All 8 beds in resuscitation bay at capacity on a Sat morning.
Chris Hani Baragwanath Hospital (Bara) is an
academic hospital but its trauma receiving area more closely resembles a war
zone. It is effectively Soweto's county hospital, publicly funded and under-resourced Named after a revolutionary freedom leader who was assassinated
the legacy of violence continues. There is as much penetrating trauma in a
single night here as an entire month back home.
Variety of penetrating and blunt trauma waiting in the "pit".
Friday night call was -wild-. Fridays
are paydays, lubricating the culture of violence with dirt cheap liquor. The
flow of ambulance stretchers into the resuscitation bay was constant. Blunt
beatings, knife stabs, and gunshots were in no short supply. Many patients even
walked in with a variety of penetrating wounds to the face, thorax, and
abdomen. The intake “pit” area was bursting at the seams, lined with stretchers
waiting to be resuscitated.
"Storage"
The overarching mantra at Bara is “get it done
with what you can.” This arises from a combination of short time and few
resources. Forgetting what I've grown accustomed to in the United States, I
learned to become effective in a different system. Where I used to call plastic
surgery to suture faces, I now use a giant 3-0 Colt needle. Sterile technique
is a commodity not necessity. Femoral ABGs, Foley catheters, starting IV lines
– proficiency develops quickly. By the end of the night, I had performed 3
chest tubes, 1 intubation, and an IJ central line without ultrasound.
A typical inpatient ward: short-staffed and under-resourced.
And this was a usual Friday night. Rinse and
repeat weekend over weekend. Procedures and protocols move patients through
like a meat grinder. By the end of my 28 hour shift, I was eager to go home. I
felt physically exhausted and emotionally frustrated. Patients deserved better
than what I gave them. I had no time to treat them more humanely, no resources
to offer higher standards of care. Even though I had worked tirelessly, I just
felt bad that in the morning I could not remember a single patient detail
beyond their injury and plan.
Driving home, Skylar Grey's Coming Home was on my mind:
