This is the End

Now that I am back in Montreal with one week of work at the Royal Victoria behind me and in the warmth that a proper winter season brings to me, I sit down to ultimately share with you, my friends, my family, the lasting impressions of a trip gone mindfully everlasting. Even from the distant perspective that I now find myself in, it is hard to wrap one’s head around the past month’s continual stunning stimuli. I thank you all very much for following this blog which has been an absolute pleasure to write. Thank you also for the nice words you have sent my way, the dizzying attractions of a new world are inebriating, but the friendship and love from back home mean much more. Hopefully I will finish writing up my motorcycle trip to Mexico in 2010 before another year passes and so you may enjoy it before long.

The End - The Doors    

After my birthday’s bountiful beauty – scenic, musical, and feminine – I was back at Bara for two busy twenty four hour shifts Sunday and Tuesday. As always with weekends in Soweto, the Montreal’s Code Orange (Mass Casualty) fill of patients already saturated the trauma bay when I arrived on Sunday morning. Also, the Pirates had drawn to the Chiefs in the prior day’s football match which had served as an additional reason to keep us busy. The fans probably disliked the game’s conclusion, but it somehow suited us quite well as a victory, and therefore a defeat, would have had a more dire impact.

The three weeks of experience I now carried felt like an equivalent multiple of what I could have witnessed in Montreal and the associated poise and know-how I practiced with never still erased the hidden silent disbelief that this busy bloody trauma bay instilled within me. The professional reacted to each novel atrocity, frighteningly creative every time, with a calm indifference as if nothing was new, as if I had seen everything but the humanity which completed my healer’s double face kept shaking its head in disapproval. No point in torturing one’s logic in a world devoid of it with a question I grew tired of repeating after a few days: "why?" There are more important things at hand anyways.

I remember taking a few seconds to breathe, not out of choice but rather because that is the time the blood gas machine takes to analyze samples, and I looked at the trauma bay in front of me. Its eight pods crowded with sixteen bloody gurneys onto which a child, a father, a student, a grandmother, a friend, a somebody, or a nobody were sadly all united in fighting for their lives. The loud beeping of monitors only annoyingly confirming what everyone here knows. A puddle of blood, urine, and vomit under a bed. Bloody footsteps retracing the many to and fro’s of nurses, students, residents, and staffs running around doing what they do best. I chuckled in stating the obvious to myself: “this is not normal”. The machine produced its results and I dove back in.

When my last call ended on Wednesday morning, I drove back home, slept until the early afternoon and prepared for one last trip with Shoshy. Not having had the chance to witness the wonders of Kruger National Park, I set off a course towards the closer Pilanesburg National Park. On my way there, I passed by South Africa’s executive capital, Pretoria. Not long enough to appreciate what the city had to offer, but enough to notice a certain post-apartheid peculiarity. Also serving as the country’s capital before the advent of democracy, Pretoria’s streets had once shared their names with prominent historical figures of Apartheid. They have since been renamed, but to avoid confusion, the previous name is still featured on street signs barred by a thick red line.

I got to Pilanesberg and entered a campsite on the North East end of the park; Christine, my landlord, had lent me a tent for the occasion. Had I known earlier that I could have borrowed it, there surely would have been more camping on this trip. Not five minutes had passed after I arrived that four people greeted me and offered their help to mount my tent. The deed done, I thanked them and they left as quickly as they came. Having not eaten yet, I strolled towards the campsite’s small restaurant to see what they had in store. I chose the impala cutlets.

The childhood years I spent sleeping in a small bed trained me well in order to sleep comfortably in relatively uncomfortable settings such as a bathtub in the USA, a small apartment floor in Japan, a sidewalk in Spain, or a roof and the Sahara desert in Morocco. In comparison, camping is like a day at the spa and I relish it, so I woke up that morning quite content with myself. I drove the few kilometers separating the campsite from Sun City where I was going to embark on a safari tour of the park. Sun City might sound delightful but it is an abomination. It is a miniature South African version of Las Vegas and, as far as I am concerned, it has no place next to a National Park. I parked Shoshy for the day, traversed a casino floor and took my seat on a large open aired truck.

As we made our way through the park entrance, I let go of my aversion to Sun City (which does provide jobs for a few thousand people mind you) and paid more attention to my surroundings. A hilly region covered with tall grasses, bushes, and sparsely scattered trees giving animals a minimum to conceal themselves and visitors a chance to spot the worst hiders. It was a bit chilly that morning and our guide offered us blankets to fight off the cold that a three hour ride in an open-top truck would bring. However, being Canadian, the low temperatures suited me wonderfully and I declined the blanket with a large smile while the rest of my fellow safarists looked on in awe.

