My elective as a medical student in South Africa

Insanity. There’s really no better word to describe what’s going on here during night shifts – especially on weekends. I just woke up after my last one and the impressions are still intense. So many patients dying. One came in with multiple gunshot wounds to the chest – they opened his chest in resus for an emergency thoracotomy. They (as a student your not actively involved and join operating and so on, and that is good!!! I am not fit enough to do this and right now i also don’t want to do it) went on for almost an hour, using literally everything medicine has to offer… and then had to call it. Another one came in with a gunshot to the head, brain mass already outside, fixed dilated pupils – it was over before it even began. These are images you don’t forget, but honestly, that’s part of why I came here.

While all that was going on, I had to manage a patient with a GSW to the back. On the X-ray, the bullet showed up somewhere around C3/C4. Everyone else was busy, so I was completely on my own. I was seriously worried about neurogenic shock at first, but thankfully it didn’t happen. CT later showed the bullet ended up just millimeters away from the spinal cord. Still, the patient couldn’t move his arm – likely brachial plexus damage. The real problem though: we have nothing to treat neuropathic pain. So I gave large doses of fentanyl – helped for a few minutes. Thanks to my experience in anesthesia I knew how to dose and monitor it – because honestly, there was zero supervision. If I had messed it up, nobody would’ve caught it. When the pain came back, the patient was suffering badly. And every single dose of fentanyl? I had to go find a nurse, ask in person, wait. Sometimes they came quickly, sometimes it took forever. That’s just how things go here. Pain is almost never treated properly.

You have to learn not to get emotionally involved. Do what you can, give your best – and then move on. I’m surprised how well I manage that now. You just put on your doctor glasses and function. I sutured three patients last night. One woman had been assaulted by her boyfriend – small laceration on the dorsal hand, which I stitched quickly. The deeper cuts were on the palmar side of her 3rd and 4th fingers, probably tendon involvement, definitely needs proper hand surgery. I explored the wound, could even see the joint spaces. To help with pain I did my first Oberst block – never seen one done before, only knew the theory, but it worked and the patient was super thankful.

Another guy got attacked with a broken glass bottle – they smash it first to get sharp edges and then use it like a knife. He was completely drunk, had deep scalp lacerations with significant tissue loss. I stitched him for almost 2.5 hours, probably 60–70 sutures in total. Started around 6 AM, left the hospital at 9. (And no new needlestick incident this time – lucky me.)

There was a lot more going on. Took tons of patients to CT, most of them drunk. Inserted countless large-bore IVs, did multiple blood gases – and that’s just the stuff I was directly involved in. I’m not even talking about the patients I didn’t touch… except the ones that died.

But honestly? This shift still felt less chaotic than the last one. Pay day is coming soon though – and when that hits, it’s going to be madness again. I’m starting to feel more settled now. I know most of the doctors, they know me, and even the rest of the staff recognize me by now. I’m slowly figuring out who’s who in the zoo. Organizing things is getting a bit easier, but I still spend way too much time running around just to find basic stuff. That’s probably the most frustrating part – and I don’t think that’ll change anytime soon.

It is for sure the first time in my life where i feel a lot more like a doctor and not really like a student anymore. My decision to do this as almost my last placement before graduation was definitely correct, otherwise i wouldn’t be able to survive here. So far i learned everything i wanted to learn initially, and probably a lot more….The learning curve is insanely steep. The biggest problem i see right now: I can’t really imagine going back into a low adrenaline environment again. The amount of (mostly positive) stress i get here really desensitizes me. So far my plan has always been to do internal medicine, but what if i want to do emergency medicine? As my main job!! Thoughts are flowing right now. I don’t think i will find the answer in my time here, but probably when i go back home. But even with so much adrenaline in my body, i think i am the calmest in emergency situations i have ever been in my life. And this is a feeling you can’t describe and nobody out of medicine will ever be able to understand. You have to feel it yourself.