Monday, 25 April 2011

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.


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?

Sunday, 24 April 2011

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.

Saturday, 23 April 2011

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


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.


Friday, 22 April 2011

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 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.

Wednesday, 20 April 2011

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 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."
"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)

Monday, 18 April 2011

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 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. 

Sunday, 17 April 2011

Night Shifts: Romance in the Gangrenous Air

Let me just start this off: This is not a love story. That is just my interpretation of what went down that fateful night in the Surgical ward . But let's not get ahead of ourselves. Let's start from the beginning and embrace the journey (the bizarre, strange, distorted journey)

It was a night shift and I was tired as shit (as usual). There were 4 dressings amongst other things that needed to be done and the resident wanted us to stay the night. Now I wasn't even supposed to be working that night, so one can imagine that my dismay was spectacular in size. I had 2 others with me but they were both girls and I knew for a fact, that they wouldn't want to share the load of the dressings with me.

Now I know what you must be thinking. Dressings aren't so bad. You remove the the old gauze with the old plaster and just pour some Betadine and put in some new gauze. It's mostly simple, harmless and quick. Not so in the Surgical ward of the ER hospital. No no no no. These people have bed sores. Pshh Bed sores? I've seen my grandmother get bed sores before. They're just discolored areas, why're you complaining Dr. A?

.........Bed sores can get infected. And when they get infected, they can either:

  1. Eat away the flesh of the person leaving an unbelievable 'raw area' behind as seen here (CAUTION: Not for the faint of heart. 
  2. Or they can get so bad that the person needs surgery to remove the dead tissue which is an even worse version of number 1.
Needless to say, bedsores suck, and you wouldn't believe the amount of people that die in our hospital over something as trivial as bedsores.

Anyways, that's when Girl came in. None of us had seen her before in any of our rotations but here she was, this blessed angel come to volunteer and help with the load. She said she was with us in the ER and they were closed (see earlier posts as to why ER has a wacky schedule of closing and opening) so she wanted to volunteer and help us out. She was spending the night too so she'd help in staying awake if anything needed to be done. 

AL-FUCKING-RIGHT! Volunteers are usually happy to do any work you throw at them. They're like slaves, only better because you don't feel guilty about abusing them. I had to go get blood from the blood bank so I told her to get started on the dressings and I'd come back soon as I can. 

Hour and a half  later (yes, I slacked off. Sue me.) I came back and there she was, talking to the patients, being over friendly and happy to help. I went up to her and asked how the dressings went. 
"Oh, I don't know how to do that but I wouldn't mind learning so can you show me?"
I grumbled but fair enough, she wanted to learn and I didn't mind showing her how it was done (because hopefully, she'd do all the rest. Yes Yes. I'm an ass) After going through one of the 'easier' patients and telling her what to do, we started talking about stuff.
"So, why aren't the girls helping you out?" she asked.
"It's alright, they find the work disgusting and they're still new interns so I don't mind if they don't do it at first. They're going to have to sooner or later."
"Wow, they're such wusses. I'm an old intern too just like you." 
"Oh no way? That's cool. Yeah, you know how the new interns look up to us. So we have to set an example."
"It's not like its a huge difference or anything. We're only ahead by 3 months or so."
"3 months?"

Bit of background info. I graduated late because I had to postpone one of my exams. So I should have finished 6 months ago, along with the rest of my friends. But now they're doing their residencies so I'm spending 6 months with the NEW interns. There's no such thing as 3 months. It's either 6 months or you're brand new.

"Yeah, ummm so I noticed you've got an accent. Are you not fully Egyptian?"
"Nope. Half Gulfie Half Egyptian. You?"
"Oh wow, I'm totally half Egyptian half Syrian. That's so cool! We're like the same!"
"Uh. Not really but I see your point. Anyways lets get done with the patient here."

Now this was my first alarm. She was obviously lying about being an intern. It only got worse from then on. The other interns and I started to notice that she hadn't really used a single medical term when describing anything.  Not to mention that she didn't know what anything looked like. She didn't know what a urine bag looked like. A Fucking Urine Bag. It's a god damn bag.  Things only got stranger as the night progressed. 
After the work was over, we were all sitting and talking, me on one side the girls on the other (because that's how shit rolls in a public government facility) and then she came in and sat RIGHT next to me. Hips were touching. Now I'm not conservative or anything like that, but here was this veiled girl that I CLEARLY don't know hip humping me. I got up and sat on another chair. She told me to come sit next to her. I told her I was more comfortable here thank you very much.  So the girls (the actual interns) decided to go to the kiosk and get some stuff to eat and drink, so they asked me if I wanted anything. 
"Some Chipsy and a coke would be great" I said .
They left and they took Volunteer girl with them. 
After about half an hour they came back and volunteer girl was no where in sight. 
"Oh hey guys, where's my stuff?" I asked hungrily.
"You'll never believe what happened. We got the stuff and just as we were about to pay, she freaked out and said NO I MUST PAY. So we let her pay and then she got a phone call and took it."
"So where is she now?"
"No idea."
"And she has my shit?"
"Goddamnit. Okay fine well she's gotta come back some time."

2 fucking hours later

"Sorry I'm late Dr. A. Here's your stuff. They didn't want to pay so I did. Hope you didn't mind. It's just that I was on the phone with my ex boyfriend. God, he's so mean. So are you single Dr. A?"
"Nope, have a girlfriend."
"Oh. Okay. Do you love her?"
"That's kind of private. Listen I'm going to go out and get some fresh air. Thanks for the chips."
And I left only to come back a few minutes later. There was a ruckus outside. A patient had died in one of the wards and all his friends and family were trying to knock down the door and kill us all. Normal stuff in the day of a doctor in the Kasr. Even the new interns got used to it. So I went back and told everyone to not go outside because of the crazy people. 
Volunteer girl screamed out loud jumped out of her seat, held onto me from the back (like a hug) and asked me to 'protect' her from the people.


I pushed her away and told her she'd be fine and we all slept in the room till it was time to sign out.  Now I had been talking to the other interns and we decided to corner her by telling her to come sign out with us when it was time to leave
. So we did exactly that soon as the clock hit 8:30 am. 
"Uh you guys go ahead. I've still got work to do here." she said.
"Ummm Volunteer Girl. We're the interns here. We know there's no work to be done. Come on. Let's go already."
"Uhhh. Okay. Let me just go to the bathroom first."
We waited in the resident's room for a few minutes. Then the funniest thing happened. She opened the door and RAN THE FUCK outside. We tried catching up with her but she was gone. Disappeared into the ether never to be seen or heard from again.

Now I talked to my friends about this. I had no clue what this girl was. My explanation was that she was some sort of news reporter trying to expose the inner criminal workings of the interns and the doctors inside the hospital. It was obtuse, but it was all I had.

A friend of mine then made things very clear to me.
"So she wasn't a doctor?" he asked.
"Hell no. She thought the blood picture report was a list of medication man! (one of the other stupid things she did that night)"
"And she was being over friendly with you that night?"
"Yeah. But that's because we're both halfies. Happens all the time."
"Think jackass. This girl came to 'volunteer' in the night shift, and was flirting with a doctor."
"Yeah, what of it?"
"She's looking for a husband dumb ass."
And suddenly, it all made sense. 
Her being super nice to me and super bitchy to the girls.
Her insisting on paying for my chips and coke.
Her making it clear she had no boyfriend.
Her touchy feely bullshit.

Apparently, this is not a one time occurrence. Alot of my friends have very similar stories of these 'night prowlers' looking for husbands who happen to be doctors. I can't help but think that, if this is a regular occurrence, it must mean that this has actually worked before. So to all you guys reading this who found love in the night shift in Kasr:

Make sure she's a real person.

PS: My girlfriend thought she was a ghost. Also a possible explanation seeing as how we never saw her again.

Saturday, 16 April 2011

Residents and Slavic Sex Slaves.

Now I'm not a resident yet. I'm still an intern and as much as I love bitching and whining about the work, the hours or the lifestyle, life as an intern is pretty awesome. You're not responsible for any fuck-up, whether its your fault or not, and soon as the clock marks the end of your shift, you are done. No one can file a complaint and if they do, you can make up any excuse and people will buy it. In other words, if you have serious homicidal tendencies and totally never want to get caught killing a patient, bear 6 years in med school and rest assured you'll have free reign to do whatever you want come your internship.

Residents however aren't so lucky. You see, the difference is that a resident is, for lack of a better word, in charge of the ward he's assigned. He needs to know every case by heart, do everything his senior wants him to do (the seniors being older residents and actual professors) and amidst all this try to learn and excel as a doctor. If for any reason he cannot hold his shit together, he's not going to make it through the residency. The reasons are plenty. For starters, you need the professor (whose ass you must constantly kiss) to sign off on you at the end of your residency. And they can be fickle, annoying sons of bitches (not all the time though thank God)

So this isn't my story. This is my friend's story because he's just started his residency here at the Kasr. And he decided to choose the second hardest field in the entire hospital : Cardiothoracic Surgery. Now, it's not hard because the surgeries are arduous and long. It's hard because that's the way it is in the Kasr; the residents get hazed and put under extreme stress (because that's what happened to the residents before them and so on and so forth) I don't particularly know why, but I can imagine that sometime long ago, a douchebag was in charge and his legacy continues (simply because no one questions it).

Now let's start from the beginning. It was the day the top 200 graduated interns get turns deciding who wants what residency. My friend (who I'm going to call Dr. Friend because I'm that original) hadn't slept in 2 days freaking out over what to choose. It's a huge decision and it's not one that can be unmade. Once you officially pick what you want, you're stuck with that residency unless you quit and choose something in the academics (or the gayer side of medicine). His mind was set. It was his turn to get on the podium in the conference room.
"My name is Dr. Friend and I choose Cardiothoracic Surgery."
He felt elated. Huge burden gnawing at his back just disappeared. The choice had been made and there was no going back on it. There was a sort of serene peace in his mind. After the conference was over, he walked outside breathing in that fresh polluted air of Egypt, anticipating how amazing his bed's going to feel in just a few minutes. He was stopped short when an older cardiothoracic resident (a colleague of Dr. Friend as well) congratulated him and said,
"Congratulations Friend. I know its a tough field but you'll do great. Now here's the thing. Here's the number of the Professor in charge. He's expecting a call in an hour. Call him. Preferably in 59 minutes because this conversation's already taken a minute."
My friend was naive, thinking "Okay maybe this person just wants to talk to me and congratulate me."
He waited out the 59 minutes and called. No answer. He called again. No answer. I even joked with him and told him maybe that was part of the test; to see how many times he'd call as a show of loyalty. He called again  and there was still no answer so he went home.