First sighting of the day was a group of impalas on the side of a water hole in which two hippos were lazily wading. Next, a lonely giraffe followed by zebras, wildebeest, a large elephant, rhinos, warthogs, and even lions. The latter actually got quite close to us showing off their impressive musculature. It was amazing to see the variety and abundance of fauna only a three hour drive away from one of the world’s large metropolises. Even more amazing was the apparent calm and serenity I found myself in heavily contrasted by the violent chaos that kept me so busy back at Bara. The only violence seen here, justified by an evolutionarily selected way of life, consisted of hunting and fighting for mating privileges. For our species, easily available food has relegated hunting to a hobby and the mating ritual has in large part been completely pacified and replaced by a playfully complex behavioral system... though muscle and power can sometimes do the trick for fellow humans which may have missed an evolutionary step.

When the safari was over, I had to face the fact that my time in South Africa was coming to an end. Just one more shift and I would fly home back to a proper winter, a city I love, and family and friends that I love even more. I drove back to Johannesburg and started packing my bag with each item evoking a fond memory of my time here. Later that evening, Christine, a seasoned horse rider, her husband, and I went to a Christmas equestrian performance showcasing Lippinzaner stallions. They used to be war horses and their long training required them to accomplish technically difficult footwork and movements in formation. While my amateur self could still appreciate the complexity of their achievements, I was more mesmerized by the immaculate whiteness of their coat. Being a big Lord of the Rings fan, I was seeing a family of Shadowfaxes parading in front of me.

Then came my last shift. What had come initially has a mixture of shock and coyness in face of such an intimidating environment now was replaced by a composed efficiency. The concentrated experience I gained over the month had forced this quick transformation in response to necessity. Sink or swim. But that day, instead of just putting in a chest drain, or removing one, I looked back at this learning path I had just traced and was glad to see how much distance I had covered in such a short period. This is ultimately what I had come for: trauma experience; superficially measured in chest tubes, intubations, central lines, deaths, blood and more blood but the impalpable real experience I had gained was perceptible through my demeanor in the trauma bay, this surreal place where I was now at home. A place where dramatic distractions constantly try to rip your attention from making life saving decisions, where the incomprehensible results of human violence keep filling blood soaked gurneys, where people die, where people are saved, and where my career will hopefully last a few decades. I tied my last stitch, particularly glad with the fact that I was only one of four students out of ten who had not suffered a needle-stick injury requiring HIV prophylactic medication, washed my hands, wished the best to co-workers and left the ward with perhaps an overinflated sense of a job well done.

As I have mentioned in a previous post, us students would often go eat at Chaf Pozi, a restaurant between the Orlando Towers in Soweto. These old, massive power plant chimneys are no longer in use but they have found a new life in entertainment when a company reorganized the facilities to accommodate bungee jumping, paintball, and scad freefall. Scad freefall involves getting lifted to a certain height by a crane and then released to fall completely unattached into a net a few stories below. I have heard people say it feels like dying: I could not resist. And I concur, it felt like I was dying, but with an enormous dose of adrenaline rushing through me after getting caught by the net, it also felt absolutely amazing.  

       

Back home, I finished packing the rest of my stuff. Christine came over to pick up the keys, say goodbye and wish me well. A friend from Bara had generously agreed to take all my stuff and follow me to the BMW dealership where I had to return Shoshy before going to the airport. The weather had been threatening all day but not wanting to have to fetch my protective riding gear from the depth of my densely packed backpack for such a short ride, I took a chance and prayed for the skies to spare me… which of course they answered with the exact opposite. Not five minutes after leaving the house, the clouds emptied themselves over me and, with the additional help of the spray of other cars on the highway, soaked me through and through. When the dirty deed was accomplished, the rain stopped, as if its whole single purpose had been to teach me a lesson, and gave way to partially cloudy sunshine. The wind and sun thankfully helped dry my clothes on the remaining few kilometers to the dealership where we arrived half an hour later due to heavy traffic.

I parked Shoshy next to the side entrance, her odometer reading 4,299 kilometers more than when we had first met. She had been great with me, a fantastic mechanical companion that carried me through the splendors of South Africa and allowed me to discover so much. This trip would not have been this successful without her. I turned off the ignition and, with her last moment of wakefulness with me, thanked her and wished her a long life. My South African odyssey was now truly over; the remaining hours left on the territory a meaningless formality. My friend from Bara drove me to the Airport and a few hours later, I was in the air planning which movie I would watch and organizing my Christmas shopping strategies.

