Sometimes I feel like I am living my life in slow motion, in reverse procession. I could be doing a random act and thoughts from 5 years ago surface. I brush it off as a random memory but quickly feel depth in it. It means something.

I guess you can’t process your life if you’re constantly in survival mode. Your goal is to survive, everything else is a distraction. Once you’re safely over the speed hump that is 5 years long (hi medicine), the not-so-great wall of China you’ve built around yourself is let down slowly. Brick by brick, you allow yourself to actually acknowledge how you felt 5 years ago and what lessons you subconsciously carry.

I made a personal decision long ago to try not to be a person that focuses on the negative in the medical world. It’s too vast and too consuming. It doesn’t end. And it’s been one of the most difficult things to do. Fact is, the negative has more of a hold on us than the positives do. Pain is more intense than pleasure. Trauma stings more than happiness soothes.

In psychology, positive-negative asymmetry or negativity bias means that we feel the lash of rebuke more powerfully than we feel the joy of praise. This phenomenon explains why the 40% bad we go through can easily trump and overshadow the good 60%.

Anyway, this thought may or may not be relevant to the story.

The story I have starts with me as an intern, the very beginning of my medical life. I drove a Toyota yaris, I slept peacefully, I was annoyingly inquisitive,  vigorous and mostly awake, I thought burn-out was a reference to Indian boys drag racing, I could stay awake far past midnight, my caffeine receptors were brand new, I did not have any bald spots and my metabolism was intact.

I was on call for a 30 hour shift and I was generally happy to be there. Most things were new and exciting. I remember thinking how supernatural it was that my signature could allow human blood to be dispensed from a blood bank. How I could order Xrays and prescribe IVI medication without question. I was not bound by the shackles of responsibility. It was great while it lasted.

The hospital I worked at was generally well run. The departments had a good balance between practicality and support. I was learning alot and felt like I was growing as a person and junior doctor.

Prof was a great guy. He had a thick accent that just made everything he said sound more profound. When he spoke, everyone would listen. Including the patients. He had a way of talking and teaching. I remember being on a post intake ward round with him, the registrar asked a question and Prof replied in detail. Soon after, we heard a squeak from behind the crowd. The patient with a panga-injury to the face had asked which is better, nylon or silk? Everyone was shocked.

The call progressed as calls do, in chaos and fluster. My feet burned as I made my way up and down the stairs. I always made it a point to carry snacks because I knew first hand what Hypoglycemia could do. In my mind, i could drop down and have a seizure the moment i felt hunger pangs. I felt the weight of the banana in my scrub pocket and I reminded myself to eat it soon.

I went to casualties to examine a patient with suspected bowel obstruction and did the needful before calling my registrar. I placed the phone to my ear and stared at the massively distended abdomen. I barely touched and she flinched in agony. Definitely a surgical issue cooking. I needed the go ahead from my senior to discuss the case with the anesthetic registrar.

Voicemail. I knew he was busy in ICU and didn’t want to disturb him telephonically. I grabbed the file and made my way up. I peeped into ICU, I didn’t see his back. I saw an empty CVP trolley and knew he could not be far.

I pushed the doctors room open, file in hand, and paused. First I thought he had fallen and sustained a fracture. After all,He was curled up in a ball on the floor, in excruciating agony. His scream echoed through the bathroom. I did as I was taught and did a primary survery, I asked questions at the same time but didn’t listen to the answers. I was panicked.

“I think my appendix ruptured”.

What. “Are you sure it’s not gas?” I reflexly blurted out.

He stared at me through gritted teeth.

Now I was sweating too. He knows more about appendices than anyone. He has taken them out 1000 times and knows precisely what a ruptured one is. If he said his appendix is ruptured, it’s ruptured.

He directed me to call a sister with Voltaren IMI. He shuffled to the bed and rolled over slowly, still clutching his quadrants.

He directed me, between screams of pain, to get materials to put up an IV line. Pretty soon, he was on the phone with his wife, organizing an ambulance to fetch him in the hospital.

I did as I was told. The thought of pricking my senior registrar was daunting. What if he has bad veins. What if the drip tissues. What if I had to poke more than once. The only thing that consoled me, was he was in far more pain so a little prick wouldn’t attract much of his attention.

I tourniquet his arm and started the routine drip slap, in search of bouncy veins. Ofcourse It was a struggle and he could see. “Go here” he pointed to his cubital Fossa. I couldn’t see a blue tinge but I could feel a bouncy vessel. I tapped x10, trying to expel my nervousness. I poked. Nothing. I pulled back. Nothing. I waited. Nothing. I advanced. Nothing.

He pulled his arm aside, clutching his abdomen again, and the jelco advanced by a mm and I saw flashback. What luck.

He wasn’t observant, he was in too much pain. He tossed his phone toward me and asked me to call Prof.