Soon as he got home, his phone rang. It was the professor.
"Hello Dr. Friend. Congratulations on choosing Cardiothoracic. Obviously, I don't need to tell you how hard it is. You've heard the stories and you're obviously more than prepared for what's to come. Anyways, tomorrow. 8 am sharp. My office. Okay? Oh, and another thing. Bring a set of clothes because you won't be going home."

I need to interject here and say something. My friend here technically isn't OFFICIALLY a resident yet. They 
get a couple of weeks off before they OFFICIALLY become residents. Anyways back to his conversation.

"Oh thank you sir. Would it be okay though if I came a bit later in the afternoon? I haven't slept in 3 days because of the stress of choosing and everything."
".............................Right of course. I totally understand... I'm going to see you tomorrow at 8 am."
"Yes sir."
"Don't forget your clothes."
"I won't sir."

This was 4 days ago. My friend has spent a total of about 7 hours in those 4 days in his own house (which luckily is very close by). I've been hanging out with him and experiencing a bit of what his life's like so I'm sure this won't be the first post regarding Dr. Friend (who I'll hopefully have a better nickname for by then).

A wise resident once told us, "Being a junior cardiothoracic resident is just like getting raped so much, that you start to think there's something wrong when you're not getting fucked in the ass."
Wise words from wise people.
I hope my friend makes it, with minimal damage to his anus of course.

Friday, 15 April 2011

Spirits and Demons Now Roam Our Halls.

So as much as I'd like to say this story's going to be one of the more 'retouched and dramatized' stories everything here was pretty much dead on accurate. So if this ever turns into a short film, please don't hesistate to put in 'Based on a True Story' right before the film begins.

This was during a mid shift in the Internal Medicine Kiosk (or koshk). It was a slow day and all we did was measure blood pressure after the other, ordering a few biochemical tests to be done every once and a while. While we were all trying to pass the time in our own ways, that's when the shit hit the fan.  Our room was suddenly stormed in by the all of the civilian guards and 2 of the military police officers. Now, you guys can surmise that the ER ward is pretty dangerous. So when something like this happens, we completely freaked the fuck out. An intern ran right out of the room before anyone had a chance to say anything. They were carrying what looked like a semi conscious military officer. They then threw him on the bed and told us to fix him.

"What. What happened here? Did someone outside hurt him?" I asked.
"No! He was asleep and when he woke up he had some sort of seizure and now whenever any one of us touches him he hits us."
"Wait what? He hits you?"
"Yeah, he's really irritable and he's slurring and not making sense at all."
"Um. Okay. Well can you guys take this pressure cuff and wrap it around his arms like this?" I showed them what to do. Man was a military officer, and I'm a flabby intern. 
Me + Touching him = Me in the Resuscitation Room. 

So they tried to pull his sleeve up. That's when he fucking lost it. He started flailing about hitting everyone around him and punching the wall with hand as hard as he could. He still wasn't responding to voice or sound. He just reaaaaaaaaaaaaaally didn't want anyone to touch him.  After seeing this, another intern decided. "Screw this" and left as well to look for the resident . 
So as I'm watching 5 guys trying to hold down one very agitated man one of the guards came up to me and told me this gem of information,
"Doc, There's something I need to tell you. Might shed some light on the diagnosis."
"Is he a druggie?" I asked that because the patient was most likely having a psychotic attack. Little did I know that military officers don't like to be accused of being drug addicts.
"No no, he's not at all. When he woke up though and started acting like this, we decided to read some Qur'an on him and that's when he REALLY got angry. Is he possessed?"
"Do I look like a Sheikh to you?"
"Then how the hell would I know if he's possessed or not." I especially like that I didn't argue his logic. I argued my capability and lack thereof of being an capable fully licensed exorcist.
"You guys don't take exorcism in medicine?
"No. I'm afraid in the 6 years of med school, we couldn't quite squeeze disease of supernatural origin, sorry."
"So what are we going to do?"
" I don't know. The Psych ward is closed right now. So I think you're going to have to take him back to the office because he's scaring every goddamn person here. Look, read some Qur'an. Call a sheikh, see what happens till the Psych ward opens up again in the morning."
"Fair enough Doc. But is there a technique to reading the Qur'an."
"Again. Not an exorcist. But I can see how you can confuse doctor and exorcist. They really go together hand in hand."

So they left, after 30 minutes of finding the right way to carry AND hold him down so he wouldn't beat and/or hit anyone. But this, I needed to see. I followed them into the office and maintained a good distance from them. They put him on the floor legs and arms spread open with a guy holding down each limb. Then one of them took out a phone and started playing Qur'an.

The man lost it. I've never seen anyone quite so much lose their shit (minus the girls of Jersey Shore) as much as this guy. His screams filled the room and he almost managed to get free but was thankfully held back down again.

