You are always there

Looking back the past 6 months which flew by so quickly, I cannot help but see God's hands throughout my entire stay in Johannesburg, South Africa. I could still remember the palpitations I had on my flight in from Singapore, questioning my decision to do a trauma fellowship here. Had I known what I do know now, I would not have worried one bit! However, hindsight is always 6/6, I believe that I needed to embark on this journey myself to learn the many lessons God has intended for me.

I am particularly thankful for my partner in crime, Susumu Matsushime, a trauma surgeon and intensivist from Japan. We started our fellowships on the exact same day, and it really helps having someone around to figure things out with. On top of working together, we frequently meet up for meals to unwind; we even set up a foodie group to enjoy good food with other fellow international doctors! I will always cherish the many trips we took together to explore the other parts of South Africa, and doing crazy things like climbing 2 mountains in a day! Thank you, brother Susumu.

I am also thankful for God's blood of protection over me throughout my time here. I am thankful that I completed by training safely and without harm. I am also thankful for Dr Alan Peter who runs a hostel for medical students and professionals. He gave me home in a foreign land, and a family and community to lean on. I strongly recommend his accommodation should one ever consider coming to do an elective or fellowship in Johannesburg. Thinking back, the worst experience I had here were the 4 times I was pulled over for traffic related offences, but that is another story for another time...

In 1 Corinthians 10:13, the Bible says: "No temptation has overtaken you that is not common to man. God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it." I always believed that God will never challenge you beyond that which you can bear, and in my time here I intensely felt that He was in control of my training. 

Let me start off by saying that I have never ever worked so hard before in my life prior to my fellowship in Chris Hani Baragwanath Academic Hospital's trauma unit. My residency training was known to be brutal locally, but it was nothing compared to what I experienced in my first 2 months in Bara! In my first week, I was acutely shocked at the amount of violence there was in this place as the patients who presented to us with their injuries were a direct reflection of what is happening out there. I even found myself questioning whether I was in the middle of a war zone on a few occasions. However, once I got used to the injury patterns, it became like factory work. Whenever a patient presented, we had an efficient system to triage, resuscitate and manage their injuries. As I progressed in my fellowship, I was made to take more responsibility, and with it more operative experience. By the time I was in my last week there, I had ticked off all my checkboxes apart from cardiac stab injuries. I had resuscitated and stabilised them during my time here, but I have never operated on one before.

On my last call, I had Susumu as my registrar. It was so serendipitous that I started and ended this fellowship with him! That night, I remembered telling him that all I lacked in surgical experience here was operating on a stabbed heart, but that I was very appreciative for all the other amazing skills I have picked up, from vascular repairs to thoracotomies. We had 2 stabbed hearts that night, and I did my first and second median sternotomies to repair their cardiac injuries. I believe this is not down to chance, but divine appointment.

I am very grateful to all my mentors and colleagues in CHBAH trauma unit, and I will definitely be back to do calls and learn more from all of you! Thank you, South Africa, for being a part of my life's experiences; this is one that I will hold very dear to my heart forever.

What doesn't kill you makes you stronger

9th April, my second day in Johannesburg. I decided to explore the neighbourhood by running to the nearby Neighbourhood Square which was about 3.5km away. An easy 7km run, or so I thought...

I was barely in to my first 2km when I felt immensely out of breath. My heart was racing, I was gasping. Attributing it to a lack of fitness, I decided to head back. The walk back was sobering; if one does not keep working at something, the decline will begin, and this can make starting again very hard. I have made a promise to my sons that I will use this time away from them to become a healthier version of myself, and I was going to attempt at least 3 runs a week. Therefore, no matter how hard it seemed, I needed to get my first run in.

12th April, post 24hr call, I decided to get that 7km run out of the way. The run was uneventful, and I felt better after it, crashing into a deep sleep until the evening. I then discovered a function on my Garmin app which allowed me to plot out a course and upload it onto my watch for use during my run. I immediately set out to find a 10km course, and uploaded it onto my Garmin Instinct 2 Solar. I was excited about this function, and could not wait to test it out on the run.

16th April, after work. This was the day for me to attempt the 10km course. I started it on my watch and off I went. The GPS guidance was amazing, directing me throughout the entirety of the 10km route. However, I realised the difference in plotting out a course on the app and actually running it. The route was killer with many climbs and descends, the craziest was a sustained 3km uphill segment that killed me. I was reduced to walking up a portion of the route and catching my breath, with my heart threatening to pop out of my chest. It was a very difficult run for me, and as I was approaching the final kilometre, looking out into the horizon, it dawned upon me that I could be way above the sea level!

Similar view as I gazed into the horizon

Reaching home, I immediately checked my suspicion - this returned: Johannesburg is located in the Eastern plateau area of South Africa known as the Highveld, at an elevation of 1,753 metres (5,751 ft). It all made sense now, I was not that unfit to have felt breathless a week ago on my first run, it was just the altitude. Knowing this now, everything became more exciting for me. Not only do I benefit from training myself medically, I can also benefit physically with altitude training! 

19th April, after work. After settling my laundry for the week, I headed out for that same 10km course. This time, the course felt shorter, I felt a little stronger. I did not walk, willing my legs to go one in front of the other, I powered through the course. Phrased succinctly by the German philosopher Friedrich Nietzsche, “Out of life's school of war—what doesn't kill me, makes me stronger." I will overcome this course, it is only a matter of time. 

What am I doing here?

Reality hit me once I was up in the sky on my way to Johannesburg. Up until then, I had been so preoccupied with settling the various tasks for my new home that I hardly had any time to prepare for my trip. The kids were much more attuned to my leaving though. In the weeks leading up to my flight, Ansel has been deliberate in his attempts to spend more time with me. Noah, much more subtle in his approach, has also gone of his comfort zone to express his want for quality time. Earlier tonight, he hung around the living room past his bedtime so that he can be with me. When Olivia noticed it, she nudged me to speak with him. "I don't want papa to leave, I want to cry already." Hearing those words from my firstborn almost made me want to cry too, I just hugged and kissed him, mentioning that it will only be 2-months before we meet again in London.

Then, in mid-flight, a sense of fear gripped me. Why am I travelling to such a dangerous place for my trauma fellowship? I was almost paralysed with fear until sleep gripped me with its hold and I thought no longer. When I arrived, the list of things to do helped distract me: getting a SIM card, collecting my rental car, driving to my accommodation, settling in, video-calling home to speak with the boys, then driving to Chris Hani Baragwanath Academic Hospital to recce the place before starting work the next day, ending with lunch and grocery shopping before heading back to crash into an 11-hour sleep.

 

I guess the answer to my question will only be truly and fully revealed at the end of my sojourn here in Johannesburg. All I know is that God is with me, He will protect and guide me. Amen.

Noah's prayer for me in church

Sunday's recce to CHBAH