‘No more pumpkins Gogo!’ and other small moments

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I was just trying to leave OPD (outpatients department) at the end of the day but one of the nurses from the ward had brought over an old Gogo for me to see (for those who haven’t met the Gogos before, this is a term of respectful endearment used for Grandmothers or older women in general. Once they reach that threshold ladies seem pleased to be referred to as ‘Gogo’). I had admitted her from clinic a few days ago with symptoms suggestive of a heart attack, so I knew her a little already. Getting an ECG requires a trip to hospital, and the blood test we use for heart damage is a ‘send away’ test so if you are suspicious enough then you have to treat the patient for 3 days while you wait for the result. Anyway she was looking spritely today and had been given the all clear. The current issue was a rather confusing history of recurrent shoulder dislocation but she looked happy as larry sat in front of me swinging her arms in all directions. What was the initial insult that caused this shoulder problem I asked? ‘It started when she swung a pumpkin onto her back with a towel’ translated the nurse. I couldn’t hold back my giggles – just imagining an old arthritic lady at home swinging pumpkins around the place. I wagged my finger in mock chastisement and declared ‘no more pumpkins Gogo!!!’ and we all laughed together as she bounced out of the department with a mischievous smile ‘no more pumpkins, remember!’.She was delighted to be discharged… I hope she sticks to butternut squash in future!

I know so far it sounds like it has all been venomous animals, bush knife wounds and glamorous ER-style medical emergencies. Of course, that stuff continues to happen and makes great pub stories, but I thought it was time to share a healthy sprinkling of the more mundane moments that we experience and enjoy to give you a fair balance. I am training to be a GP after all and much that I am doing here both draws on and adds to my GP training (even the tea is quite good). And some times, the small things and the moments of connection with patients on a very human level can be the best.

‘She says you are curing her, doctor’ interprets the nurse who is working with me in clinic this week. The 45 year old lady gives me a coy smile and my heart swells. Actually, I didn’t do very much, I just started her on fluoxetine (an antidepressant) and have been following her up quite closely since. Before I started GP training I was unsure about antidepressants, but I have witnessed some real transformations in people after just a few weeks, it can be quite amazing. This lady came to see me with chronic body pain. It is a very common presentation here, especially in women. Often the pattern of pain doesn’t correspond to any particular diagnosis (the hemi-body-pain syndrome is a common one) and can be a physical expression of mental distress. As I went to prescribe her yet more tramadol, my pen hesitated just above her clinic card. There was something flat, sad, about her so I asked a few probing questions. She has a son in his 20s with epilepsy and she is his main carer. It is hard work and isolating, and she has no external support. She exhibited many signs of depression. After just a couple of months on treatment she was brighter, engaged and smiling. I may not have fixed her social situation but at least she is in a better place to deal with it.

The male nurse was holding his head, the Mum had the legs. I had thought about giving some sedation but it comes with not insignificant risks and I hoped we could get this over and done with quickly. Why do children the world over shove small things in orifices? I used my crocodile forceps to catch hold of the pea and managed to pull it out. It broke up a bit but I was pretty pleased, I’d removed this 1cm dried legume from the 3 year old’s nostril. Just for safety sake, I told Mum that I’d have a quick check once he had settled down to make sure the nose was now clear. 5 minutes later when I went back into the room, he got so upset and snotty at the sight of me that he cried out of his nose and exhaled the humongous intact remnants – almost a broad bean in size! We were all astonished, even the little boy looked pretty pleased with himself; they took the bean home in a pot.

‘Ukopha? Ukewa bhosha? Ukewa suza?’ cue embarrassed giggles from the patients. My zulu has crept along painfully slowly this year, but I’ve mastered a few key phrases. Unfortunately I don’t have any social chit chat but can conduct the most simple of ward rounds on maternity, or conduct an examination. As always in medicine we have to ask the most undignified things so as I go round clumsily enquiring if the ladies have passed stool or flatus they often indulge in a laugh at my expense! Many of our pregnant ladies have reasonable English as they are of the younger generation and most have completed high school. Sometimes the more fluent ones will help out and shout across the ward to translate for me! I find it acts as such a wonderful leveller when I can get patients to help teach me a bit of Zulu. As I have become more familiar with the language I have come to appreciate the descriptive nature of some of the phrases. When I first arrived the long back and forth of greetings frustrated me but now I enjoy the reciprocal exchanges called out as you walk past colleagues and patients in the corridors. Terms of address are familial and respectful – I would address an older lady as Mama and one my age as sister ‘sissi’. In a setting when patients can often be overwhelmed and intimidated by our medicine, it seems to me the perfect sentiment to remember that we are all brothers and sisters after all. And my favourite phrase… rather than asking a patient if they have felt their baby moving, ‘Ingani i dladla kahle?’ is your baby dancing well?!

