant with touching and palpating a patient. They'll do it don't get me wrong. But they're going to do it quickly and inefficiently. They'll want to be done as soon as they can so they can atone for their sins of touching another man's body ( this is a joke. At least I certainly hope it is) This can lead to missed diagnoses especially in Internal medicine, where physical examination, is pretty goddamn essential to making a proper diagnosis. I really don't think God's going to be chastising you for touching a grown man's swollen scrotum. No matter which way you look at it, it cannot be misconstrued as sexual, even from the man's point of view. Unless of course he got the hernia on purpose because that's how he gets off: By having Niqabis feel his herniated groin. But that's like 0.03% of the world's population, TOPS!

• The Niqab will get everywhere. Imagine if you were a Niqabi surgeon. Your Niqab will always be touching the patient infecting him with your holiness, and thousands of thousands of germs. He'll die virtuous.........and of sepsis.

• They're fucking creepy alright? As a patient, I'd like to not be surrounded by a shroud of dark blackness everytime I visit my doctor.

Seeing this is a sure fire way of raising up my blood pressure. Just look at the eyes. You're going to keep looking at them and end up overanalyzing the smallest gesture. Look at the woman on the left. She's clearly fucking pissed off. Or is she?

 I DON'T FUCKING KNOW! AND NEITHER WILL THE PATIENT!

Point is, being a doctor and a Niqabi woman, in my opinion is almost an impossibility. The only area I can see them excelling at would be in the Obstetrics and Gynecology Dept. Even so, if you're going to want to specialize in OB/GYN you're going to have to go through all the rounds as an intern and as a resident as well. And even if you get to the residency, you're still going to have wear the Niqab because other men will most definitely be around you. And mothers, do you really want the first thing your baby sees be a Niqabi woman?  

Then why do they do it? The reason, I've surmised, is painfully simple. To get goddamn married. You would be amazed at the number of girls, Niqabi or otherwise, that go into Med school simply to find a nice young doctor to marry and bear nice doctor fruit with. It's a sad reality, especially when you realize that medicine here, is ridiculously competitive, and that she's probably taking the spot of someone who actually WANTS to be in medicine for reasons , like, I don't know, say, healing goddamn people?

All in all, this is just a personal stance I have. It's not against the Niqab completely. It's just against the Niqabi Doctors. So if you happen to be a Niqabi and a doctor, please , I urge of you, tell me how you do it, because I sure as hell cannot see how.

Demons and Drugs.

This'll be the last story I tell about my days in the Psych ward.

After a week in the ward, I decided to sit in during one of the psychotherapy sessions between a doctor and a patient.. I asked both the patient and doctor for permission to sit and they both agreed. Little did I know, I was about to witness some 'crazy ass shit'.

During the entire session I didn't speak or make a single expression. I remained silent and kept my cool. You'll understand how hard this was in a minute.


The psychiatrist started:
"So how are you feeling today?"

"You know how I feel. I feel like shit."
"What's going on? Why do you feel like shit?"
"It's because I can't sleep. Every time I close my eyes, I think he's going to come and kill me."
"Who's going to come and kill you?"
"You know god damn well who's going to kill me!"
"No. I don't. Who's going to kill you?"

Are you ready for this? 














"Amr Diab."
"The singer?"
"Yes the goddamn singer. He wants to kill me. He knows I'm onto him and now he wants to eliminate my existence."
"What's the big secret about him?"
"If I tell you you're going to laugh. You won't believe me. But one day, I swear, ONE DAY, you'll read the newspapers and find out I was right."
"I'm not going to laugh. I promise. Just tell me what the big secret is."

".................He's a demon."
"Excuse me, a what?"
"A demon. He's not human. I know this because every time I see his face on the television, I see the real him. He's a devil. He wants everyone to listen to him and that's how he possesses people! He's done it to my brother, god rest his soul."
"What happened to your brother?"

"He was killed by Amr Diab."

I need to mention that she actually laughed. I was pretty horrified. It was hilarious but still fucking horrifying to think that this man genuinely thought Amr Diab was a demon trying to kill him.


"Why would Amr Diab kill your brother?"
"Because my brother was a better singer than he was. Amr Diab couldn't handle street performances. That's where my brother shone, and that's when Amr Diab came and ran him down in a car. They could never prove it was him driving the car. But it had to be him."

"If he killed your brother, don't you think he's had enough? Why would he come chasing after you now?"
"Because I know who's even higher in the hierarchy, but you won't believe me.."

"Tell me already. Who's controlling Amr Diab?"

"Shhhh... It's Hosni Mubarak. He's a demon too. He's not human."

We eventually wrapped up the session and he left. I couldn't help but feel sorry for the guy. I know it's hilarious to think that Amr Diab is a serpent demon that can possess people through the television, but this man genuinely believed that to be true.

I was curious about the patient so I talked to the doctor.
I asked her what she thought the diagnosis was.
So she told me this:
"Delusions of Persecution, Psychosis and Hysteria brought upon by Drug Abuse."
My next question was almost immediate:
"What kind of fucking drugs was he on? Acid? LSD? "
"No, he tested negative for hallucinogens. But he smokes a ton of hash."

I didn't question her. I should've. The stoner within me wanted to scream out

"WHAT THE FUCK IS WRONG WITH YOU? NO WAY HASH CAN MAKE A MAN GO CRAZY LIKE THAT"

But I didn't. Because then I'd have to explain why I was defending this 'horrible' drug.

I put 'horrible' in quotation marks because horrible here is a synonym for fantastical and magical.


It's sad that hash is getting such a bad rap too. It's such a half assed diagnosis, especially in Psychiatry. I mean what sounds more plausible here:

• He loved his brother alot. He was walking down the street and a car came in and smashed into his brother and ran off. As the car sped off, all he could hear was the new Amr Diab song in the car.

OR

   
                                                                                +

                                                                                        =

Yeah, I didn't fucking think so.

I Want Virgins....And Bad Actresses to Fuck! (Day 2 in Psychiatry)

I'm hoping you all read my first post on my first day in the Psych ward. I like to think it'll offer you true juxtaposition and insight to how wacky things are(It doesn't, but this story will)

Second day at the ward, I was much more relaxed. The guy that pranked me was around and he decided to introduce me, properly and correctly, to the patients. Now there were a lot of patients, but one struck out as very curious.

He had a Palestinian scarf wrapped around his neck and held a paper sword and was just walking around, reciting Quran and other religious prayers. I asked the guy that pranked me what his story was. He told me to go talk to him. He promised I'd be very intrigued. I manned up and decided to go initiate a conversation with the man.

"Assalamu Alaikum." I said in the most non threatening, non intimidating way possible.
"Wa alaikum assalaam. Now there's a proper greeting. You'd have made a great recruit!"
"Uh Thanks. Recruit? Recruit for what?"
"For the war of course! God's war! Against the non believers! And here I am stuck in this silly building, when I can be outside, slaying non believers with this sword of mine."
"................That's....ummm...interesting."
"Yeah well, it really sucks we're not living during the time of the Prophet anymore. God, what I would have done had I been there. It would've been amazing!"
"Absolutely, I mean talking to the Prophet enough would have been really cool."
"Forget that! The wars man! There were so many! So many non believers back in that day to kill. You'd walk down the street and find a non believer."

He sighed, "Boy, those were some good times. You just know they're having all tons of awesome freaky sex with the virgins now."

Wait... It gets better.

We walked back to the common room where patients were playing backgammon, dominoes and watching TV on their super big flat screen (The Psych ward is pretty god damn awesome, if you're not crazy).

He plopped himself on the chair and started  chastising everyone for watching the 'filth and sex depraved garbage' . Then Yousra came on the TV and that's when everything changed.

Yousra's a female actress here in Egypt. She's pretty famous and she's been acting for a very long time. She's old and plastic.  Here's a link http://www.zawya.com/pr/images/EgyptianActressYousra_2007_11_04.jpg.


I was expecting him to lose his shit and start a religious tirade against her. The blonde hair, the fact that she plays empowered females, you know, the stuff that drives insane religious people more insane.

He looked at me and said,

"Maaan, what I'd do to fuck her. You just know she's got a great pussy. Wouldn't you fuck her Doc?"

What..the...fuck?

