The first portfolio task was a good way to reflect on the HPD. Turns out that Joburg Gen was the worst option because of how bad the organisation was. We were kept waiting for 2 of the scheduled 3 hours in the morning. Below is my portfolio task:
Stalking the halls of the concrete jungle that is the Charlotte Maxeke Johannesburg Academic Hospital I find it hard to imagine that quiet ever haunts its wards. Excited medical students followed nurses that daily walk the long corridors blindly. It was on a part of our guided expedition that we met a patient named Mark. Mark was a middle aged, handsome man happily listening to music while staring out of the window of his ward. He had left his family in the Cape to come to Johannesburg looking for work. His voice laced with disappointment, he spoke about how the person that had offered him a job had let him down and he was left out on the street. After six weeks of fighting to find food, Mark decided that he wanted to end his life. He jumped off the roof of a relative’s house, head first onto the concrete below. Partially paralyzed, he now lay before us on his bed.
A now remorseful Mark spoke of how selfish it had been for him to so rashly attempt suicide. There was no hesitation in his voice as he recounted the story, almost as if it had been rehearsed. He spoke of battles to get his life changing surgery that would allow him to sit up (and not remain merely lying on his bed). He seemed to have a new outlook on life, a positive one reflected in his efforts on mastering his archenemy, the wheelchair. He spoke with disappointment as he recounted his attempts to mount his “steed” that morning, with no avail. It was easy to understand his disappointment, but it was difficult to comprehend how a man had changed his outlook on life in merely three weeks.
Lost in the haze of the usual Grey’s Anatomy or House episode, it was difficult to see the reality of the picture in front of me. It seemed like the happy ending to the fairy tale, but I was reminded of the usual twist that usually accompanies stories in real life. Although the man retained eye contact throughout the conversation, many parts of the man’s story did not add up and it was difficult not to wonder about what he had not told us. He had seemed to be extremely open about his ordeal. A colleague’s question (about who had found him) rattled me more than it did the patient. But then it dawned on me that we had perhaps not earned the right to deserve such honesty. “It’s a basic truth of the human condition that everybody lies. The only variable is about what.” – Dr Gregory House. His story seemed too rehearsed, or perhaps I was being too harsh.
The counseling that he had received could have brought about the sudden change in his point of view, but it seemed that perhaps the somewhat “luxury” life inside of the hospital had left him blind to the realities that would await him when he left. After coming from an environment where food, a warm bed and a shower were hard to come by, he moved to an environment where all of his daily needs were provided. Although Mark spoke about having the support of his wife and a job to go to when he left the hospital, I am not sure that he was able to grasp the magnitude of the change that he would have to undergo. He would probably never be able to walk again and, in my eyes, this could almost be viewed as a regression of his previous circumstances rather than an improvement. It will be a true test of his “newfound” character when he is forced to face the world.
This only being my first patient I was left with many questions that I was not able to answer. Many of the questions that I wished to ask seemed to be too invasive and difficult to phrase correctly without seeming judgmental: “Why were you not staying with your relatives here?” “Why did your outlook on life change so quickly?” Although I had become immersed in this man’s story it was still difficult to believe. In my mind I could only think, if I were his doctor then I would be here to treat him and not judge him on his previous actions. The countless prisoners stumbling through the halls echoed this line of thought. Although this is easy in theory, it is very difficult to implement in practice, especially when the hospital’s resources could be better used to save those that in fact wish to live.
Today I learnt that it is not my place to always judge those that find their place advertently or inadvertently in the wards of Charlotte Maxeke. I also learnt that sometimes the difficult questions are the questions that perhaps need to be asked in fulfilling the biopsychosocial analysis. By asking the those questions it allows the patient to think their answers through and allows for the possibility for counseling that I am not currently equipped to perform. Some of these questions could be the tools that prevent the patient from again attempting to commit suicide. I also learnt tolerance, that although perhaps I disagreed with Mark’s methods, I should still be able to try to understand his world view.
In a hospital environment it is very difficult to gauge sincerity. My patients have a story to tell, but I will never know exactly what they are leaving out. I will never find out whether Mark was telling the truth or not. I do believe, however, that the hard questions that I was unable to ask do have a place in the medical field. Mark was a fantastic first patient. In my heart I hope that he was sincere and that he is able to one day support and experience life as it should be experienced, with family and friends always close by. It has finally begun to dawn on me that today was not as surreal as it seemed. Mark was real…
*points finger into the air* [Still the best thing that has happened this week!]
It was great to talk to some of my very good friends this week, a great release after the week that we had.
A quote from A softer world:
"Children are the future which, let's be honest, is way worse than not having hoverboards."
"I get a crazy impulse when you smile at me like I want to step in front of buses, in a good way."
"It's a basic truth of the human condition that everybody lies. The only variable is about what." - Dr Gregory House
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