‘She is explaining to you that it isn’t for drinking from doctor’ says my nurse colleague. I have no idea what we are talking about but one of the old ladies on my ward looks pleased as punch as she shows me a bottle with a straw in it. She has been in with me for a while with a few medical problems and I had diagnosed chronic lung disease also. She was rather grumpy at first, but seems to have warmed to me now, and I’ve noticed that she speaks really simple Zulu to me to help me understand. I hear our physio laughing behind and she tells me that the contraption it is a Blue Peter version of a flutter device – for blowing into as part of chest physio. Our therapists are so resourceful here that it was made from household materials, but apparently it took her so long to explain that it is not for drinking from that the patient is now delighted with herself that she understands it and wants to demonstrate to us all!

Moments of compassion and support in a hectic day. It had been a frantic day, I stayed late in OPD because the queue of patients was so massive so I got back to my ward late and had a pile of referrals to do in the next 3o minutes. Our lovely medical student (RayRay) insisted on helping me rather than going to theatre which was such a support. I made a cheeky phone call after routine hours to my favourite specialists – the Infectious Diseases team. I spoke to a lovely consultant about a tricky patient we had discussed previously. At the end of the consultation she gave me encouragement to keep up the good work with the limited resources we have saying ‘it must be so hard for you guys out there’ – it is really nice when the specialists appreciate the tricky rural setting we are in and reach out to support us. As we hung up she told me that I must go home now and have a rest, something I sometimes need to be reminded of!

Smiles with the babies. Now that I am working on the paediatric ward, the perks of my day are cute smiles. Well kids can bounce back from illness so quickly and act as such barometers of their own illness. One day I can see a kiddy who is irritable and dehydrated and after just 24 hours of treatment they are bouncing up and down in their bed – it can make discharge decisions really easy! Even the chronically unwell children can melt your heart when they finally start to smile again after days or weeks of sickness and lethargy. We sadly have a few children who stay on the ward long term as there are limited options for social care in our area if the extended family are unable to care for the child. When I have a spare 15 minutes it is a treat to have hugs and give milk to the little 1 year old boy who steals your heart with a smile and then cries if you try and put him down. The first time I couldn’t bear it, one of the other Mums was laughing at me being a softie and I had to find a nurse who would take him for cuddles instead! Yesterday I took a trip around the hospital with a teenage boy who is severely disabled with learning disability and visual and hearing impairment also. As I pushed his wheelchair into the sunny breeze and we ran down the slope he waves his arms in excitement and gave me a big smile. It is the first time I have had a definite response from him and it was the best feeling!

More laughs with the Gogos. My nurse translator in clinic is a lovely one. Vivid braids piled up high and a gold-edged tooth, she has a beautiful smile and warms to all the patients. Which is great, apart from when I am trying to be ruthlessly efficient, which of course I’m terrible at. ‘Right, no more chatting’ I plead, as I need to get back to the hospital on time this week. But this Gogo is a total chatter box, even the nurse can’t get a word in. She came in with abdominal pain so I get her up on the couch. It is a cold day by local standards, about 28 degrees instead of the usual 38. So she lifts up her skirt, and then the next one, and then not one but 4 pinafores. I admit defeat. We all start laughing simultaneously and I allow myself a reprieve of 20 seconds or so of just enjoying the moment with these two vivacious ladies before we get her to clamber down and I try and hurry her out the door.

Dancing, as always, is one of the joys of my Mseleni life. We have a little crew of dancers and run weekly classes. One week we were invited to run a class on a Saturday for the HIV positive teenager support group who were having their monthly activity day. I was somewhat nervous as many of these teenagers have difficult backgrounds with chronic illness and broken families so I thought that there could be some attitudes in the group, but they were the nicest bunch of teenagers I have ever worked with. Christie, Kat and I taught a routine and had great fun dancing around with them for a few hours. A few weeks later I saw one of the older boys in clinic. We were discussing his need for weight loss (some of the meds can also complicate this issue) but he told me that it is ok now because he is exercising – he has set up a dance class with some of his friends where they are learning our routine and others! And so dance feeds into medicine and the cycle continues!

And so you see that although the diseases may be more tropical here and the setting quite different, patients are still patients and compassion and humour are still some of the most important tools of our work. Our local patients certainly know how to laugh and celebrate and I’ll miss those mischievous Gogos when I’m gone!