"But what about religion man? What about your relentless war and journey to be a martyr for God? What about the Virgins!?"

"Oh that's all well and good.. But I'd GLADLY sacrifice all those virgins for sex with Yousra."

So here's my idea to get rid of every single suicide bomber, and we have to act now, especially that Osama's dead and Qaeda's weak.

Americans, instead of dropping bullets and fucking firebombs, print flyers of this woman and drop them right now in every country with crazed Islamic terrorists:

Guaranteed. To Fucking. Work.



Note: Now I don't know how many foreigners read my blog, but I figured I'd include this little addendum to inform people. This man was clearly not well in the head. He's by no means, an example of Islam ruining someone's brain. Islam doesn't ruin people. Religion does (especially if practised wrong). I also want to note that the person never killed anyone and he was just delusional.. He was by no means a danger to anyone at all. He just talked shit. 
Thank you for taking the time to tilt your head and read my Italic note .

Psychiatry is Awesome. But Only If You Have A Sense Of Humor.

I love psychiatry.

I do. I'm not talking about psychology. Psychology and psychotherapy is important too, but eventually with some patients, you're going to hit a brick wall, and that's where the wondrous drugs psychiatrists prescribe comes in.

Anti-depressants, Anti-psychotics, Sedatives are the legal equivalent of mushrooms, ecstasy and heroin. That alone makes the field of psychiatry a world rife with rainbows and unicorns.

Now, I need to mention that Kasr Al Aini does in fact have a Psych Ward, and a good one at that. But you have to understand something:

The mentality of the normal Egyptian does not allow for psychiatry and the study of the mind. Ergo, you need to be really really fucked up in the head for your family to commit to you a government hospital's psych ward.

Needless to say, my month spent in the Psych Ward was fucking awesome.

I remember the first day I went. I was looking for the resident so that she'd be able to give me tips and pointers on how to deal with the patients. What to say, what to do, etc.

I met the nurses and security guards and asked about the resident's whereabouts. They told me she was out and due back at any moment. So I decided to wait.

A man came up to me. Big and burly. He looked at me straight in the eyes and just groaned a big UGGGHHHH. I figured he was one of the patients so I asked the nurse what I should do. She looked and told me not to freak out.

So I freaked the fuck out.

He kept touching my pockets till he got to my cigarettes. Then he made an ever bigger groan GAUHHHH.

The zombie was communicating with me, and I think he wanted cigarettes.

"Do you want a cigarette? Is that what you want?" I felt like I was talking to Lassie.
He nodded his head like Mary's retarded brother in 'There's Something About Mary"
I took one out and gave it to him. He started smoking and he seemed calm.

I decided to wait in one of the empty rooms till the resident showed up.

Motherfucker followed me and closed the door right behind me.

So let's paint a picture of the situation right now. I'm locked in an empty room with a zombie. Rape was inevitable.

He walked to me and his face was RIGHT in front of my face with only a few centimeters of space in between.

"GRAAAAAAAH!!"

I prayed to God and hoped the zombie would  have mercy on my anus.

Just as I was about to scream, he started laughing.

I got Punk'd in the Psych Ward.

Wait. It gets better.

We started talking and I figured he was the security guard (they don't usually wear uniforms). He asked about what I wanted to specialize in and whether or not I was interested in Psychiatry as a field or not.

"Of course I am. I love psychiatry. I think it's interesting."
"That's great. Well you'll have a great time here. Most of the patients are harmless so you've got nothing to worry about. So are you more in interested in the Drug Rehabilitation side or the Psychiatric Illness side?"
"No, I'd definitely have to say the Psychiatric Illness side. The problem with Drug Rehabilitation is that the patients are usually assholes. You help them. They swear they won't do drugs again, and within a week they've relapsed and they're back here again. It's just a waste of time."
"Umm.. I'm a druggie."
".................You're not a security guard?"
".......No. I've been here for 2 weeks now and I think I'm ready for the outside world."
"Oh... I'm sorry for what I said then. So what drugs were you addicted to?"
"Hash and Tramadol. I really am worried I'm going to relapse Doc."
"Well listen, I understand they're both drugs and everything and you'd be much better off without any of them, but if you HAD to relapse, then go back to Hash. You need to stop taking the Tramadol. Hash is totally fine so long as you do it in moderation."
"Wait, so you're saying I should smoke Hash?"
"No, No, No. That's not what I'm saying at all. I'm saying that IF you were to relapse, then relapse on the Hash because it's much easier to quit too."