Then a surprising thing happened. He eventually started calming down. More and more till he eventually slept like a baby. We were all stunned and that was that.

Now, there are several logical explanations to what went down that night. The most logical being that he was having a psychotic attack and in Egypt, religion plays a very big part in the culture. So seeing exorcisms on TV can lead your brain to genuinely think that reading out loud texts from a holy book is the cure. But there was something about the whole entire thing that was just a bit too .....abnormal  I want to say. 

So I went back to the Kiosk and saw the resident and he asked me what the fuck happened.
I told him this, 
"Well, the provisional diagnosis seems to be Possesion by Demon but our spectre-analyzer is broken right now so I couldn't confirm it."

Note: We don't have spectre analyzers in Kasr Al Aini. The government was too cheap to buy one off of the set of Ghostbusters.

Thursday, 14 April 2011

Sorry We're Closed. Please Come Again at a More Convenient Time.

Since I've started my internship in the ER ward, Kasr Al Aini's ER ward has closed approximately 4 times (each time lasting a few days and one of them lasting a week). Here's a bit of background information I think you'll need to understand the post a bit better (not because any of you are stupid or anything.....Well some of you are but I digress).

My rotation started on March 1. That's about a month after the police decided to call it a day and abandon the entire Egyptian population. Now I don't know if the police decided to grace other places (like for example all the embassies and traffic conjunctions that I see on my way to work). All I know is that someone up in the hierarchy of 'important people' decided actively ," What? Hospitals? Fuck that. Who'd want to attack a hospital?"........The answer is : Alot of fucking people.  My first week was a morning shift, so I hadn't seen anything too dangerous happen. We still had civillian security and for some reason thugs tend to lay low when it's sun outside. Like vampires, except not sexy and more smelly. But as I was told, the night shift was horrific. Stories of doctors held at knife point to prioritize patients and just general violence towards doctors that delivered bad news. The interns, along with the doctors and nurses, under the guidance of the Manager of the ER ward decided to shut the place down and hold a protest in solidarity in front of the Dean's office. Now the dean was new, but she seemed nice enough. We finally talked to her and she seemed willing to understand that our situation was delicate. "I don't know what to do. We don't have the finances for privatized security and the Ministry of Interior doesn't seem to give a shit right now." So we asked about the military. She said it was a work in progress and hopefully we'd get a few soldiers by the end of the week. We eventually did. We got a sweet jeep and a bunch of military officers ready to protect us much as they could.

Minus a few silly situations here and there both involving thugs that didn't seem to care and the officers themselves not being as , 'efficient' as one would've liked them to be, life was good. Most patients came in. Thugs were weeded out and anyone who caused a scene was escorted outside. But then, something happened. I wasn't there the day they decided to leave so I got a lot of conflicting reports, but suffice to say: One night it got really bad, and there were more thugs than usual and the officers didn't want to hurt anyone (because gee, who'd want to hurt the thugs with knives) so they up and left. This left  the 2 civillian security guards with a bunch of crazy assholes so needless to say, the ER ward shut down that night. Thankfully no one was murdered or anything (though I heard that an intern was beat up pretty brutally that night) Thus began the week and a half long shut down of the ward. Mind you, we still had to sign in daily because the hospital is government owned. And if anyone here reading has ever worked for a government facility, they'll understand that signing in and signing out are pretty much the foundation of every government job here in Egypt. Fuck what happens. So long as a signature is shown, we're all dandy.  Now, the manager had our back  on this. The Dean, however, didn't. She threatened to fire every single doctor and nurse working in the ward, stating things like,  "When I was an intern, we were in danger too." (in the 70s.... in Egypt. The 'Hippie' period. I'm sure it was hell. I'm sure getting fleas from unkempt hair, and excessive sun exposure to micro skirt thighs is equivalent to men wielding swords and bats) She said it was our duty as doctors to heal the sick, our lives be damned. I wasn't there when she gave this sanctimonious speech but someone I know actually swears she said "Look at it this way. If any of you die. You'll die as martyrs and get to go to Heaven."  ...............I'd say something witty, but that statement is pretty fucking out there just on its own thank you very much.

Thankfully, none of us got fired. At the end of the week, lo and behold, the blue cars came back. The cops came back. Donning their extra cool sunglasses, sweet ass berets, sexy vests, here were our saviors come to save the day. They stayed in their car and said they'd watch our backs. The problem was they were being literal. They literally stayed in their cars and watched our backs as patient's families were beating doctors inside or threatening to kill all of us (Because you know, homicide becomes a predisposing emotion when someone in your family is on the verge of death) So we closed again, and opened when they worked , and CLOSED AGAIN. We're currently closed right now so I have no idea what's in store for our wacky ward next.

Now, as glad as I am to not be working in the ward (because hey, every time they close I get to spend some quality me time with my friends, my TV shows and my games) I'm sure patients aren't exactly enjoying this as much as I am. Let me paint a picture for you , and mind you, this happens every single day when the ER ward is closed.

