Margot at lake Sibaya The pathology here and incredible cases never cease. What does cease, or perhaps mellows, is ones tolerance of what is going on and what one sees. Kaposi’s sarcoma, a rare cancer but common with AIDS, used to have me reaching for my camera every time, but now it is yet another of the horrific complications that we have on our ward every week. The sight of a psychotic patient, stark naked and screaming past the ward, grabbing bags and emptying them out on the ground, initially would have startled me, but now gets a grunt and an order for haloperidol and lorazepam. The call to the ward for the ‘gasping’ patient used to induce a sprint from our Park home up to the wards, but now the futility of it all is so obvious and the gasping AIDS patient is probably being released from his torment and suffering. This may sound callous but is necessary to ensure personal survival and one does ones best. Post Caesar bliss! Another psychotic patient that springs to mind started off as a trauma patient and appeared to be waiting quietly for an x-ray of his obviously broken lower leg. A frantic call to the x-ray department revealed a very agitated middle aged gent trying to walk on bilateral fractured tib-fibs. Now this takes some doing and certainly made him sweat. It appears that he had some sort of spiritual experience that encouraged him to leap from a moving vehicle and cause his injuries. We had a big battle with him and getting a needle near him was no small task. I have memories of grappling with him on the floor tugging at his broken leg (which did serve to get it into a fine position!) while he screamed out to the waiting room “Mlungu mena bulela!” (the white man is trying to kill me!) This did have the added benefit of emptying out the waiting room. Some very kind Orthopaedic surgeon accepted him for further management, poor chap! Then there was the 18yo lad who was apparently evading the constabulary. In his haste he was impaled on a branch of some sort and managed to disembowel himself. He was amazingly quite well but was a sorry site with multiple abdominal wounds and his stomach hanging out limply. I was very proud of my general anaesthetic while Dawie did a sterling job at replacing his gut and suturing up all the holes. I discharged him from my ward 2 days later. Bikes and the truck off to Swaziland The Obstetric catastrophes never fail to impress me. Not much is meant to scare Emergency Medicine specialists but O&G stuff gives me the heebies. I think that I have had to manage a fair number of the recognized Obstetric emergencies but last Friday I had my first prolapsed cord. This is where the umbilical cord slips down the birth canal before the head. Obviously if it is compressed then it is game over for the baby. An astute midwife had made the diagnosis and she had mum in the knee-chest position and had her hand firmly up the vagina keeping the head off the cord. My colleague scrubbed for the Caesar and I got drugs ready, rolled mum onto her back and with that wonder drug Ketamine slipped her off to sleep. A very slick Caesar and a healthy boy was born. Some opiates, a bit of local to the wound and mum was happy too….no fuss! In fact we did 2 other Caesars under Ketamine last week; one a stroppy teenager who wasn’t interested in a spinal and another in whom the spinal had failed. What a drug…. A couple of Fridays back I did the flying clinics. This involves climbing into a tiny 4-seater and bouncing down the runway literally in front of our house. In fact the kids waved from the front door! It is a beautiful flight over Lake Sibaya and we were lucky to see a few Hippo down below wallowing in the clear blue water. The landing at the first clinic was character building and the pilot had a knack for avoiding mole hills, sand drifts and cow shit. I felt a little seedy as I started my clinic. That was tame compared to the next hop. My plan to eat my lunch between clinics was rapidly put on hold and the approach was hairy to say the least. The pilot said that he had been asking the electricity corporation to move the wire for ages and apologized for the fact that we had to leap frog this wire before plunging down to the runway and bringing us to a halt in front of the clinic. Let me do a Caesar any day! The flight home was relatively mild and a strong tailwind got us back in record time. A swollen finger .This was good because I was on call for the week-end and sadly my first case was one of two rape cases I was to deal with over the week-end. These are miserable cases to deal with, for the poor victim mainly, and the fact that they take about an hour of painstaking evidence collection. Apparently few of these cases ever result in a conviction but we are obliged to go through the motions. More importantly here is sorting out post coital contraception and HIV prophylaxis, which is a months worth of nausea and vomit inducing medication. Friday didn’t get any better and a few car crashes kept me busy. The worst off was a young woman who had been thrown from a bakkie. She was barely conscious and there was a boggy swelling over her occipit. Blood trickled from her right ear and that was enough for me to transfer her urgently to our base hospital for neurosurgical intervention. Anyway, enough gore. We have also had a lot of fun lately. A steady stream of visitors has ensured lots of activity and we have had a number of great trips away. I attended the Rural Doctors conference in Swaziland and Ilda and the girls came along too. We stayed in a fabulous game park called Milwane and had fun riding horses, mt bikes and looking for game. Then we had a week-end in the Natal Midlands when Ilda had some down time and I went off with the girls. We did some more great riding but the trout fishing was not successful! Then last week-end we flew down to Cape Town to see my sister and Mum. Cape Town is always a blast and we had a cultural extravaganza visiting the Planetarium, Gardens, Kirstenbosch, Art gallery and even went to Mama Mia. There was lots of wining and dining, catching up with varsity mates, beautiful drives along the coast and walks on white beaches. This week-end we camped on Lake Jozini and came home via Mkuzi game reserve. So much fun that there are murmurings of extending the African experience…..