My first day of Psychiatry and I might have accidentally convinced a recovering addict to smoke Hash again.



I'd say that was a good day.




PS: I had taken his number and I'm happy to say that he's clean and gotten his life back together again. He still smokes hash, but MUCH less than he used to. Which is fine, I think?

Count From 10 To 1 Slowly Pleas....Oh Shit Cockroach! *SQUISH*

Yeah okay so we're not too hygienic in Kasr Al Ainy.

But can you blame us?

Yes.. Yes you can.

It's not just the lack of hygiene we've got in the hospital that's the problem. It's the absolute neglect of even attempting to stick to even our own sub-standard hygiene code. It becomes especially hilarious when it becomes contradictory. Here's an example:

I was prepping up to attend my first surgery. There's a whole system to how you have to wash your hands. It's very thorough and specific and once you've got the garb and gloves on you absolutely cannot touch anyone or anything except for the equipment and/or the patient's body. So I washed up, had someone help me wear the garb (he was washed up too) and wham bam I'm in the Operating Room. Now, I'm an intern, so most of the time I usually just watch and pretend I understand what it is the surgeons are doing. So I kept my distance and watched . I folded my arms and observed without making much noise. Suddenly, my resident looked at me and told me,

"Go wash up again now. You broke the rules."
"What? What the fuck? I didn't touch anything?"
"You folded your hands."
"But I washed them! I did. You saw me wash them!"
"Your hands touched the garb when you folded them. Go wash up."

So I did as I was told and I went back inside, and I was extra careful to not touch anybody.  Then the fucking nurse bumped into me.

"What the hell Dr. A? Go wash up again."
"Are you serious? She grazed my ass. That's it. Nothing else. I'm pretty certain my ass isn't going to come in contact with the patient."
"It's protocol. "

So I went again.


This happened 3 more times. 


My hands resembled the face of an 87 year old woman. Finally, the operation was over and we got out of our suits but still wore our scrubs (that were also sterile and kept in the ward). My resident told me not to worry and that, during his first surgery, he had to scrub up 5 times as well. He just told me that the more surgeries I get to attend, the more cat-like my reflexes become in avoiding contact with anything. So I asked how many surgeries were left and he said a couple. So we went outside and smoked a cigarette  and walked back in. He told me he'd meet me in the OR and I said alright. I went back and got another set of scrubs because I compromised my old ones by stepping outside in the filth infested hallways of our hospital. After getting dressed and scrubbing up, I noticed they started the operation already so I went in quickly.

Here's an important note: The hospital itself has scrubs that it gives to people who don't own their own. The hospital sterilizes its shit. So, though the scrubs may look worn out by dozens of sweaty surgeons, they're clean. You can own your own scrubs but they should also be left in the lockers so they get sterilized with the rest.


That's when I saw it.

The fucking resident was wearing the same goddamn scrubs he wore outside. This is the same resident that told me to fuck off when my ass grazed a nurse wearing sterile scrubs.

After the operation was over, I talked to him about it. I asked him why he didn't change into the scrubs that were sterilized in the OR.

"Oh no, these are my own scrubs. I don't have to borrow them from the OR. I'm sure they're clean."

He was sure they were clean. We smoked a cigarette, squashed a cockroach outside, and met friends and did the customary hug and this mother fucker is SURE his scrubs are clean.










I can't wait to be a resident.


, 

Abdul Halim Hafez Died Because He Liked Swimming With Bare Feet.

Bilharzia.

Only in Egypt (and some parts of Japan) does that word mean something. Now just in case I'm getting readers from countries that don't include the word pharoah in their day to day vocabulary, let me break it down for you.

Bilharzia is a disease that's caused by a parasite known as Schistosoma. These funky critters live in the Nile and penetrate your body through your feet and legs soon as you dip into the water. It used to be so endemic in Egypt that giving a history of being a farmer meant you had Bilharzia. The disease is called Schistosomiases abroad but it's called Bilharzia here after the great Theodore Bilharz, who dedicated all his time here in Egypt to learn more about the parasite. Rumor has it he was terrified of the Nile so much that he barely used to take any showers when he lived here. The funny part to that story is that he still died here, not from bilharzia but from typhus ( which commonly comes from fleas or rats) Just goes to show that if Egypt wants to kill you, it will.

Anyways this was during a clinical exam I had 2 years ago. We had to examine the patient and come up with a diagnosis. My patient was a middle aged woman who had an obvious hernia. We talked about her hernia so I asked about her past history:
"So any other diseases you might have?"
"Oh no. It's just the hernia."
"So no diabetes or hypertension?"
"Oh God no, I'm healthy as a fiddle."
"That's great."
"Oh, I have Bilharzia though. Is that relevant?"
".................................yes it's relevant. Why didn't you tell me about this?"
"Everyone over where I'm from has it. So I figured it's okay to have. I mean it's not going to kill me or anything like that."
"Um. Are you familiar with Abdul Halim Hafez?"
"Oh my God. I love him!"
"He died from Bilharzia."
"What?! You're saying this is a dangerous disease?"
"It eventually kills your liver. Yes goddamnit it's a dangerous disease. Why didn't you take the medication?"
"Back then they were shots and I was scared of shots."
"So you decided, fuck it? Screw my kids, screw my life, I don't want to take shots so I'm going to die?"
"Well I didn't know Abdul Halim died from it. Maybe if I did, I would have taken the shots."
"...........Okay. here's what you're going to do because you're making me very angry now. You're going to take this medicine, orally, just the one time. Then go check your liver to make sure there isn't any permanent damage."
"How big is the pill Doc? Because I can't swallow big pills."

This is when I lost it. I started shouting at her. I may have told her that her kids are going to be orphans as well. I don't remember. I tend to lose focus and memory when i'm fucking enraged. Anyways, that was that and I shifted to the balcony to wait for the professor to discuss my case. That's when the strangest thing happened.

She came in to the balcony and she looked at all the other doctors and said,
"All of you are going to be bad doctors, because you don't ever want to be honest with the patient."
She then pointed at me and said,
"This man here, he cared so much that he got angry at me. I hope all of you learn from him and start caring for your patients more."
She then hugged me and told me to never stop caring.




Bitch...Was...Crazy.

Sectarian Strife.. Big Words...

I'm not going to get started on the fact that when anyone says "Christian" or "Mesee7y" in university most people seem to cringe.
I'm not going to get started on the fact that on my first day at university, I was specifically shown a tree known amongst the freshmen as "The Christian Tree" and told to stay away from it lest people think of me as some sort of inferior being.
I'm not even going to get started on the countless conversations I've had with idiots that would say "He's Christian. Stay away from him lest he drag you away from the right path."

This is a story about a family, a Doctor that's nationality alone is suspect of terrorism (that'd be me) and a fellow intern that happened to be Christian (because I only knew that day). This was during my shifts at one of the ICU wards (that's Intensive Care Units for all you people who've somehow avoided watching ER, House, Grey's Anatomy, Private Practice, all 3 CSIs, Private Practice etcetera etfuckingcetera).

A patient came in at night and he had his family with him. He had liver failure and was vomiting blood so we dealt with it. I put a tube (Ryle's catheter) up his nose and connected it to a bag so that the blood would go into said bag without all the nasty feelings associated with throwing up. We were done and then we went outside for a smoke. Just as we were about to go out , the patient's daughter decided to ask my friend something. I went on without him. 5 minutes later he came to me and he seemed very perplexed.

