In the state system in South Africa, we didnt see old people. Not REALLY old people. The combination of HIV/AIDS, poorly controlled diabetes and hypertension and trauma meant that sadly, if you made it to 75, you were lucky.
In Ireland, we have the flip side of the coin.(I am sure this is true of most '1st world countries'). People get Old here. Really old! I did 6 months of medicine last year, and it was a massive crash course in geriatrics. I had no idea of the intracacies of taking a history from an aged person, or which are the right questions to ask, or how to ask them, or what differential diagnoses you need to consider. It was a steep learning curve, but I got there in the end, and now feel pretty confident with the oldies.
I have mixed feelings about the aged population: they can be VERY difficult to deal with, and sometimes their families are even worse. So here are a couple of thoughts about old people...
1)Their bowel movements are REALLY important to them. I once (accidentally!!) made an old lady cry when I told her I needed to put on a backslab for her elbow fracture: she wasnt upset by the fracture or the backslab, but the fact that she needed to have a bowel motion at 8 am every day, and wouldnt be able to successfully do so with backslab in situ.
2)Their families can be their best allies... or their worst enemies. People who care for the aged fall into two categories: excellent or appalling. The former are supportive, visit their old person regularly, dont mind helping change dressings or adult nappies, provide practical help with food and walking aids etc, and are generally well informed about the medical conditions, medications and are willing to practical and realistic when the time comes to make big decisions, eg resus decisions.
The latter are the opposite: they are overly 'possesive' of their old person, but without any thought to how to really help: I have seen old men who live with their daughters coming in with weeks worth of dirt caked in their fingernails, dirty greasy hair, and toenails creeping under the bottom of their toes- could you not run your dad a bath? could you not help him clip his toenails? With his arthritic back and hips he probably cant manage to do these things on his own anymore.
When you suggest to this type of person that the old person needs to go home with a catheter/have dressings changed daily/have someone supervise medication, they will argue loudly with you and explain why they cant possibly do this, even though they are the 'carer' (and sometimes, getting the state 'carer's allowance!).
3) They are NOT stupid, but people treat them like they are. For the first time in my life, I encountered patients here who have never been told their diagnosis, even when its something like cancer!, because their family 'thought it best' not to tell them. What a load of hooey.
4) Loneliness is what kills most old people. (Apart from strokes and MI's obviously!). My heart breaks for these old ladies who have outlived their husbands by 30 years, or old chaps who live on their farm with their equally old brother, unable to farm anymore, but without anyone to sell or give the farm to. There is a big problem of alcohol abuse in the elderly here, but I understand it to an extent: They go off to the pub every day and have lunch there, both for the food and the company, and end up with a life long habit of 2 or 3 pints a day.
I'm not a big fan of oldies, and those who know me will know that I am not the most patient or people: but in dealing with the elderly I have learnt a bit of compassion, and also what it means to really be the patient's advocate: someone needs to stand up for them! Then again, maybe I'm just getting older myself, and a bit soft in the head:)
Wednesday, April 22, 2009
Nights
Midnight to 8 am is a funny shift: it sounds awful, but is actually pretty great. I dont mind nights at all: you get to miss most of the bullshit that parades through casualty in the day, and actually help (mostly) sick people, and you get to take guilt free naps all day. It gives me a secret thrill when I get into bed at 09h30, knowing that most people are just starting their working day.
Doing a week of nights does warp your perspective of time a bit: usually I'm not sure what the date or day is, someone has to tell me at the start of every shift. I am a great procrastinator, and this gets worse on nights, where, before you realise it, its the end of the week and you have done NOTHING productive except work and take numerous naps in the day. My running program takes a pause during my weeks of nights, and sadly, I end up eating the same thing 5 or 6 nights in a row (usually make a big dish of lasagne or whatever... ).
I quite like the vibe at 4 am: casualty never sleeps, there is always something happening....I always wonder about people who come in to hospital in the early hours of the morning: obviously if you wake with crushing chest pain, thats one thing, but people who come in with say, a recently twisted ankle, at 5 am. What were you doing to twist your ankle at 4 am? Why weren't you SLEEPING?Anyway, I dont really mind, it keeps things interesting.
