My Five Favourite Presentations

In the EC you see such a vast array of presentations. They can range from trauma to headache, to miscarriages, to appendicitis to overdoses. Some are easier to manage than others, and depending on your interests, some are much more enjoyable to manage than others. When I pick up a folder with any of the following written on the front I need to take a deep breath.

1. Any combination of hearing voices/aggressive/known psych patient: basically this equates to “this consultation will take forever”. Either the patient is so circumstantial that it takes them half an hour and eleven different stories to get to the point. Or they are so grandiose that they believe they are far too important to talk to you. (The other day a lady told me that she is Jacob Zuma’s personal nurse and I must let her know if she can assist me with anything. She even offered to see a few patients for me.) Either way, getting a history is a mission and that’s only half the battle. You then need to get hold of the psychiatrist, convince the patient to let you take their blood (a hazardous task), devise a plan to sedate them without their knowing (the nurses are very good at this, I advise recruiting them), and then fill in a Form 5 for involuntary admission. 45 minutes later you have admitted your patient to the psych ward and the nurses have added another 5 freshly triaged patients to your pile. 

2. Abdominal pain: a thousand and sixty two causes. A couple life threatening, the others not so much. Ultimately seeing a patient with abdominal pain means sifting through a good number of symptoms, trying to distinguish the drama queens from those truly in agony, and doing a vaginal examination or two, in attempt to find the cause, which is more often than not a urinary tract infection. Which, by the way, is not a good enough reason to visit an emergency center at 8 o’clock on a Saturday night. Another cause of abdominal pain that is a real winner is drug use, particularly tik. The other night a man came in clutching is stomach and rolling on the floor in the triage room. He looked like the tik type but denied using any drugs, but alas, his urine drug screen came back positive for, you guessed it, tik! When the sister informed him of this, his response was the greatest: He really doesn’t use tik, but his friends do and that’s why his urine test is positive. Um ya, I don’t think that’s how it works but okay!

3. Any kind of rash! Seriously, it’s extremely unlikely that a rash is ever going to be an emergency, and if it is you’ll know about it. And I really have no idea why you have this rash or what’s causing it. Just go get yourself some steroid ointment, it’s probably eczema anyway.

4. I’ve mentioned the next one in my previous post: “Hoes buie” or “Coughing a lot” which is usually accompanied by “fever”, “night sweats” and “loss of weight” aka TB. Reading this on a triage form destroys your soul a little bit and puts you one step closer to contracting TB yourself. In only four months, I’m pretty sure my lungs have accumulated a small army of TB bacilli, just waiting for the opportune moment to attack. South Africa is one of the TB capitals of the world, with almost 1000 per 100 000 people living with the disease, so that’s 1% of the population, or 529 000 people. And a large proportion of these people are situated in the Western Cape. My point is that we are all bound to be exposed to a TB filled cough every now and then, on a bus or in a shop, or in my case, at work. On a daily basis. Everyday. TB. Everywhere. 

5. And finally, the Weekend Special, assault. With a brick, or a panga, or a golf club or, like last night, a high heel shoe (I’m not even making this up!). Weapons come in many shapes and sizes it seems. I don’t mind having to put in a few stitches on a week night; it provides a nice distraction from the mundane coughs and colds, and it’s almost therapeutic. But by 2am on a Saturday night I just can’t anymore. This past weekend was quite a rough one. It seems like the whole of George was drunk and involved a massive street fight. Let’s just say that the staple gun and I became fast friends. In the early hours of Sunday morning one of the nurses and I sat side by side, each suturing seperate patients and the four of us had a long discussion about the pros and cons of going out on a Saturday night. One of the cons being that you risk ending up with 15 stitches in your arm (the number of stitches being directly proportional to how hard you party). Eventually, I concluded that it was better for everyone if we all just stayed at home on a Saturday night.

As you can see, picking up a file in EC is like a box of chocolates, you never know what you’re gonna get! Except I’ve never come across a chocolate that I don’t particularly want, except maybe chocolate covered raisins (who decided it was a good idea to cover raisins in chocolate?). So I can compare any of these five presentations to chocolate covered raisins, and anything else is a Lindt Ball in my books! 

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