"What happened?" I asked.
"The weirdest thing just happened. I was told I didn't care for the patient enough."
"What do you mean? We did everything by the book and he's feeling better."
"It's not that. They knew I was Christian."
"So?"
"So they said they expected me to treat them better than all the other patients because Christians needed to stick together."
".................."
"Yeah it's weird. They gave me some holy water and asked if I could take care of them specifically. I think they're actually worried that the nurses and the doctors don't give a shit about them."
"Oh wow. Did you tell them we didn't give a shit about anybody?"
"No I'm serious. That's so weird. This is like the 3rd time this happens to me. I don't get why Christians are so weird about this. I mean I understand that we're the minority and that sometimes stupid shit happens every once and a while, but for the paranoia to actually reach this level. That's just frightening."
"We don't know what it's like in the slums and the lesser neighborhoods. Not everyone is comfortable and so accepting."
I then told him about the Christian tree and everything.
"Wow. That sucks. Why can't people realize that we all suck,  regardless of religion?"
"One day friend. One day. But we'll be dead long then, and guess what, I get to go to heaven and score with virgins. You just get a garden."
We laughed and that was that.

I went to the patient and his family and eventually and they had asked me where I was from on account of my accent not being fully Egyptian. I told them I had Saudi and Afghan roots not to mention the Egyptian side of my family. I could totally see the fear on their face until I eventually talked to them. We joked and they were really wonderful people. They gave me some Holy Water and I was touched by their commitment to God and their sharing it with me.

There's no reason or moral to this story. This is something that just happened. I recalled it because I bumped into the family a week ago and I was so glad to hear that their father was doing better.
There are lots of problems here in Egypt, one of the bigger ones being the religious clashes that occur every once and a while. The problem especially comes with people who aren't necessarily xenophobic or racist. The Muslim side of this problem says "Well, they segregate and do their best to isolate themselves out."
The Christian side of this problem says, "We'll never be looked at the same way, so we might as well just hang out with ourselves."

Both are horrendously wrong. I know this is an uphill battle and I'm pretty sure it's not going to be solved in our generation. Then again, no one ever thought they'd see this in their life:

To anyone who cringes when they hear the word Christian and/or Muslim, I urge you. Look at this photo. Inspect it closely and see how happy these two people are and remember that the best thing that happened out of this revolution wasn't that a president stepped down, or that a country showed signs of getting back on its feet. It was the unity the people had, when for a whole month, no one was Christian and no one was Muslim. You were simply Egyptian.

Care for the Patient. Right, See That Over There? That's a Pig, With Wings.

As a doctor, I'm expected to put up with all sorts of crap the patient has to offer. I have to respect them much as I can, even if its not mutual, and try my best to alleviate whatever injury or sickness they might be afflicted with.

Now this is my blog, that I write, that reflects my opinions and thoughts. I do not need to be politically correct here. I share my thoughts (as vile or humorous as they may be) and regurgitate them onto this computerized canvas. So, let's talk about patients I fucking hate:

• The educated patient: I know what you're thinking. What the hell? Educated and knowledgeable people? How are they worse off than the ignorant? I'll tell you how in even MORE bullet points:
• They will always second guess you. Nothing is ever enough for these patients. They will want full tests and imaging done on them. Now full tests and imaging takes alot of time; alot more time in a public hospital that's facilities are piss poor, which brings us to point number 2
• They will bitch about how long everything's taking. See, odds are educated people found in our hospital have most likely been to other hospitals where something called 'money' is exchanged for proper and better service. Now this is clearly not how we roll here in Kasr Al Aini. A simple routine CT scan can take up to 2 hours sometimes even 3 to get done (machine might be getting fixed, the operator might be out to lunch, the resident who signs off on the request might be asleep due to long shifts) So there's a plethora of reasons as to why shit takes too long in our hospital. But does the educated person understand? No. Of course he doesn't. He's been to Dar El Fouad before, so this service is just APALLING! Well asshole, guess you should've gone to Dar El Fouad instead of gracing us with your dickish presence.

• The Old People: Again, you're probably thinking, "Awwww but old people are so cute and cuddly, and they have so much wisdom to share. I know! I saw it on Grey's Anatomy!" False. Here's another list of why Old People suck as patients:
• The smell: People always talk about 'old people' smell. I'll let you in on a little secret. "Old People' smell is a delicate fragrance only gained by the mixing the pungent aromas of piss and shit so specifically, that you get a brand new "shiss" scent. They cannot clean after themselves and their relatives usually don't give a shit either. Now I know this isn't their fault and I promise you, that when I do clean after them sometimes, I smile and talk and make sure everything's dandy. But in the end, I'm forced to deal with very, very 'strong' scents on a daily basis, and yeah that does piss me off.
• The dementia: This to me, is alot worse than the smell. There's cute dementia (like remembering you're the younger version of you and its 1940 and war is upon us again). Then there's batshit dementia. I had a patient screaming at me for an entire day because:
• I didn't give him back his stick (that he used for funny things like hitting fucking doctors and nurses) 
• I didn't want to unfurl the curtains between his bed and his 'son' (who was an even older comatose patient that deserved the privacy he needed before he passed away.                 