The only other down side of nights is that it really buggers up your sleep pattern for a couple of days.... I usually cant get to sleep for at least 2 or 3 nights after nights... its quite frustrating!
Last night was a good night: wrestled with a man's shoulder until it popped back with a satisfying clunk, helped 3 MVA victims (they were all fine), listened to numerous old grannies and their dodgy hearts and lungs, reassured patients and their families, referred on all my patients without any arguments with the admitting teams (I'll write another post about this another time...), and still had time for coffee and a hot cross bun at 4 am. Sometimes I REALLY love my job:)
Doing a week of nights does warp your perspective of time a bit: usually I'm not sure what the date or day is, someone has to tell me at the start of every shift. I am a great procrastinator, and this gets worse on nights, where, before you realise it, its the end of the week and you have done NOTHING productive except work and take numerous naps in the day. My running program takes a pause during my weeks of nights, and sadly, I end up eating the same thing 5 or 6 nights in a row (usually make a big dish of lasagne or whatever... ).
I quite like the vibe at 4 am: casualty never sleeps, there is always something happening....I always wonder about people who come in to hospital in the early hours of the morning: obviously if you wake with crushing chest pain, thats one thing, but people who come in with say, a recently twisted ankle, at 5 am. What were you doing to twist your ankle at 4 am? Why weren't you SLEEPING?Anyway, I dont really mind, it keeps things interesting.
The only other down side of nights is that it really buggers up your sleep pattern for a couple of days.... I usually cant get to sleep for at least 2 or 3 nights after nights... its quite frustrating!
Last night was a good night: wrestled with a man's shoulder until it popped back with a satisfying clunk, helped 3 MVA victims (they were all fine), listened to numerous old grannies and their dodgy hearts and lungs, reassured patients and their families, referred on all my patients without any arguments with the admitting teams (I'll write another post about this another time...), and still had time for coffee and a hot cross bun at 4 am. Sometimes I REALLY love my job:)
Sunday, April 19, 2009
Why I love the Irish
1) Their belief in the fact that everything, and everyone, has some Irish heritage. When Barack Obama was elected president, the newspapers were full of new about his great great great grand uncle, who is from county Mayo (or something). The Irish press recently ran a story on how surfing was invented in Ireland. Surfing? There are surfers here but I very much doubt whether they could compete with the 'big wave' riders of say, Hawaii. At first I thought they were joking, but these articles appear in major newspapers, not tabloid junk, so I can only assume they are being serious!
2)They all know each other. This is a bizarre thing, and unsettled me at first. They will also deny this fact vehemently but it is true. The fact remains that Ireland and its cities remains a collection of 'big small towns' - even Dublin, the capital, has a population of only one and a half million people. The other thing is that families are big here, and close: cousins and nieces and nephews are much closer than at home. So these facts set us up for a situation where everyone seems to know everyone, and if they dont know each other yet, they will find someone that they have in common to break the ice in about 5 minutes.
3) They talk about the weather. A lot. Its because the weather is so crap here, and thus occupies a lot of thought and talk time. And its not small talk either, people will introduce the weather as a legitimate topic of conversation all the time.
4) They are a proud nation. This sort of ties in to no 1), and is a bit hard to explain. But I think I notice it because South Africans are quite similar: despite having a lot of problems in both countries, we are both proud people and very patriotic. (Although.... this has changed a bit with the big recession.) When they won the Six nations this year, you should have seen the amount of green clothing and rugby memorabilia floating around.
5) They are obsessed with death. There seem to be a lot of complicated and prolonged dates and rituals associated with dying (for example, a funeral takes three days!!!). There is the funeral itself, the remembrance mass one year, 5 years and I dont know how much longer afterwards. The newspapers are bursting of death and in memoriam announcements... and here is the thing: its not just old ladies in nursing homes who read them. Young people my age read the death notices every day! Down in Tralee, the local radio station announced death notices every day at lunch time.