I had forgotten that the call must infact go on. I had forgotten that there lay a patient with bowel obstruction in casualties and had to operated on. I knew the registrars had an indisposition roster so someone would come in to cover. Prof would know what to do.

The phone rang and prof answered quickly. The registrar said a few painful words and prof understood.

Silence.

“There’s no indisposition for tonight”.

He said something along the lines of every single night had an indispostion cover except today. He asked about pending cases and the registrar said none. I listened.

Then it hit me.

“Wait! There’s a patient in casualties with what seems like a bowel obstruction that needs surgery” I said.

The registrar looked at me.

“Why didn’t you tell me?!”

Er. Because your appendix was rupturing? I apologized.

Prof interrupted him quickly and said no problem, he would be here shortly to operate. I should get the patient to theatre and get the registrar out.

The private ambulance had arrived quickly and loaded the registrar onto the stretcher. The sister joked about inserting a catheter and NGT and only the paramedic laughed.

I was scared.
Prof was coming.
I had a patient to mobilize to theatre.
I had to operate with Prof.
My registrar was going to his own surgery.
It was just me on the floor for now.

Pretty soon, our case was being summoned to theatre and Prof had magically appeared. It was strange to see Prof here at night. Consultants come in when things are dire. Were things dire? I didn’t know yet but I had my suspicions.

He smiled at me and gave me a pat on my back. He asked me what my first name was.

“Great Sabrina, tonight it’s me and you to conquer this surgery! I need expert retraction from you. Do good!”

I went with it. I was still extremely nervous because I knew I had the entire night to go and anything could happen. My mouth was dry.

The surgery started off smoothly and Prof was a mastermind. He knew his way around an abdomen, no matter how disfigured it was by obstruction. The fecal matter poured out like the river Nile. Prof grabbed the dead bowel and held it toward the light.

“This piece of dead gut. Be gone!” He threw it into the histopath tray.

He sniffed the air behind his mask and visor.

“It smells like a rotten banana!” He testified.

It took me a minute to register that it was not the bowel with a banana smell, but my pocket contents. I stared into the abdomen. I forgot about my banana in my pocket and now it’s mushy, brown, and rotting.

Prof moved my hands away to being closing the abdomen. I was still shocked.

“Sabrina! , why are you so pale?!”

Er no prof, nothing. I shuffled to avoid squishing the banana more.

His thoughts were interrupted by my cellphone ringing. Once. Twice. Thrice.

The anaethetist was kind enough to fiddle and answer my phone. I remembered my registrar and his burst appendix. I was the first port of call now.

” Hmm.. she whispered… okay… hold on.
She peeped over. Casualties has a stabbed chest. They think it’s the heart. They’re doing chest compressions and want a surgical opinion….”

“Whaaat. A stabbed heart on a Tuesday. Interesting. Also do they want the surgical opinion on the atabbed heart or the chest compressions?” Prof carried on suturing and thinking. .

“OK. We are almost done here. Sabrina, I need you to unscrub and go down to help in casualties. I will close up and be behind you! Now go Sabrina!”

Prof could see I was scared. What did I know about giving an opinion on stabbed hearts? I was terrified. What would I go there and do? Does the knife stay in the chest whilst doing CPR? what if you accidentally push the knife in deeper? I had so many questions but asked none.

He saw my fear and fatigue. He pulled the last closing stitch on the bowel and looked at me, still holding it tight.

“Sabrina. I know you are fearful and that is okay. You need not worry because I am behind you. We will handle whatever may come to this hospital and the night will eventually end. Already, you have saved 2 lives. The life of your registrar and the life of your patient. You already have a 200% success rate. Trust yourself. Now go!”.

I unscrubbed on the way and ran downstairs. Profs small pep talk gave me courage. I knew the fear was real but so were his words. If Prof could trust me, I could trust me.

His words made a difference.

I got to casualties to a flock of doctors busy resucitating. Someone handed me a chest drain and directed me to the right side.

My hands trembled with the forceps in its grip. I felt the drain slide in the pleural cavity. I tried to filter the outside noise while I concentrated on the steps and securing of the chest drain. My sutures seemed tacky and out of place. I could feel the drain slipping out.

I heard Profs voice from afar and looked up. He joined me and directed me calmly. ” throw your suture the otherway. Look, that doesn’t look like a pursed-string”. I eventually got it right while he directed me.

The Resuscitation went on for another hour but long story short, unfortunately the patient demised.

We sat at the admin table and looked at the beds filling up with new patients. Prof looked tired and post-call already.

He muttered something about the entire town smelling like a rotten banana, being too old for this and how I was Sabrina the teenage witch.

I laughed quietly.

I quickly cleaned out my pockets and found the dead banana. Ripe and black. Mushy and slimey. I decanted it into the bin and poured alcohol into my pocket.

Prof spent the rest of the night examining abdomen in casualties with me.

I will always remember him by his words and the sheer courage it gave me in a scary situation.