ON CLERKSHIP AND DRY BONES

The epitome of a medical student’s life is clerkship: that’s before graduating from med school of course. My clerkship started on a rather interesting note. My first rotation was in Orthopedic Surgery. Orthopedics is basically the medicine of the musculoskeletal system; at least in theory it is. Where I was, things roll a little bit differently.



The wards:

I learnt to locate these by my sense of smell, which (I must say) was bad for most of the rotation owing to the weekly visits to the Ear Nose and Throat clinics. Most of the cases there are trauma. Unfortunately, trauma cases are on the increase. In fact, road traffic accident victims occupy most of the beds. The rest are victims of burglar attacks, ‘Nyerification’, survivors of a ‘Wanjiru episode’ or those who believed they could fly, actually tried it and lived to tell the story. And after the trauma of natural and not so natural causes, they are all bundled up in the ward (that explains the stench). Their fate: a simple recovery or, being victims of malpractice, a long uncomfortable and complicated hospital stay and an even longer hospital bill.

The consultant:

My admiration of our consultant knows no bounds. A simple hulk of a man, a frame built well enough to break a bone and fix it. He has this gorilla-esque demeanor, an ever twisted neck-tie and an uncanny sense of sarcasm that only ages of practice can justify. And he knows his stuff too. His teaching techniques, rather unorthodox I must say. He keeps pinging very open ended questions: like telling you something about a fracture and asking you what you should tell the anesthetist (like it’s him who broke a bone). He likes concise answers, very military of him I should add. In fact, all he needs is a stolen war medal to make a fool proof alibi of his being a veteran war medic.

The practice:

You know those moments when you are about to do something then your friends tell you to break a leg? Well, it’s not that easy. Neither is fixing a broken one. Actually it depends. The simple ones just need a cast, but when surgery is required the game changes. A chisel, a hammer, some screws and plates, nails, tape measure and other things to measure angles, bolts to mention but a few… those are the essential tools of carpentry, erm, sorry: orthopedic surgery. So similar are these two that one famous orthopedic surgeon wrote, “To operate on the bone requires the tools of a carpenter, yet orthopedic surgery is not carpentry; the biological imperatives ensure that it can never be.”

The lessons:

Other than the simple straight forward concepts, there are a few other bizarre ones I have to mention. First, the indications for limb amputation of are better known as the 3 ‘D’s : Dead /Dying, Dangerous, or Damn nuisance (that’s how they wrote it I swear). Secondly, a boner is not a bone: just plenty of blood in erectile soft tissue. The hydrostatics behind it is plain to the eye. The paradox is that one can get a fracture of the penis. Let’s leave the cause of that to doctor-patient confidentiality and its management to your imagination.

What next?

Next on my plate is general surgery. Before that, I hope none of my friends will ever say that they have a bone to chew with me because from then onwards, I will assume they are talking hyenas. As for my new rotation, I'm mostly looking forward to it. I must say though that I associate it with a lot of alliteration: Surgery, Surgeon, Scalpel, Sear, Suction, Scaffold, Suture, Strap… Sigh; let me display my ignorance no further.