My elective as a medical student in South Africa

I honestly don’t even know where to start. Last weekend was payday – and I ended up working about 38 hours out of 48. And holy smokes, that was pure madness.

Friday night started off quiet, almost suspiciously quiet, until around 5 AM we suddenly got completely flooded. Eight patients from an MVA (motor vehicle accident). EMS told me that at least five had already died on scene – we got the rest. One of my patients looked absolutely fine at first glance. But when I did the full body check and rolled him over, I found a 10 cm deep laceration across his thoracoabdominal flank. His eFAST showed a massive hemothorax – so I put in the ICD :)) Another patient I had to manage completely on my own (all doctors were busy) had fallen about two floors. He was stable, eFAST negative, no neurology – but later turned out to have a C2 fracture. On rounds, the consultants asked me about the exact mechanism of injury. All I could say was: “All I know is that there was alcohol involved.” They all laughed – and honestly, that probably sums it up.

Saturday night though… was the most insane shift I’ve ever experienced here. I thought I’d seen a busy ER before – turns out I hadn’t. There was a local football match that evening, and around 1–2 AM we got flooded. “Warzone” is honestly the only word that fits. At one point we had 25 patients crammed into an area meant for 15 critical beds. I did two ICDs that night, countless eFASTs, assessed more patients than I can even remember. At one point a patient rolled in with blood in the airway – acute A problem – and we simply had no ventilators left to intubate him.

By morning the ER was still overflowing, and instead of leaving, I just stayed on. What was supposed to be one night turned into 26 hours straight in hospital – without a second of pause. In that time I personally assessed MVA, PVA, mob assaults, stab chests, GSW chests – and placed three more ICDs. That brought me to my 10th chest drain in total. And honestly, I’m very confident with the procedure now. From incision to pleura is maybe 60 seconds, sometimes less. Smooth, clean, controlled. That was one of my big goals here – and I nailed it.

Somewhere in the chaos, I found a patient in the “pit” who had been waiting for hours. Seven stab wounds to the back. He told me he was coughing more than usual – and within seconds of talking to him, I was sure he had a pneumo or hemothorax. eFAST confirmed: massive hemopneumothorax. Bad for him, but I was quietly proud that my doctor brain was still working after 20 hours straight. I put in the chest drain, it worked perfectly, then spent almost two hours suturing him up – back, arms, scalp, everything. He told me the attackers used a butcher knife.

And that wasn’t even it. Faces, eyelids, neck stabs, back stabs, scalp lacs – I sutured them all. Earlier this week I even saw a patient stabbed right in the cardiac box. Textbook Beck’s triad, unstable as hell. Within minutes he had a central line and was rushed to theatre for an emergency sternotomy. My third time watching one here. Unbelievable how skilled the trauma surgeons are – and he survived.

Last weekend I was also asked by another student to help transfer a ventilated patient to CT – apparently I’m “the only student confident with ventilators and meds in emergencies.” Their words, not mine. The patient’s MAP dropped from 70–80 in the ER to under 40 in CT. No doctor around – it was on me. I reduced the PEEP, pushed some adrenaline, stabilized him enough to finish the scan. I was never more glad to arrive in the ER than that and i needed a few minutes of silence after that. He’d been assaulted with a machete. The CT was horrifying: intraparenchymal bleed, multiple skull fractures. And when we exposed his head wounds, I counted four or five deep lacerations. Brutal.

So yeah – this is without question the best time of my life. I’m doing things I’d never be allowed to do back home – but always within the scope of what I feel safe and trained to do. And it’s an incredible test of how far my education and experience have taken me.

On the other side, I had one of the most frustrating moments of my entire medical life so far. There was this confused patient who kept changing his story – first it was “stab chest,” then “stab neck,” then suddenly “mob assault.” The physical assessment itself was fine, but when I did the sonography, I found an IVC dilated to about 3 cm. On top of that, the kidneys didn’t look good at all – basically just a big oval blob with no clear parenchymal separation. That worried me. So, I went to one of the interns. He wasn’t sure what to make of it and more or less told me he didn’t understand what my brain was coming up with. (Funny enough, most of them know that I actually like internal medicine a lot – and occasionally i even get asked by them what i think). Anyway, he suggested I should speak to a more senior doctor. So I did. And she just shut me down with: “I don’t take handovers or patient presentations from students.”That honestly pissed me off beyond words. And if I ever hear something like that again, I’m not sure I’ll be able to hold back. My reaction will be memorable, for sure. Because here’s the thing: I’ve got final-year blues. I feel like a doctor already. I want nothing more than to finally finish med school. I’ve never been this close to the goal I’ve been working toward for so many years – and I just can’t stand that level of disrespect anymore. Yes, I’m absolutely aware I’m still a student, not a doctor. But I want to be respected for what I can already do. I honestly believe my clinical judgement has never been sharper than it is right now. And when I say I’m worried about a patient, I think my colleagues should at least listen. Most of them do, to be fair. But not all. And that’s the part that cuts.

Thanks again for reading all of that, i really appreciate it!