South Africa has scarred itself onto me, into me. A sometimes painful process, but as like a tattoo, a beautiful, everlasting, and symbolic branding of one’s life changing moments. The country, the people, the work, it was all what I hoped for and then some. An adventure perhaps fraught with risks such as needle-stick injuries, crime, or motorcycle accidents, but oh so worth it. Nothing is risk free. It is up to you to adequately discover yourself, discover who you are, what you are, and how you wish to live your life. No one is going to find out for you. And once you feel you have gained a certain self understanding, it will be easier to weigh the pros and cons of important decisions and figure out when the benefits outweigh the risks of enterprises deemed hazardous by others. I for one was ready to risk contracting HIV. The life is yours, the choice is yours. And if shit hits the fan, no bitching allowed, deal with it. South Africa was risky but phenomenal and often with things that can be bad for you like alcohol or women, they are wonderfully addictive, and if you chose right… phenomenal.

This is the end, beautiful friend.

Cheers folks,

TF

Monsters of music

Freedom of Speech - Liquid Tension Experiment

Friday morning last week saw the end of yet another twenty six hour call. Nowhere near as hectic as December first but enough to keep me busy all night. I was reminded how much I love ketamine with hyperactive children and how trauma medicine can be a bit like plumbing as I inserted plastic tubes in the same patient's subclavian vein, pleural space, trachea, stomach, and bladder. I came back home and went to bed only to wake up in mid-afternoon to make last minute preparations and ride out to Kwazulu Natal one last time.

I had made arrangements with Ed, the owner of the idyllic Inkosana lodge to stay one night at his lovely establishement and go to a Christmas concert the next day given by the Drakensberg Boys choir just one kilometer away. The weather was a bit more forgiving than last time I had ridden south out of JoBurg. I noticed at some point just before Harrismith, however, a large thunderstorm to the east. I could see the bright electrical explosions lighting up the clouds' entrails as if a formidable mythological battle was taking place. Everything in this conflict's path would suffer the fight's collateral damages and I was strongly hoping that I would not add to the victims' toll. Every time the road veered left I held my breath as the cloud grew bigger and darker from my perspective and I drew a sigh of relief when my trajectory turned right again.

As opposed to the last time I crossed into Kwazulu natal, instead of taking the smaller roads to get to the Royal Natal park, I stayed on the highway with the objective of arriving at Inkosana lodge before dark. But I lost my wager against time. Having woken up in late afternoon due to post-call recuperation and being in a mountainous region, night arrived faster than I had hoped for. I would not see the highway version of the breathtaking views I had first seen after crossing the Oliviershoek pass two weeks past. What I did see though, was just as appealing. The moonless night's dark veil was drawn over the mountain landscapes of Kwazulu Natal yes, but it also served as a canvas for the snaking procession of car lights, red and white, making their way along the valley under the glittering spotlights of stars undimmed  by the absented glare of street lights. Thankfully still on my left, the ongoing meteorological battle raged on despite the peaceful spectacle around it. It was beautiful.

I finally got off the highway at the Winterton exit and began conquering the few remaining kilometers of secondary roads separating me from a warm bed. Some stretch of tarmac made boring, thought I,  by the extra precautions of driving at night and by the frustratingly invisible sights that might border it and I would thus miss. While I did operate in these conditions, it was nevertheless a stretch which I will remember fondly. Shortly after coming off the highway as I was saying, the secondary road quickly turned to dirt. Hard-packed with a little gravel and a few rocky obstacles and potholes, the road had just enough technicality to keep me entertained in a relative comfort zone of safety.

Not much of an earthly spectacle to behold, hidden away by the late hour's aforementioned cloak, but the heavens danced away in celestial beauty, each star teasingly winking at my concentrated off-roading self. Their visual siren's song eventually became unbearable to ignore any longer and I was forced to stop on the side of the road, look up, and do nothing else. The now distant storm, no longer menacing my journey, had not lost any of its vigor. But instead of seeing a colossal conflict, all I saw now were flashes of light from an imaginary photographer, shooting away at the splendors hanging above both of us. I recognized the southern cross, adorning many flags of nations in the Southern Hemisphere, and was even lucky enough to witness a few shooting stars. I stayed there, motionless, laid back with my feet up on Shoshy's handlebars, looking up at the show, waiting for my riding thirst to manifest itself. It took twenty minutes.