Group of friends are crossing the street.
Egyptian traffic dictates that 1 out of 10 of them is going to get hit by a car.
"Oh my God, we need to take him to the hospital right now!"
They get in the cab and they're driving as fast as they can. This guy's life is in danger, he's lost alot of blood and he needs medical attention right away.
Finally, after 30 minutes of grueling traffic, they make it. The doors of the hospital look like the Pearly Gates themselves.
"Our friend.. He's been in a car accident! He needs some medical attention RIGHT NOW!"
"Sorry, we're closed."
"What? Excuse me?"
"We're really sorry. But we're having an internal affair going on with lack of security right now, so you're just going to have to take your friend somewhere else."
"Oh, take him to Demerdash. We think they're open right now"
"About an hour from here. You're going to want to take the bridge. Again, we're really sorry here."

Now this goes against my inherent laziness, but I sincerely hope we sort out our issues with the hospital's security as soon as possible. I wouldn't want to be playing Grand Theft Auto IV knowing people are dying because that'd just ruin my playing mood.

Should a patient know what's wrong with him? Jury says No!

One of the more annoying things I've noticed that happens constantly and frequently in the hospital, is that patients usually have no idea what's wrong with them. I'e been asked several times by patients' families and the patients themselves the simple question of , "Doc, What's wrong with me and when can I go home?"

Now there ARE several explanations to this dilemma that I'm pretty sure is Egypt specific.

  • Patients don't bother asking the residents when the resident looks at their chart, RIGHT IN FRONT OF THEM. Whenever they ask me, I tell them, "What did the resident tell you?" and they say that they didn't ask. They don't ask because they feel that if they do ask, they'll inconvenience the doctor. Alot of times, the residents will be rushing through the patients when checking their files and charts because they have other places to be. This isn't saying that the patients aren't getting the care they need (they don't but it's not because of the resident usually). It's just that the residents usually have no time. Alot of the times, patients feel that they'll inconvenience the doctor simply by asking. They assign this god like status to the resident and if he's questioned even once, they have a propensity to believe that the resident will just say " Did you just question me? That's it! Fuck you. Fuck your family! Get the Fuck out of my ward."  This isn't true (well , most of the times at least)  To these patients, I tell them to just ask their resident nicely and they will answer nicely.   

  • The asshole patient and/or assholes of a family. Yes I know, it goes against every moral fiber of my being to say that some patients are just genuine assholes but yeah, some of them really are. Now usually, it's mostly the family who are assholes. These people want to know EVERY single step of the process, and once told, they will not shut the fuck up about what to do. They think their patient  is the only person in the entire hospital, and that the entire hospital staff should bend over backwards to save this and only this man's life. The problem with telling them what's wrong with the patient (especially if its a severe illness) is that they'll question your skills as a doctor (because they'd rather not believe you than believe the patient is super sick). This becomes even more of a problem when they decide to want to go to another hospital (because maybe another hospital's going to tell us he's not going to die, because you know... That's how hospitals work. Like raffles) So they put the patient's life in jeopardy by risking and threatening to move him AND/or not give him the medication you prescribed. It becomes a ethical minefield when you think about it. Do you not tell these people the severity of their patient's illness in hopes of just offering treatment because they will lose their shit if you do, or do you tell them and damn your patient to die because they're fucking stupid. I know what you guys are thinking, "How do you know which families are assholes and which aren't" There's a general rule to this. If 7 people are coming in to bring 1 patient and they're screaming at you as you're trying to help,  rest assured they're the people I'm talking about.

  • The patient is kept in the dark because his family has decided he's to weak to sustain the diagnosis for himself.  This, to me, is the worst situation. What happens is , the patient's family come in to your office to ask what's wrong, so you tell them. After you tell them, they beg you not to tell the patient because 'he won't be able to handle the diagnosis' . Obviously this is more prevalent in more serious traumas and conditions. They will literally go down on the floor on their knees begging you not to tell the patient saying that they'll tell them when the time is right. I, personally, fucking hate this. I've had this happen to me a few times and I'd respond by going to the patient and telling him what his family just told me. If he says "Just tell me Doc" I do. Nothing should ever be kept from the patient.  Ever. There's even a worse example of this that happens, and that's when someone dies. Now, when someone dies we usually tell the relative who's waiting outside. So we had a death happen a while back and he had a bunch of relatives waiting outside, but his brother was the one waiting closest. So we went to him and told him. What he told us next was unbelievable. He told us not to tell the family or talk to them because he'd deal with it. So we agreed thinking he'd have his own way of saying it. The guy went outside to his sister and the rest of the family and told them "Guys! He's fine! Let's all just go home and visit him tomorrow." I never understood why he said that until the next day. He showed up again the next day and I asked him  why he did that. He told me it was for the safety of the doctors. Had he told them, they would've gone in and beat the living shit out of every single one of us. Scariest part of it all, was that he was dead serious.
Now these are just a few examples of so called 'breaches' in the doctor patient confidentiality relationship, and it's the kind of stuff you're sure only happens in Egypt. But you know what? Ethics be damned, the way people are here, normal moral ethics don't work. You need to understand the patient's social background and deal accordingly. Otherwise, people will beat the shit out of you. And who wants that?