6) The way they talk and little grammar expressions they use. My favourite ones: the random use of the word 'so', and in "See you later,so." (Encountered this one down in county Kerry). Also, the expression 'I'm just after': it literally took me weeks to figure this one out but basically it means, 'I've just come from', eg "I'm just after getting some bad news". The word 'like' is also liberally added to the end of sentences left right and centre.
It hasnt been easy adjusting to a foreign culture and lifestyle (and the weather certainly didnt make it easier!) but somewhere along the line I decided to stop complaining and start seeing the funny, or at least endearing side of things. No, its not the same as SA, and the people are VERY different, but thats not always a bad thing!
2)They all know each other. This is a bizarre thing, and unsettled me at first. They will also deny this fact vehemently but it is true. The fact remains that Ireland and its cities remains a collection of 'big small towns' - even Dublin, the capital, has a population of only one and a half million people. The other thing is that families are big here, and close: cousins and nieces and nephews are much closer than at home. So these facts set us up for a situation where everyone seems to know everyone, and if they dont know each other yet, they will find someone that they have in common to break the ice in about 5 minutes.
3) They talk about the weather. A lot. Its because the weather is so crap here, and thus occupies a lot of thought and talk time. And its not small talk either, people will introduce the weather as a legitimate topic of conversation all the time.
4) They are a proud nation. This sort of ties in to no 1), and is a bit hard to explain. But I think I notice it because South Africans are quite similar: despite having a lot of problems in both countries, we are both proud people and very patriotic. (Although.... this has changed a bit with the big recession.) When they won the Six nations this year, you should have seen the amount of green clothing and rugby memorabilia floating around.
5) They are obsessed with death. There seem to be a lot of complicated and prolonged dates and rituals associated with dying (for example, a funeral takes three days!!!). There is the funeral itself, the remembrance mass one year, 5 years and I dont know how much longer afterwards. The newspapers are bursting of death and in memoriam announcements... and here is the thing: its not just old ladies in nursing homes who read them. Young people my age read the death notices every day! Down in Tralee, the local radio station announced death notices every day at lunch time.
6) The way they talk and little grammar expressions they use. My favourite ones: the random use of the word 'so', and in "See you later,so." (Encountered this one down in county Kerry). Also, the expression 'I'm just after': it literally took me weeks to figure this one out but basically it means, 'I've just come from', eg "I'm just after getting some bad news". The word 'like' is also liberally added to the end of sentences left right and centre.
It hasnt been easy adjusting to a foreign culture and lifestyle (and the weather certainly didnt make it easier!) but somewhere along the line I decided to stop complaining and start seeing the funny, or at least endearing side of things. No, its not the same as SA, and the people are VERY different, but thats not always a bad thing!
Thursday, April 16, 2009
INTRODUCTION
Hi folks:) Now i know there is a lot of shite out there on the internet, this is just my small contribution. Anyway, i have been inspired my friend karen little, and seeing as there is always something floating around in my head begging to be written, it seemed it was time for a blog. Hope you're all not bored to tears.
Now as any doctor who has ever worked in Casualty will know, there really is no cure for stupidity. All countries have their share of fools and most of them float through A and E at one point or another (let me just say at this point that I do love my job and have no problem with genuinely sick people, in fact, I will go the extra ten miles for them.) The only difference usually is language and skin colour.
When I was working back in SA,I used to get very frustrated at patients who only came to 'Western' doctors as a last resort: they would go to traditional healers and sangomas first and only present to us much too late, when things were really getting out of hand. SA docs are often frustrated at the lack of education in state patients, and how difficult it is to explain concepts like viruses, bacteria or cancer to them and their families. Language barriers are only a part of the problem: even with translation, some patients genuinely refused to accept that their family member had, for example, bacterial meningitis, and insisted that they had rather, for example, been possessed by angry spirits. Ignorance and poor education are big problems. It was tough.
However, not nearly as tough as what I have encountered here in Workingclassville in Ireland. Here, we have a much more dangerous beast: the 'Educated and a little bit paranoid' patient. Like Mr X who I saw with a lower respiratory tract infection.