I was welcomed to Inkosana by Ed's three white German shepherds and his familiar grin. I quickly fixed myself some dinner to quiet the growing rumblings of an empty stomach and savored the fruits of my labor while enjoying the literary sustenance of my present read: Le Comte de Monte Cristo. After a quick chat with the other guests benefiting from Inkosana's simple delights of nature and tranquillity, I fell asleep with the feeling of being at home. "A belonging" would be an overstatement, but the welcoming atmosphere and the breathtaking landscapes of the area resonate more with me than the high fences and the malls of Johannesburg.

I woke up to an immaculate sky with no clouds in sight - no evidence of the previous night's show - and to the west, the Drakensberg's outline encroaching on nature's blue ceiling. While I ate my breakfast in view of this setting, I made a simple plan of today's activities: ride, concert, ride.

With a little less than four hours to spare,  I set off south with Giant's castle national park as my approximate objective. The morning's beautiful weather had stretched the limits of visibility and all around me, the South African expanse offered itself in a dizzying array of wonders. I had initially come to the rainbow nation with the hopes of raking up the off road miles, but I was also beginning to appreciate discovering the little villages lost in the middle of nowhere. Placing particular care in avoiding the common, more easily travelled roads, the towns I crossed had seldom seen strangers and I felt privileged to witness a simple glimpse of their dwellers' life. My strange one-man convoy was often met with puzzled looks at first which then turned to pretty smiles soon after. Nowhere else was this succession of contrasted expressions more striking than in children. Smiling, waving, running after me sometimes. One particular child thought one hand waving not to be adequate, and he greeted my visit with flailing of all limbs and a smile to make any mother jealous. To all these acts of kindness, the best I could return the favor with was to wave back and smile a hidden grin under my helmet, my benefactors unknowing of the warmth they kept providing my heart with.

Approaching Giants Castle, I entered a valley leading me straightwards to the national park. it was covered in a thick green coat of grass, the hills thankfully deforming the road into a soft slalom while a small stream meandered along the valley's floor. I imagined that Scotland perhaps looked similar and lost my mind to a daydreamed tour of Scottish distilleries before finally coming to and arriving at the park's gate.

The park ranger welcomed me and complimented me on Shoshy. we enjoyed a quick chat during which we shared our different views of winter: his dislike and my adoration. just next to the gate was a lonely gas pump simply protected by a thatched roof; a very strong contender for the title of favorite gas station from the long list I have accumulated over the years. The first place had thus far been held by a gas station in North Carolina at the eastern end of the tail of the dragon (an 11 miles stretch of road nicknamed thusly for its 318 turns and famous amongst motorcyclists) which offered 110 octane gas.

The scenery had been gorgeous, Mother Earth adorning her best dress that day, but I had a concert to catch and there was no way I was going to miss that concert. Upon my return to the lodge, a light lunch was all I needed before taking off again with Ed this time who had decided to buy himself a ticket when I first manifested interest two weeks ago.

The concert hall had been decorated with Christmas ornaments and the young chorists-turned ushers showed us to our seats in their incredibly kitsch outfits. But music was not originally intended for the visually minded and I accepted this unfortunate fashion decision provided their performance would make me later ignore it. The lights dimmed, the audience hushed, and the boys, holding lit candles, made their entry not from backstage but from the entrances we ourselves had just used, installing themselves along the aisles leading to the stage. The conductor flicked his wrists and it started.

From these tiny little creatures emanated a sound so soft, so smooth, so pure  but powerful and full of purpose that it caught me completely off guard, annihilating whatever apprehensions I may have had and swiftly placing me under their charming spell. My father often refers to choirs like these, such as King's college in England, as little monsters both because they are formed by young boys and because their musicianship is so extraordinary that they will perform a piece in a way more perfect than the composer had imagined it. Monsters of music. It was so beautiful that my senses did not know what to make of it, like a child being given all the toys in the world. It is an overload, one which we are sadly unaccustomed to. I have difficultly describing the indescribable. Years of concert going, composing, playing, music classes in university, and perhaps good genes as well have given me a decent set of ears roughly capable of distinguishing the good from the better. And this was phenomenal.

Like slowly sipping through a glass of a rare single malt, or being taken aback by one of nature's landscaping masterpieces, moments like these stand out on their own in the movie of one's life. And the beauty of it is in their subjectivity. What I describe as bearings of bliss in my path through life could easily be detours avoided at all costs by another. And that is fine. It only makes these moments personal as partially defining of your identity. The difficulty lies in surrounding yourself with people you can share these moments with because while such displays of beauty are fantastic, deep human connection trumps them all.