PS: Seeing as how this wasn't that funny of a post here's an entertaining story relating to what I just talked about that happened to me the other day. There was this guy that needed to change his dressing on his lower back (Dressings are just pieces of cotton wrapped in gauze soaked on wounds that are washed with antiseptics. We change the dressings to prevent infection) So the guy specifically told me he didn't want to be sprayed with the topical antibiotic spray because it burns like a bitch. Now the guy needed to be sprayed. So his wife just whispers to me ," Don't tell him. Just spray." and she proceeds to trick him by showing an empty bottle of spray saying it's all finished.I disagreed.  I told him, "Listen, I know the spray hurts like a bitch. But it's to prevent you from getting infected again and so reduces the time you get to spend here. So the man agreed and I sprayed and it was all over. After I was done, he called his wife an asshole and told me, "Thanks for being up front with me Doc. As for you woman! Don't talk to me for a whole day! "  So she looked at me and said "Thanks for ruining my marriage Doc!"  I did what anyone else in my position would do. I laughed. Does that make me an evil person? 

Saturday, 9 April 2011

Hilarity in the Triage

One of our rotations in the ER comprises of a week in Triage. Now Triage is a great system. It's basically the first room a patient walks into. What should officially happen is, the doctor inspects him or her and makes a provisional diagnosis and assigns his condition a status ranging from Vitally Unstable to Stable.

Now I'd love to say that happens here. No. What happens with us is we take a look at the patient, ask what happened and immediately tell him to go to a room. We're like secretaries. Actually, we ARE secretaries. An example to illuminate what I mean can be as follows:

Patient walks in with a limp and severe pain.
Me: What happened?
Him: I fell on my leg and can't move.
Me: Okay, go to the Orthopaedic ward.
Him: You don't want to look at it.
Me: No no, that's not my job, that's their job. My job is to point out where you should go.
Him: Oh so you're not a doctor?
Me: No no I am. It's just that for this week this is what I do.
Him: Must suck doesn't it?

Even the patients know how redundant the job is but hey, who am I to argue hospital protocols. Now I was assigned the night shift, and the night shift is famous for crazy ass shit. So here are a few funny things that happened over the week.

  • Patient comes in with his friend: "Doc, you gotta help me. It burns so hard when I pee and I'm pretty sure there's pus coming out of it. I don't know what to do and it really hurts. Do you want to see? "  I didn't. So the guy looked young and based on his appearance and symptoms, my first guess was Gonorrhea. (Yes, we do get sexually transmitted diseases here in Cairo. We might be a religious city, but we're that kind of religious where a guy can pray 5 times a day and still fuck a really cheap hooker under the guise of ,"Hey! At least I pray!") So i asked his friend to excuse himself on account he didn't want to embarrass himself when I asked. The guy said the friend was like his brother and he knew everything about him. I said fair enough and asked whether or not he's had sex recently. Both their reactions were priceless. Their eyes opened up, they looked at each other for 5 seconds then he said ," Ummmmmmm, Sex? Hmmmmmm. Nope. Not that I can recall."  I asked again. He actually said, " Wait let's see.. Nope. No sex."
    Let me just say to all the people who are going to lie about their history whenever they encounter a physician. There are some answers that kinda need to be answered quickly without  delay. If I ask whether or not you're married, I expect an answer within a few milliseconds.  The funniest part was the OTHER guy's reaction. He looked like a ghost, which led me to believe they both probably had sex with the same disease ridden hooker. Oh well, guess that's what happens when you pay 50 pounds and expect sex.

  • Big burly motherfucker of a guy comes in and he's holding on to his neck with both his hands. The man's lost alot of blood and he looks like he can still beat the shit out of me. So I asked, "Oh my god, what happened to you man?" So he just says ever so casually, "Oh this? I was in a fight and I just need some stitches." So I asked to look at the injury. To say that the injury was deep is an understatement. I could see the vessels clear as day bleeding out and here he was just cool as ice. So I told him he needed to go to resuscitation. His answer was fucking epic, "No doc. I just need some stitches. Fight's still going and I need to be back in there."
    Egyptians = not afraid to beat you AND bleed on you at the same time.

  • A girl comes and she's completely passed out. She's with two of her coworkers (because they're all dressed the same) and she looks like she's about 25. So they lay her on the bed and tell me screaming in fact, " You have to help us! She just collapsed on the floor and we don't know what to do! Please Doc!" So I looked at her, breathing was regular. Pulse fantastic, Blood pressure was pefect.  If I didn't know better, I'd say she was sleeping. So i asked them if anything psychologically traumatic happened today. They thought about it and said that she was talking to her husband, argued, closed the phone and BAM! Her face met the floor. This is what we call a psychic patient, and I was super glad we got one, because the treatment of a passed out psychic patient is the coolest thing. Ever.  What you do is you try to snap her out of it by shaking her or eliciting pain (like pinching) but the best thing to do that'll guarantee an instant response is to get a syringe full of alcohol and inject it through the nose. It doesn't hurt but it'll sure as SHIT wake you the fuck up. So I got the syringe ready and the coworkers were freaking out and I told them not to worry. So I injected it all, and she woke up like she was waking up from the scariest nightmare of her life. HUGE Gasp and just teary eyes. The coworkers looked at me and said, "Wow, medicine really has advanced throughout the ages." I told them, "Yeah, it also helps when your coworker's medical problem is simply bitchy husbanditis." 