'Sir, I do need to tell you that you are in the 'morbidly obese' category. You weight is becoming a health risk factor in itself, and you are headed for heart disease, diabetes, and hypertension. You need to lose about 15 stone(thats about 100 kg for the metric world)to be a healthy weight for your height.'
"Well you know doctor, all the men in my family are this big... and I eat the same food as my wife and she's tiny."
'Riiiiight. Well, anyway, here is a short course of antibiotics for your infection. You may also want to stop smoking marijuana, its certainly not doing your lungs any good'.
''Well atually I've done my research on the Internet and theres no trials that show that its actually bad for you."
'Riiiiiigggght. You may also want to take some regular paracetamol for your fever and generalised body aches.'
"Well doc, I'll take the antibiotics but not the paracetamol."
'So you'll smoke marijuana (a mind altering, brain destroying, cancer inducing drug) but not take paracetamol (one of the most effective pain and fever relievers we have, with minimal side effects)?'
"Doctor, marijuana has been used as a medicine for thousands of years. Paracetamol is poison provided by drug companies looking to make money."
Right. Of course, Big Pharma's out to get you. He then proceeded to tell me that he wouldnt take high blood pressure or diabetic medications either, becuase 'they can be managed naturally'. The irony is of course, that people like this keep Casualty departments in business, so I really cant complain too much.
I do think it hilarious and fascinating though, that someone from a first world country with a good education system and access to all the information in the world can still be as frustrating and difficult to counsel as a patient from SA who has no high school education, even though we speak the same language.
Now as any doctor who has ever worked in Casualty will know, there really is no cure for stupidity. All countries have their share of fools and most of them float through A and E at one point or another (let me just say at this point that I do love my job and have no problem with genuinely sick people, in fact, I will go the extra ten miles for them.) The only difference usually is language and skin colour.
When I was working back in SA,I used to get very frustrated at patients who only came to 'Western' doctors as a last resort: they would go to traditional healers and sangomas first and only present to us much too late, when things were really getting out of hand. SA docs are often frustrated at the lack of education in state patients, and how difficult it is to explain concepts like viruses, bacteria or cancer to them and their families. Language barriers are only a part of the problem: even with translation, some patients genuinely refused to accept that their family member had, for example, bacterial meningitis, and insisted that they had rather, for example, been possessed by angry spirits. Ignorance and poor education are big problems. It was tough.
However, not nearly as tough as what I have encountered here in Workingclassville in Ireland. Here, we have a much more dangerous beast: the 'Educated and a little bit paranoid' patient. Like Mr X who I saw with a lower respiratory tract infection.
'Sir, I do need to tell you that you are in the 'morbidly obese' category. You weight is becoming a health risk factor in itself, and you are headed for heart disease, diabetes, and hypertension. You need to lose about 15 stone(thats about 100 kg for the metric world)to be a healthy weight for your height.'
"Well you know doctor, all the men in my family are this big... and I eat the same food as my wife and she's tiny."
'Riiiiight. Well, anyway, here is a short course of antibiotics for your infection. You may also want to stop smoking marijuana, its certainly not doing your lungs any good'.
''Well atually I've done my research on the Internet and theres no trials that show that its actually bad for you."
'Riiiiiigggght. You may also want to take some regular paracetamol for your fever and generalised body aches.'
"Well doc, I'll take the antibiotics but not the paracetamol."
'So you'll smoke marijuana (a mind altering, brain destroying, cancer inducing drug) but not take paracetamol (one of the most effective pain and fever relievers we have, with minimal side effects)?'
"Doctor, marijuana has been used as a medicine for thousands of years. Paracetamol is poison provided by drug companies looking to make money."
Right. Of course, Big Pharma's out to get you. He then proceeded to tell me that he wouldnt take high blood pressure or diabetic medications either, becuase 'they can be managed naturally'. The irony is of course, that people like this keep Casualty departments in business, so I really cant complain too much.
I do think it hilarious and fascinating though, that someone from a first world country with a good education system and access to all the information in the world can still be as frustrating and difficult to counsel as a patient from SA who has no high school education, even though we speak the same language.
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