                   How did he show his disdain? By spitting at me, EVERY SINGLE TIME I passed his bed.

                   Old people can be such assholes sometimes.    

• Women over the age of 40 that need a urinary catheter: This, and this alone, is why I'm never going to  be a gynecologist. I've changed dressings on infected amputated limbs that reeked of pus. To this day, I've not yet completed a full insertion of a catheter into a woman's urethra. The smell haunts me to this very day. Ladies, please, I beg of you. Clean your lady parts. Especially when you get older. You'll be doing the medical community a giant goddamn favor.

• Scared mothers: Now I can't blame these people. I know what it's like and I understand their position. Their baby is sick and they're scared shitless. But goddamn it, how the hell am I supposed to diagnose anybody with them screaming at me and shouting at me every single time the baby cries during a procedure or an examination. The end result is always the same: I go temporarily deaf, she loses her voice and the baby's crying even harder now. Ladies, please: I understand that this is a horrible time for you, but I promise, I do, that if you leave me alone to do my job I'll try my best to see what's best, and if i fail, then you still have your voice to fucking use to puncture my ear drums.

All in all, ask any doctor what the best patient is and they'll tell you: "The Comatose". They're our unsung heroes in the hospital. They don't cry, they don't bitch, they don't whine and they definitely do not spit on your face. It'd do every prospective patient a little good if they learnt something from the unconscious patient.

Philosophical Dialogs Make Me Happy and Sad. Especially When Had in KFC

So I went to sign in a couple of days ago, and seeing as how the ER was still closed, decided to hang out around the hospital for a while. A thing you need to know about interns and residents. We might start off initially by hating the hospital with every goddamn fiber in our being, but eventually it starts to grow on you. The dilapidated halls. The constant screaming and crying. The lack of any proper AC ventilation even in the heat of summer. These are the things we miss when we're not there. So I called up Dr. Friend to see how he was doing in Cardiothoracic Surgery. (see http://hospitaldelerium.blogspot.com/2011/04/residents-are-just-like-slavic-sex.html for more information on Dr. Friend).

"Hey man. What's up? You free for a bit?" I asked.
"10 minutes. The KFC outside. Move now."

I did as I was told and met him inside the KFC. He looked exhausted. He looked like every single cell in his body needed to rest. He told me to order as he went to the bathroom. We sat down a couple of minutes later.

"So how's Cardiothoracic going Friend?"
"I want to die."
"Hahah, the work can't be that bad. Try to cheer up."
"It's not the work. The work is the best part. I don't even mind doing the dirty work. It's just that every goddamn night I go back home at 5:30 am only to wake up at 9:00 am. I don't know they do it. I've been doing this for 6 days now. 6 days of sleeping for just 3 hours man. Ramadan's coming up. What the fuck am I going to do in the blistering August sun during Ramadan."
"It'll work itself out. Your brain's eventually going to realize that 3 hours is the new norm. It'll access some energy and fix you right up. You just need to wait for the biological shift to happen."
"Right sure. Of course. Problem is the brain's going to access the energy and steal away my lifespan and I'll die early."
"Screw those last 5 years of life man. You won't want to live with dementia and giant prostate pressing on your urethra. Anyways what're you doing now?"
"Need to go to the Internal Medicine Hospital to check on a patient there. He's got this chest tube attached and I need to make sure all is well."
Just as he said that his phone rang. It was the senior resident far as I could tell. Suddenly he had a huge smile on his face and thanked the guy and closed the phone.
"What happened?"
"FUCK YES! Remember that patient I had to go see in Internal Medicine?"
"Yeah, what about him?"
"DEAD! I don't need to go check on him anymore. That gives me an extra hour of time off!"
"Alright! Sweet!"
We high fived.