Like all proper Christmas concerts, it was full of good cheer. It featured a mix and matched collection of classical Christmas chants, their modern counterparts as well as Afrikaans and tribal African songs many of which featured the boys on drums, xylophones, and other instruments. Some more traditional songs had the crowd join in and I was very glad to offer my vocal contribution. One particular rendition of a Russian piece describing the fascination of children on the first snow of winter had the boys take part in a make believe snow fight while the conductor hid under his score... Until he was ultimately hit by a stray snowball and viciously retaliated by stuffing snow down his pupils' imaginary coats.

Coming back down to Earth with the concert's inevitable ending, Ed quickly drove back to the lodge as he had many things to prepare before welcoming people to an exhibit of his paintings he had organized that night. I hung around for a short bit and later began the quick hike back to the lodge. Not ten meters after passing the front gate that a small car pulled over in front of me. In it, two girls, one German, the other Swedish, both attractive university students that had noticed me at the lodge and the concert and were offering me a lift: I could not say no... Out of politeness of course. After enjoying their company a short while, I reluctantly decided it was time for me to go back to Johannesburg.

Another great weekend in South Africa,
TF

PS: Im already home!!

JoBurg Livin'

While the first half of my South African odyssey was rich in discoveries and motorcycle adventures. I have come here to practice medicine and this is quite exactly that which has taken most of my time lately. With the submission of CaRMS on November 2, I now had the freedom to take up more call shifts and get to witness first hand what I had come to experience. I thus had less time to get out of town but this limitation lent itself to open the opportunity of JoBurg exploring.

I have already shared my wild animal sightings on my frequent jogs to neighboring Klipriviersberg nature reserve. I have also spoken about having lunch in Soweto and having a guitar voice duo make me completely forget about hunger. I have spoken about the braai with medical students from six different countries, and life here I'm general. I have not however spoken about visiting the apartheid museum, having lunch at Chaf Pozi, a restaurant in the shade of the Orlando towers in Soweto, and an unforgettable drinking night in Greenside.

Outlands – Daft Punk

Johannesburg does not have a Louvre, a Hermitage, nor a Prado but it does not have to blush in embarrassment for it doth have the Apartheid museum. While many countries had used segregation as “only” a social line of conduct, South Africa went as far as legalizing it; that it was law that a white man was superior to all other races. Some bad tongues would say that the early Afrikaans settlers which migrated from Cape Town towards the East and the interior, having only a bible as reading material, created a narrow minded society… But there is obviously more than just blaming religion to the origin of one of the world’s most reprehensible political systems in modern history. In the late XIX^th century, gold was found in the area of today’s Johannesburg. So much of it was found that the following gold rush had the city grow exponentially, producing close to a quarter of the world’s gold in the early XX^th century. Many laws in the first half of the XX^th century were enacted – following already entrenched societal rules – to keep the rapidly growing black and immigrating Asian/Indian populations from gaining power and to physically separate racial groups keeping the white race “pure”, culminating in the establishment of full out legalized segregation in 1948: Apartheid… as far as I understood and can explain this complex history in a few lines.

Once my ticket purchased, I walked towards the entrance, or rather entrances: one for “blankes”, one for “nie blankes” – your “race” determined by a random selection inscribed on the back of your ticket. I had not paid attention to my ticket and being subjected to this reality took me by surprise. For a brief moment, my automatic reaction was “I hope I’m white” which I initially thought was a funny thing to think. But it was a very powerful realization. It was fear. Fear that I could be treated in a different way even if it was in a pretended scenario. That in the span of one second, in the safe, consequence-less confines of a museum, the possibility of a double standard made me instinctly uncomfortable. Now try that for a lifetime.

  

Your race was not only determined by your skin, but by your language, where you live, the race of your parents, your culture, etc… A completely man-made classification to suit the whites’ agenda to maintain control based on a completely artificial reasoning. A person’s identity – and written as such in their identification documents – was determined by another’s false vision of the world. On top of being a second class citizen which alone is maddeningly infuriating, your identity did not even belong to you; hard to imagine something more frustrating.

The visit is obviously a sad and somber one, but it ends beautifully with the birth of a new democracy, with a story that restores our faith in humanity and what open mindedness, empathy, and hope can accomplish. South Africa’s transition did not come to pass without setbacks and the road ahead is not without its share of challenges. But there is a road. Its encouraging destination in the eyes of an entire population traveling it side by side, the rear-view mirror only confirming and encouraging them to keep going forward.

