Friday, 13 May 2011

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


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.

Wednesday, 11 May 2011

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."
"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."


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 Sag.
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.

Tuesday, 10 May 2011

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 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.

Monday, 9 May 2011

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?


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.

Friday, 6 May 2011

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


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.



Yeah, I didn't fucking think so.

Thursday, 5 May 2011

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."
"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

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?"


"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 .