Conversations with Deluded People

I didn't want to post this because it's a bit political but I was just so frustrated and I needed to vent.
Today is 9/4/2011. Earlier today at about 3 am in the morning , the military along with the police forces shot  at the protestors in Tahrir for about 3 hours. Now, there's an official statement by the army saying they were only protecting the people and they were apprehending some pretty important people who were involved in the thuggery acts during the revolution.

Regardless of the truth behind their statements or not, live ammunition was used and people, pardon my french, freaked the fuck out. Now I was in the ER pre-op/ post-op ward (where the patients are either waiting for their operation or recovering). I went and checked to see whether or not we got patients from Tahrir (some said a few, most said none). I went back to my ward to tell the patients (the ones I formed a bond with) and listen to what they had to say. Some said the protesters were violating the curfew, others said that it was obvious that the army was going to turn on the people and some said we should wait and hear and collect data first before damning anyone. The general consensus however was unified. Grief at the overkill method, hope that no one died (I've seen the picture with blood. Gruesome stuff but I'd like a death toll please) and fear on what's next for Egypt.

While talking to the patients, one of the janitors cleaning up the ward looked at me and told me:
"You are a liar. Stop spreading lies about the army. There is no way they could do this to us." He said it quite angrily. The worst part is what he followed up with:
"Are you even Egyptian? You don't sound Egyptian." I told him I wasn't and his response was that of disgust and imaginary confirmation. What I surmised out of the situation was that this asshole of a janitor thought I was operating some sort of hidden agenda. Here we are, 2 months later, and a man will believe something that was irrevocably proven to be false over something as factual as videos, photos and eye-witness reports on the news channels.

I was furious, but I let it go. I laughed it off and said to the patients, "I'm sorry I forgot to tell you guys. I do have an agenda. So call me Dr. Agenda from now on okay? " We all laughed it off and I hope to God I made the janitor feel like a retard.

One thing I will never understand is the people's unyielding support for any institution. No institution can represent a country. That's because every one of them is led by men, and last I checked - Man corrupts easily. 

I hope things don't escalate. I sincerely do. God bless

Conversations with Crazy People

People can be so crazy sometimes. Case in point. I just signed in for the night shift and decided to walk through the hallway to check on my friends. So i hear this woman (a patient's relative) shouting and screaming at the top of her lungs. Things like "The Minister of Health is a CORRUPT business man who has BILLIONS of DOLLARS and isn't doing anything" I brush her off and go towards the resuscitation room and see that one of the better nurses is pissed and shouting at the piece of shit hired cop (the police finally decided to grace us with their presence on 8/4/2011. This was their first appearance since the revolution started, but this is another story that I will tell soon) 

Back to the nurse. She was shouting because the woman I mentioned earlier pretty much insulted her for no reason whatsoever. So I asked the police officer why he wasn't doing anything about this. He told me that she was a woman and the police can't do anything to women. I suddenly remembered all the women that were hit or beat by the police during protests and more who were harassed when they simply needed help, but now was not the time to fucking go crazy on his shitty retort.
 So I decided on being the paragon of justice, (I was also really bored,) and decided to intervene on the nurse's behalf. I go to crazy woman and she's still shouting and just making derisive comments about everyone and everything so I simply ask:

Me:What's the problem?
Me: Can you please lower you voice. There are other patients here and you can't really shout in the hospital.
Me: Fair enough, what happened?
At this point her son decides to tell me: Get out of it Doctor if you know what's best for you. This isn't your concern. So I told him it was and carried on talking to the crazy woman.
Me (trying my best here to not laugh at the woman's insane logic): Okay can I please say something and you need to to listen to this.
Her: FINE!
Me: Listen, I understand you're going through a rough time. Your son (turned out it was her sister's son but whatever) is sick and you don't know what to do and you all thought that Kasr Al Aini must have beds. Please understand that we have no reason to lie to you. Also, understand that it doesn't matter. Revolutionary, murderer, child, star. Doesn't matter. What matters is if we have beds or not. We get thousands of patients a day, hundreds need the ICU. So I'm sorry but you need to go to another hospital.

So she left. She eventually calmed down because I talked her down and she left without causing a bigger ruckus. The funny thing is the backlash I got from the nurses and the workers. They all seemed unified in telling me I should've just left her alone completely till she ran out of breath. I like to think she shouted because no one listened but these are just speculations. 

The nurse then told me, "You should've pissed her off more."
So I laughed and asked her why. 
She said, "So that they'd hit you and we'd have another reason for closing down the ER again."  Now she was laughing, but there was a hint of honesty and I couldn't help but smile that cynical jaded smile of mine.

PS: During the revolution, when the pro-Mubarak thugs appeared in Tahrir, there were countless eyewitness confirming that they came in using ambulances from Kasr Al Aini. So we totally did support the revolution. We were toughening up the protestors.