Give it Away – Red Hot Chili Peppers

Everyday for lunch, we usually go out. Food being so cheap, the cafeteria so bland, and time so scarce to prepare lunches that going out is the natural answer to this situation. One of my favorite destinations is Chaf Pozi, a restaurant found just between the two massive painted Orlando towers a five minute drive from Bara. It is a place that only does one thing and it does it fantastically well: braai. Braai is the Afrikaans term for barbecue and Chaf Pozi one of its best ambassadors. Despite the name of its cuisine however, the majority of its clientele primarily speaks Zulu because this is Soweto after all. There is no menu, only two counters: food and drinks. And food here really means meat. T-bone steaks, chicken drumsticks, pork chops, chucks, lamb chops, boerewors (sausages) etc… Side dishes include pap, a maize based mashed-potato substitute, as well as chakalaka, a spicy carrot-bean dish.

Chaf Pozi is well known to the students at Bara and their frequent visits over the years have granted us the favors of the owner and generous portions. But aside from the delicious food and the amazing service, the ambiance is probably what I appreciate the most. The place is full on any day of the week with music guiding the digestive dance of its replenished guests. This was no metaphor: people actually dance. At lunch. On a weekday. And once, to the amusement of the crowd and to the hilarity of my colleagues, so did I. I am usually easy to pick out from a crowd, but being the only white dancer both in appearance and technique… I stood out. I made such an impression that I was asked to dance again by a few people whose wishes I was only too happy to grant.

Sabra Cadabra – Metallica

It was a Tuesday evening. On a short back and forth Facebook messaging exchange, I asked Kevin, a fellow Canuck also doing a trauma elective, if he wanted to go for an easy, simple, casual drink. Thinking it to be a good idea, we shared our plan with others and met at Gin, a bar in Greenside, an area in the North West of Johannesburg. Rounding up our duo were Kiwi Kevin from New Zealand, Pascal from Switzerland, and Jeff from Ottawa. It was student night. Beers were ten Rand each… roughly one dollar. There was a beer pong table. It was a good night.

We started around 8 PM in an almost empty bar and began playing beer pong with the few other patrons present. After a few games, the place quickly filled up and we decided to change things up a bit. Memory fails me, but the blurry bits I do remember had Jeff organize a first game of flip cup against a random set of people we gently forced to join us. We made a ruckus both singing the “Oleeee ole ole ole” Habs song cheering for the onset of drinking hostilities and celebrating our flawless victory at the game’s triumphant conclusion. The entire bar noticed. And there were many, many, many more games played highlighted with plentiful high fives, random stranger hugs, and general good cheer.

At one of our frequent bathroom pit stops, Kiwi Kevin found an ID card by chance belonging to a good looking brunette. In a fantastic example of inebriated disinhibition, we exploited this fortuitous discovery by meeting every single brunette in the bar… and their non-brunette friends. In another good example of inebriated disinhibition, I enjoyed a flirtatious exchange with a lonely cougar on the prowl. I forget how the conversation ended but I did not get slapped despite my best efforts. After a countless number of beers and flip cup victories, I left the bar with Pascal around 2 AM leaving both Kevins and Jeff behind. Pascal, with Swiss exactitude, was the only one to show up on time for work that morning. A few days ago, the two Kevins and Jeff came back to the same bar: they were greeted like rockstars. It was a good night.

Cheers folks

TF

Pay Day

Last Saturday was December 1^st; a time that normally marks the coming of Christmas and the holiday season. A wake up call for people to seriously think about the presents they will buy, the family dinners to organize, final exams for some, or putting on winter tires for others. Shopping centers all across the world have already dawned their glittering holiday attire and Johannesburg is no exception. What marked this December 1^st for me apart from the lack of snow and the summer temperatures was the unfortunate coincidental meeting of a weekend with the end of the month.

Weekends are usually busier for the trauma unit. No work: people go out, people drink, people fight, and people end up with a knife blade or a bullet where it should not be. This happens fifty one times per year and does not surprise anyone at Bara. The reality here is obviously different and these are the kinds of horrors we have to deal with. Some weekends are different though, even for Bara, and last weekend was just that. The end of the month is when people here get paid. Combine a weekend with a pay day and you have a perfect storm with a payload so hard to cope with that even a three thousand bed megahospital like Bara had to divert ambulances coming in with critical patients to other hospitals for several hours.

As I previously mentioned in another post, I would rather describe an experience than specific cases. I feel like this transcendence is more appropriate in order to share my “world”. Here is what I went through on my twenty six hour shift on December 1^st.

