My elective as a medical student in South Africa

Depending on how things go, this might be the last post on my blog. My last shift is Friday night – which also means my last shift as a medical student. Ever. I can’t quite believe how fast time has passed.

So, what happened at work? Honestly, I’m way past the point of what you normally experience as a student. There isn’t much of a learning curve left anymore. Last weekend, I even gave away several opportunities for chest drains to newer students. My goal had been to get confident with the procedure – mission accomplished. I’ve done fourteen now, way above what I had originally planned.

Besides the usual stabs and gunshots to head, neck, chest, abdomen, or extremities, I’ve ended up doing some pretty fancy suturing. I basically reconstructed a three-quarters amputated ear after an MVA. Plastic surgery didn’t want to do it, so my doctors asked me – apparently, I somehow got a reputation as the guy who does good sutures?! No idea how that happened, haha.

Then there was a lady with a lip laceration after her boyfriend hit her with a glass bottle. I repaired it – and on rounds, the consultants asked who had done the sutures. My heart nearly stopped because I expected to get roasted. Instead, they told me it was an excellent repair and that I should consider changing my career path. Definitely not the feedback I had prepared for.

I also placed my first central line here – just a femoral one, but still. Central line is central line, and it was a hard-fought opportunity to finally get one.

And yesterday morning we had a guy with a 2L hemothorax who crashed into hypovolemic shock. I pointed out that he might need a large-bore IV. His veins were not the best, and in shock they never get better. I grabbed a 14G, hunted for a decent vein, and got it in quickly. My reg was standing next to me and said, “I don’t know how you do this, but this is mad impressive – I don’t think I could do this myself.” Coming from probably the coolest reg I’ve ever had, that kind of compliment just makes you really, really happy.

Now that I talked a lot about the positive stuff, I should also mention the bullshit. Students here are apparently not allowed anymore to use the sonar machine (I’ve done somewhere between 200 and 300 eFASTs on my own, placed multiple IVs with sonar and more) because a DOCTOR broke a part of the machine. Officially, we’re not even allowed to use it under supervision anymore, which is just mindblowing. Funnily enough, I regularly get asked by junior doctors to do an eFAST for them because they don’t feel confident using it.

And in the past one and a half weeks alone, I took eight ventilated patients to CT, probably half of them far from stable, and I had to use every bit of knowledge I have. I changed the vent settings on every single one because some of the settings were horrifying – a 60 kg woman doesn’t need a tidal volume of 900 ml, a pO₂ in arterial blood of 350 mmHg doesn’t need an FiO₂ of 90%, and so on. Now there was an official letter from the bosses saying vent changes are only supposed to be made after calling the consultant on duty. I don’t know if this is my fault, but if it is – I honestly couldn’t be happier to leave.

Don’t get me wrong: the surgeons here are probably among the best in the world. But some of them have zero clue about pharmacology or ventilators – at least less than me. And when I talk to international doctors, intensivists or anesthesiologists, they all agree.

In the last weeks, the general mood in the department shifted and became a bit toxic. Students got critiqued for all sorts of random things, while nobody seemed to care that we pay a small fortune to be here and that 60–80 hours per week is not exactly standard for students back home. Suddenly there were all these new bullshit rules.

To be this close to my last shift ever as a med student is probably the only thing keeping me sane. It is time for me to graduate – and it has never felt more like the right time than now. I had the best time of my life here, I learned more than I ever would have back home – but for me, it’s time to leave.