Monday, 4 April 2011

My First Day (caution: Naivete abound)

My first day in the ER, I was assigned to the Resuscitation Room. This is the worst  and most stressful room in the entire ward. Basically, it's where the really critical patients come in (ranging from gunshots to car accidents to falling off balconies) We have a simple rule: if there's even the slightest bit of head trauma, they need to go to the resuscitation room. Thankfully, I ended up with a morning shift (which had the least flow amongst the 3 shifts ; nights being the hardest)

I went in and got myself acquainted with the residents and colleagues and went  straight to work with the patients. I'd noticed that most of the patients in the room needed a neurosurgical consultation (as most of them had head injuries) but the neurosurgeon was nowhere in sight. So I asked the resident where the guy was because it looked like they needed attention right away. I say looked like because after 6 months in the hospital, your definition of 'urgent' and 'right away' begins to broaden more and more and include a bigger timespan. He laughed and told me that we'd have to wait a couple of hours till the doctor came.

"A COUPLE OF HOURS! For God's sake man, these people need attention now!"  It was my first day ; what can I say? I was young and na├»ve. I decided to take matters into my own hands and look for this son of a bitch neurosurgeon (who was probably munching on some Rotato chips at the kiosk right outside the ward).  So I made sure I didn't have any work left and ventured out of the room into the hallway looking for Dr. Neuro. It was odd because I everyone I asked seemed to be covering for him. I kept thinking, why the fuck would anyone cover for this piece of shit doctor who's on call but never around. I finally found him half an hour later. He was sleeping in a supply closet! Needless to say, I was furious. Here was this man, bereft of humanity, sleeping like a baby while other patients were dying simply because he couldn't set aside his beauty hours of sleep. I woke his ass up and dragged him down to the room so he could look at the patients. I asked him how he could sleep here and he just shrugged it off and looked at some of the CTs belonging to the patients. 

At the end of the shift, as I was going to sign out, I bumped into a good buddy of mine who had finished his internship already. So I ended up talking about how much of a dick this Dr. Neuro guy was. So my friend looked at me and said to me, "Dr. Neuro was the neurosurgical consult when I was an intern here too." So I said to him, "Was he a dick then too?"  His reply was chilling, "You don't get it. He's been ON CALL SINCE I was an intern here."

My friend finished his ER rotation 2 months before I started.

Dr. Neuro has been the neurosurgical consult 24 hours every day, for 2 months.He goes home once a week for a couple of hours so he can take a shower and come back.

Wow. I felt like an asshole. I eventually got to know Dr. Neuro and he's a great guy. He could have exploded in my face when I was an ass to him but he chose not to. Now, whenever there's a neurosurgical consultation, I wait for as long as humanly possible (without putting the patient's life in danger obviously) before I wake him up.

I remember this one time I was talking to him a few weeks later at 7 am in the morning. We were watching the janitors exchange shifts and he said to me, " It's not fair. They get to change shifts  and I don't. This is what's become of my life. The janitor has more access to human rights than I do."

I did what any other person would do. I patted him on the back and lied:

"You're going to be alright." I said.

First Post, or How I Learnt to Make a Prologue.

Let's get a few things straight before I start this piss poor attempt  of a blog chronicling my days in the Emergency Ward in Kasr Al Aini Hospital. Even though I'm probably going to mention a few stories that'll make it seem like I hated the hospital along with its staff and protocols, I just want it to be written in metaphorical paper that I don't. If anything, I'm astonished. Astonished at the capabilities of a hospital to help save and cure an enormous number of people (or at least try to anyways) every single day with minimal funds and poor working environments. This isn't even mentioning that every single service provided is free of charge (there IS a cost but it's a more personal one and I'll get to that later). Every single day the emergency ward gets AT THE VERY LEAST 1,500 patients a day. That's ONE THOUSAND FIVE HUNDRED SICK PEOPLE (give or take a hundred hypochondriacs and/or psychological crazies). And all this is happening in ONE ward. So before I get on with this, I just want to thank every single person working there right now and every single person who's working there tomorrow and the day after and the day after and so on. Now that's not saying I don’t hope a few of the people running the place burn to death in a pyre of justice but I digress and that was never the point of this blog (though I'm pretty  sure I might mention one or two occasions)
What is the point then? Well, it's simple really. Every single day I am exposed, as an intern, to ridiculous events. They've become so commonplace and I can't help but share my stories with all my friends (boring the close ones especially because they get to hear my stories more than once).  I'd like to claim that the point of this book is to offer intuitive insight to the machinations of an ER ward in a public free hospital but then I'd be lying. The real reason is simply to entertain the readers. I feel compelled to share these stories because some of them truly are outrageous and are simply too good to just let go of into the unwritten ether. Some of these stories will make you laugh, others will sadden you and some of them might even elicit a "What the fuck?", especially from the holier than thou  readers.

Now as much as I'd like to claim that this recollection is going to be 100% factual and that all these stories happened to me, that's not the case. It's going to be about 90%  factual with some embellishments here and there, kind of like digitally retouching photos. It's still the same, only better. Some of the things that happened that I might talk about might not have happened to me personally but to close friends, but for ease and laziness I'll just pretend they happened to me.
If I get too medical, I'll be sure to try and explain myself so that all you common folk can understand. No worries, I've gotten used to it.
I hope you enjoy these stories just as much as I did living them. Cheers.

A (still currently an intern in Kasr Al Aini)

N.B: Most of these stories are after Egypt's revolution. I say that because in the midst of all the chaos, the police guarding the entrance up and left us entirely to fend for ourselves against brutish thugs (that were either patients intimidating doctors or patients' family members intimidating doctors. All in all intimidation's the key here).