The Dirge for November – Opeth

Morning rounds (going over each new ward admission from overnight) start at seven. I asked the call team how their night had been: “Not too bad considering it’s pay day weekend: a couple stab chests, stab necks, only one gunshot wound, no deaths… pretty quiet. Lots of lacerations though.”

Once the rounds and the ward work were over, the previous day’s team went home to sleep and I headed over to the resuscitation area.  On my short walk there, I could not help but draw a parallel with my experience in Inuit communities in the Arctic exactly a year ago. It was a Saturday night in a tiny little village called Salluit: a drunk teenage girl had been assaulted by her drunk teenage cousin with a piece of broken glass. I was a fairly green medical student back then and after having stitched the girl’s eyebrow, I turned to one of the nurses in disbelief looking for some answer that might make me regain my use of speech. “This is what happens on weekends here”. Now with an extra year of clinical experience under my belt, I still had an uneasy feeling about what I was going to see: that creepy calm before the storm.    

It was not as chaotic as I thought it would be in the end. Or perhaps, I did not react as chaotically as I thought I would. I had prepared myself mentally and emotionally to the dreadful things I was going to see in South Africa and it was a matter of applying this frame of mind. It is a difficult balancing act; that of careful, competent, calculating callousness with caring concerned compassion.  A robot makes a terrible doctor, but so would a drama queen. One has to be both unphased by the human drama unfolding before him and caring enough to have patients feel “safe” in your hands. Yes, it is a difficult balancing act, but oh so important; like looking straight into someone’s eyes while he exsanguinates and telling him “We’ll take care of you, Baba (term for adult males). We’ll do our best”. With this, the patient may feel reassured. With this, his heart rate may slow down, decreasing the rate at which he is losing blood. It may buy you a few more minutes, the time it takes to run to the blood bank, snatch a few units and run back. Everything matters.  No, I did not react as chaotically as I thought I would.

Time is an additional vital sign here. The raggedy shredded bodies accumulate waiting to see a doctor hours and hours after initially getting injured. If a patient is still alive hours after getting assaulted, time crudely confirmed the patient’s stability. Many wait so long while their blood thickly cakes on their faces and clothes because the emergency response teams are oversaturated or because they were unconscious either from head trauma or from simply being drunk – a lot of them drunker than I have ever been despite my best attempts during my rugby days.

Medicine is practised differently here, partly because of the sheer volume of patients that require treatment and partly because of the physical capacity for such treatments. In Montreal, lacerations are superficial cuts that require a few stitches. The lacerations at Bara are fleshy trenches requiring multi-layered stitches (once the bleeding has stopped of course), and further investigations to identify possible arterial or bony damages.  In the best of worlds, these would be addressed in an operating theater but since ours are overflowing with more critical patients on such nights, we repair them in the pit (the ambulatory trauma department). This often includes hands and faces which are the sacrosanct domains of plastic surgery back home. The concept of an emergency is also different. I learned in shock that a lacerated facial nerve is not the latter.

This brings me to preach about my values on practising medicine in foreign countries. This trauma elective is a fantastic learning experience but I did not come here to play doctor and practice procedures that I am not qualified to do. I sought additional training at personal cost to prepare for this. These people are not Guinea pigs and they should not be subjected to a lower standard of medical care. Primum non nocere. One obviously has to bend the rules when it is physically impossible to comply with them, like trying to do a sterile procedure with no sterile gloves, but they are nevertheless a standard to continuously aspire to. In the converse situation, you are nothing less than an asshole and a failure as a professional.

What a Wonderful World – Louis Armstrong

I remained calm throughout my shift but I was angry. So very angry. A disguised anger behind the double mask I just described, but I was nevertheless boiling inside. I had described the trauma victims of armed aggression in a previous post as having been subjected to a labor of hate. But part of the complex truth behind the trauma epidemic in Soweto is not solely explained by hate. Hate alone could not cause so much destruction. It is indifference which I painfully learned to blame. Some people just do not care and the frighteningly primitive responses to a vast array of life challenges seem to funnel down to the bark of a gun, the flash of a blade, or worse… A “tire necklace” or a “Goodyear special” is when a poor soul is restrained with a gas-filled tire around his chest and arms and is then lit on fire. People also get dragged under cars in a premeditated way. The weight of human life does not factor in the equation and it violates my belief system so harshly that I was filled with anger. A calm silent anger behind the focus of my work, but intense and burning deep.

And it goes on. You may have just witnessed the worst thing in your life but there is no time to process, to breathe, as there are other patients to see. One minute you are performing chest compressions on a person with a stabbed heart, his warm crimson life pouring out of his wound and onto your hands, inside your gloves with each compression, the next minute, you are inserting a chest drain into someone else.

