The Common Vein

September 2009

Living in Australia

married to Nurse Baker

Children

Dagney 25

Josh 23

Occupation Pediatrician

email

mhopp@ozemail.com.au

Reflections after forty years

?Where the f.. is that lazy bloody registrar??  only one week into this job and called to attend a c/section on a woman in labour ten weeks short of term and I am left to catch the baby on my own.  Naturally a ?precious baby,? (weren?t they all?) multiple previous foetal losses and everyone in the operating theatre looking grave. ?Baby? looked more like an enlarged sperm, tiny, semitransparent, wet, slimy, lifeless. Did they expect a resuscitation or resurrection from this fresh (I was then) houseman who had only practiced on plastic manikins up to that time and should have been nursed through his first neonatal resuscitation by a registrar who was nowhere to be found.  I was handed the lifeless half a kilo or so of blue jelly and remembered enough of the theory to realise that I had to secure an airway. How was I going to do that without help? ?What I am doing here and why? sprang into consciousness, with Radiology now suddenly sounding infinitely more attractive a speciality choice than paediatrics.

My baptism of fire was 31 years ago and I did stick with paediatrics, almost certainly because the story ended well.  Successful intubation (securing a breathing tube into the windpipe) at second attempt followed by a few puffs of oxygen into those tiny immature lungs was all it took to speed up and strengthen her barely audible little heart with resultant rapid improvement in her colour and tone (muscle strength) and spontaneous movement following on almost immediately, allowing transfer to the ICU of a living and kicking baby. She had a stormy postnatal course but went home well with grateful parents, without obvious sequelae from a ?tricky? start.  I have been privileged to resuscitate countless babies since and to nurse many junior doctors through their first experience doing the same, but still have nightmares about my first.

Unlike Lindsay, I grafted for matric, having less natural talent than the Green Machine. I spent the next nine months maturing in Walvis Bay as an infantryman-driver assigned to C Company, home to many close friends all lucky enough to have also cracked a stay in the area as Bokke (you had to be there). I attained the lofty heights of full corporal while pondering my options for the future and maturing with my Brothers in Arms.

After the army I held my breath until accepted into medical school and it took a total of 12 years or so to start breathing easily again. Swept along by a tsunami of high achieving medical students, studying for hours on end became the norm and I somehow got through it and found a particular attraction to paediatrics. I have never been able to fathom my physician colleagues who chose adult medicine over paediatrics, spending the majority of their time unravelling the multi-system diseases of geriatrics, although with my advancing age and high cholesterol, I?m relieved they did. Kids are wonderful, rarely presenting with more than one disease entity at a time and usually recovering quickly from the vast majority of severe or even life threatening illness, and mostly doing so on their own with minimal intrusion by our current armamentarium of sophisticated therapeutic options which is 21^st century medicine.

Apart from the weighty privilege of being trusted with managing children?s health and illness, I have been inspired by their wonderful mothers. All paediatricians know that the woman who aims to be her husband?s equal lacks ambition. When fathers bring in their children (without their mums), us baby doctors are happy if they have a rough idea about their children?s age and sex. They battle with the more mysterious details like birth weights, milestones, immunisation and past medical histories, let alone what medications the child had taken, presence of fevers, their appetites or G-D forbid the details of bodily functions like wee or poo, all the bedrock of paediatric diagnosis.  Mothers? wonderful attention to detail, insight into their children?s wellbeing and their sense of urgency when appropriate is humbling to us guys.

As rewarding as thirty odd years of paediatrics practice has been for me, it also served up a surprising and unexpected bonus. A one thirty am bleep while on call for the ward at Transvaal Memorial Hospital as a senior houseman found me in comfortably close proximity to a young nurse with concerns that a child?s drip had tissued. She was gorgeous and I recalled my registrar commenting to his colleague that ?Nurse Baker was very easy on the eye.? Having been on nights, I had not met her, but clearly, there she was and I was able to confirm his observations with interest. Over and above her beauty, she had a cultured English accent, a gentle but firm assisting hand and an instantly recognizable love of the children in her charge. Call it shallow but I was totally smitten. We have been together since then, currently clocking in at thirty-one wonderful years.

I joined a two-man private paediatric practice soon after attaining fellowship but retained an academic interest, ultimately heading up the Paediatric Growth and Endocrine Clinic at the Johannesburg Hospital where I worked on a regular basis, also providing an endocrine consultancy service to Baragwanath Hospital, as it was known then. We had two wonderful children, Dagney now 25 and Josh 23, still both vehemently supportive of their place of birth.  I loved my work and my life but two scary visits by uninvited guests to our home and persistent nagging from emigrated friends, prompted an application to pastures greener, ultimately culminating in a move to Australia almost exactly ten years ago. The only position going at the time was in a small country town in southwest NSW called Griffith with twenty-six thousand or so residents and a Base Hospital which services a population of sixty odd thousand where I was to be the soul paediatrician.

It was known as the breadbasket of Australia until the eight or so year drought hit, robbing the area of a significant proportion of its rice, wheat, canola and corn plantations, but fortunately all permanent plantings including the vineyards, citrus orchards, stone-fruit and nut plantations have high security water, achieved by a series of irrigation channels that has allowed the area to survive. I arrived on a one year contract but grew to love the place for its rural flavour, wonderful restaurants and locally produced full bodied reds for which it is quite famous and has achieved many accolades, both Australian and international.  As a result I am still here, living just out of town in an idyllic setting of indigenous trees and abutting on my three hour mountain-bike trail that has become as familiar to me as any road in Morningside was all those years ago. I am within a five minute walk of the best winter navel orange plantations in the world, outstripping Outspan and Californian alternatives hands down, with flavour significantly enhanced by fresh picking on a morning walk. It takes me exactly four minutes from a full bodied red (only one when on call) on my stoep, overlooking my wooded domain, to labour ward where I am called often, now intubating newborns of all sizes without the stress suffered when I started, all green and expectant.

Lots more but I will end there to get the bio in on time, otherwise risk being ostracised by G.O.D., who, incidentally, was one of my brothers in arms in a less idyllic but not less important time of my life.

Last reunion in Aussie