I know this sounds horrendously harsh and brutal, but we deal with dying patients every single day. We can't be expected to feel sorry for every single one that dies. Especially those with terminal illnesses who are much better off dead than they are alive. All depressing does is lead you to straight to the psych ward. So before you judge me or my friend, try staying in a hospital for a year and then come back and talk to us.


I started talking again, "So what's your situation with the army?"

For Non-Egyptians reading. Serving in the army is an obligation and not a choice. If you have a brother and you're going to serve time in the army. There are ways to get out of it but that depends on very specific circumstances and scenarios.


"Don't know yet. I get called in August and we'll see from there on. I doubt they're going to take me in though based on my weight and all."
"Alright! Well that's great news. Least you don't get sucked into Army duty for a year."
"What are you talking about? If I could, I'd lose the weight."
"What?"
"Think about it. There's nothing to do there AND I get to sleep more than I do here. Shit, I envy the other residents who get to go."
Here was my friend, wishing to be in the army rather than stay as a resident in the hospital. 

It kind of makes you wonder .....................................




(about how fucking important sleep is)

Size Matters...

This isn't a story from the ER ward. I'm afraid its an older story that happened a few months back when I was still a young innocent intern who honestly thought he'd help save lives. Such glorious days those were.

This was about 4 months ago, in the Internal Medicine Hospital, or the prison as we like to call it. Its nomenclature sounds odd until you actually go and inspect the hospital for yourself. It literally is designed like a prison, complete with bars on the windows. Not only that, but most of the patients that get to stay don't usually make it (most of the diseases are organ system failures and a few complicated cancers). Needless to say, it's a fun and marvelous place full of wonder and enchantment (for those with Satanic inclinations).

I was on the 7th floor and I got to know most of the patients. They were all really cool and friendly and we often joked around. One day though, one of them was in a bad mood so I asked what was wrong with him.

"It's the hernia Doc. I really want to fix it but the doctors say I can't on account of my liver failure."
"Can I see your hernia? I just need to see if there are any complications like redness."
"Sure Doc. But be careful down there."

He wanted me to be careful because he had something called a scroto-inguinal hernia. Now everyone knows what a hernia is . A Scroto-inguinal hernia is a hernia that protrudes to your balls. It's not fun to look at , and I'm sure as hell it's not fun to actually have. Oh did I mention they grow to huge sizes?  Massive and gargantuan balls. You can see an example here http://bit.ly/g0L5lj but I must warn you that like everything in Medicine, it's pretty fucking disgusting.


"It's fine. It's not complicated or strangulated so you're good. But do you mind if I ask you just one question?"
"Sure Doc, ask away. What's up?"
"Now this hernia you got. You didn't wake up one day and BOOM have huge balls all of a sudden. This was a progressive thing. Looking at the size of it, I'd say it's been about 6 months."
"Yeah. You're right. It was about 5 months and everytime I'd cough it'd just get bigger and bigger."
"Okay, here's my question. Why in God's good name did you wait for 6 months as your balls just got bigger and bigger and bigger and bigger, now effectively being that bouncy ball kids use to bounce around (people who watch South Park will understand this reference. If you did: Good for you!)"
"Honestly Doc? I thought God was blessing me."
"Say what?"
"Yeah, I mean it was growing slightly at first and I figured, hey, whatever increases in size under the belt has got to be a gift from God right?"
"............ And it didn't, alarm you that it just kept getting bigger?"
"Well, I thought about it and figured that maybe, just maybe, it would have stopped. Like it was some sort of growth spurt, only better."

This is, unfortunately, a common occurrence in Egypt. People mistake diseases relevant to balls and penis as gifts of virtue and virility from the Gods. So please people, if your dick's hard for hours, go see a doctor because no, it's not you suddenly overcoming being a premature ejaculator.

PS: The funniest part of all of this was that after I was done talking to him, I met his wife. She was all upset and kept saying this was all her fault. When I asked her why, she'd said that she's the one that told him that it wasn't worth getting looked at.
One can only imagine the weird sexual shit they must have been up to what with his huge testis.