By day break, the new team arrived to relieve us. While I remained vigilant throughout the night, I had difficulty staying awake during morning ward rounds. The type of fatigue that sees you rewrite orders five times because they are illegible, and no my notoriously bad handwriting had nothing to do with it.   I got home safely and crashed in my surprisingly inviting tiny single bed.

This was quite a test – physically, mentally, emotionally, and professionally – but one which I am glad to have passed according to my personal standards. Medical students fight endlessly with doubt on their unsteady road to learn the incredibly complex and vast art of medicine. Earlier this week, the smile of a patient I first assessed on December 1^st reassured me and confirmed that my time and efforts will make me a competent emergency physician. He had four holes in his heart.

The road is long, the cost is high, but I was built for this.

The woods are lovely, dark and deep,

But I have promises to keep,

And miles to go before I sleep,

And miles to go before I sleep.

-    Robert Frost

Yours truly,

TF

Day to day

Come Fly with Me – Frank Sinatra

On this rainy Sunday evening, having passed my South African experience’s halfway mark, I would like to reflect on the day to day minutia that we often omit to mention but that end up greatly contributing to the spirit of a travelling experience. I remember each of my past travels as having a certain vibe to them, and this is what I would like to portray.

Johannesburg is notorious for its sadly rampant crime situation and this can be felt in everyday life. In residential neighbourhoods, all houses are little fortresses protected by high walls sometimes topped with an additional electrical fence. The doors and windows each have a sturdy metal grid protecting the house with another layer of security. And of course, there is an alarm system. Despite violence being more common in such areas, houses in the townships are not as bubble wrapped as in the wealthier neighbourhoods. Perhaps because people there have less to lose, perhaps because they simply cannot afford such measures, but I also suspect that fear is proportional to income and people who have no daily exposure to the harsh JoBurg realities end up overexaggerating them. Yes, Johannesburg is a very violent city but it is not a post-apocalyptic decrepit capital of lawlessness. Yes people get stabbed and shot on an almost daily basis, but it is still possible to take a walk outside and avoid death. From the household security systems to the gated malls and their security guards, many things in JoBurg remind you of the criminal reality this city faces but it is important that one keeps their impression just at that: reality.

Speaking of malls, they are as numerous as they are huge and the great majority of them feel relatively new. The end of apartheid signified that close to eighty-five percent of the population was technically now on an equal playing field of opportunities with the other fifteen. Despite a flagrant educational disadvantage, many blacks have joined the ranks of the middle class; this and the lifted punitive international financial measures have dawned a new era of consumerism in South Africa as symbolically represented by their shopping malls. The Maponya mall in Soweto (Soweto!) is bigger and more modern than anything I have seen in Montreal.

The cost of living is quite nice on the wallet. One can get away with a good meal at a restaurant for a little less than ten Canadian dollars including drinks. Gas however roughly compares to North American prices and toll highways can be pricey.

Braai’s, or charcoal/wood barbecues, are a staple of South African cooking. Many houses are equipped with braai facilities in their garden and since my house is no exception, I organized one last week with students from Bara. We were seven, representing six different countries (USA, Sweden, New Zealand, Australia, Switzerland, and Canada). It was great to be able to exchange our different medical views and experiences in the warmth of the fire. On a food note, we cooked mostly meats and I used the lemons from the tree in the garden to make lemonade.

Weather wise, as I have already explained in previous posts, Johannesburg sits just shy of two thousand meters above sea level on the South African Highveld. Therefore, the nights are cold and the days are hot with the occasional evening rains. Because of the altitude, white skinned people such as myself burn even faster than usual as I unfortunately learned on my first week: an unfortunate lesson in the form of a farmer burn.

I knew before coming here that singing is engrained in the South African fabric. What I did not know however was how easy it would be to witness it. Sisters in each ward at Bara sing together at every shift change. Everyone with spot-on pitch, everyone with spot-on rhythm, and every song with a two to three voice harmony. While many of my colleagues do appreciate the sonic beauty displayed by the sisters they do not quite understand why my head damn well nearly explodes everytime I listen to such an incredible delight. At lunch in a small restaurant in Soweto with three friends from Bara, a guitar and voice duo came to serenade us while we ate. The woman’s voice was like butter: so smooth, so rich. We could have just sat there listening to her, forgetting our worries, four medical students getting lullabied into pleasant submission. I can not wait for the Drakies’ concert next Saturday!  

Cheers folks

TF