To Malamulo Hospital (apparently, it translates to Commandments) today. Have photos of the OR (see the sidebar), including the lovely scrub sinks, and the buckets full of water because there is no running water today, pepani.
I didn't take photos of the hospital itself, because lovely as it is, photos can't do it justice. Colonial redbrick, 100 years old. Low buildings with covered walkways hemed in by arched 'windows,' vines and bougainvillea and all manner of well-kempt greenery.
The clinical officers were Jane from Kenya, a matter-0f-fact woman about my own age, and Blessings, a local young man, bright and attentive. They have minimal training but manage admirably at the front lines, undoubtedly better than I could running a ward without support at this point.
The cases were routine, two ladies with ovarian cysts; one had evidence of old PID in the form of extensive adhesions. Young as she is, her fallopian tubes appear to be so damaged that she is likely never to concieve, a disaster in a place that values a woman's fertility above most anything else.
We also visited Thyolo District Hospital which was under construction with the aid of Medecins Sans Frontieres while I lived here in the past (Hi Ibrahim, I wonder where you are and what you are doing, you jerk.). It's amazing, clean and modern yet very much fitting the environment. Fantastic. And they have a CD4 cell counter.
You see, people who test HIV positive in the absence of CD4 cell counts are not eligible for antiretroviral treatment until they get sick, WHO class III or IV. In limited resource settings this makes sense, saving the resources for the people who need them most. Unfortunately, some people in these categories are too sick to tolerate the ARVs; we have two patients at least who are in that situation. With CD4 cell counts, people in classes I and II may become eligible if they have a CD4 count under 200.
But a counter costs thousands of dollars in initial outlay and then in reagents and maintenance, so it is largely out of the reach of Mulanje Mission Hospital. They await with bated breath the introduction of the rumoured machine which can do the counts on a drop of blood and costs around $5000 instead of $20 000.
And maybe then the cracks through which our two ladies have slipped will narrow, and people after them will have a better chance at getting the drugs when they need them, before it is too late.
2006-11-29
2006-11-28
Teaching!
Great teaching this morning on the management of simple fractures and how to use plaster of paris.
More great teaching on cervical intraepithelial lesions and cancers by visual inspection of the cervix with acetic acid. I think my preceptor is more upset about this issue because we have already seen two ladies with likely invasive cervical cancer in her office this week (and it's only Tuesday).
It's preventable. Not generally curable, but preventable.
******
Things that Make Me Happy
More great teaching on cervical intraepithelial lesions and cancers by visual inspection of the cervix with acetic acid. I think my preceptor is more upset about this issue because we have already seen two ladies with likely invasive cervical cancer in her office this week (and it's only Tuesday).
It's preventable. Not generally curable, but preventable.
******
Things that Make Me Happy
- Kandodo warm bread
- Sunshine on the flame trees
- Not getting peed on when holding a baby
- Short power outages
- Mosquito nets
- Paying someone to iron my blouses (ever heard of tumbu flies? Yuk!)
- Frogs
- The massif turning pink in the sunset
- bug repellent with DEET
- headlight flashlights
- iPod
- pineapples
Things that Make Me Sad
- Children dying of malaria
- When the test comes back positive
- When she says her husband will beat her and throw her out of the house
- When you say, twins, and she says, oh, no!
- When you check the cervix and it's already too late
2006-11-27
Mulanje District Hospital
One patient after another coming with a history of dead children and now infertility. Wanting to conceive. HIV positive. Some on ARV treatment, others newly diagnosed. And with no CD4 cell counter, until they get sick enough (WHO class III or IV), they will not be eligible.
I am sort of at a loss here. On one hand I want to say, you have had three children die of AIDS; your own lifespan is already limited, and the country is littered with AIDS orphans. Why do you want to make more?
On the other hand, I want to congratulate her for being alive and hopeful enough to want a baby.
And the third point of view, the one that counts, is that this life is hers, and this decision is none of my damn business.
I am sort of at a loss here. On one hand I want to say, you have had three children die of AIDS; your own lifespan is already limited, and the country is littered with AIDS orphans. Why do you want to make more?
On the other hand, I want to congratulate her for being alive and hopeful enough to want a baby.
And the third point of view, the one that counts, is that this life is hers, and this decision is none of my damn business.
Mulanje Mission Hospital
Lilongwe bus station and Old Town have largely been cleared of traders. No more thronging press of people!! Hopefully fewer pickpockets and outright theives, but someone still tried to nick my katundu.
You can still rely on curios sellers to lie about their names, and to speak passable English, and to help you out for a few kwacha. I paid one of the guys to escort me through the bus station which had been utter madness in the past. I was astonished at how it had changed, and the guy put me on the right minibus to get to Blantyre. And then I had to find my own way. And here I am.
It's gorgeous. In some ways, it has changed a lot, but not in others. There's a pizza place in Chitakale that does lovely thin-crust wood-fired (obviously) pizzas. You can have your choice of Coke or Fanta, or for a couple of Kwacha extra someone will run next-door and buy you a beer.
There's a paved road from Mulanje Boma up the side of the mountain, leading to a posh hotel, Kara O Mula. The sunsets are spectacular, but the likely superb view down to the Boma is blocked by the enormous trees-not a complain, as trees are getting rarer. Apparently they are building a swimming pool as well.
Emmy works at tourism Mulanje, above the pizza place. Miriam has become such a lovely big girl, from being a babe in arms.
The Mulanje Golf Club has a small pool which, when I went, may as well have been my own private pool.
I am saying with my preceptor, a gynecologist who has been here for eight years, and a gracious host.
Here at the hospital. The operating theatre is incredible. Everything you need: Light, AC, a basic table that raises and tilts and splits, whatever. A small supply of suture material. Very basic anaesthesia: spinal (bupivacaine) or ketamine.
I assisted at a C-section, a couple of TAH's and some open evacuations of TOAs. I was present but not scrubbed for an emergency C-section on Saturday evening. I have to thank Joey in Montreal, the peds resident who helped me through NICU, because I was handed a blue baby from thick meconium and a nurse and I had to resuscitate him. I could hear Joey's voice saying "Suction, suction. Ok, good, now we have to stimulate the baby." Calmly, quietly.
Bradycardia.
I can't feel a heartbeat.
Bag, chest compressions.
Suction.
And suddenly, the baby pinks up. I have a heartbeat! He's breathing!
He didn't cry until later that evening but now he's perfect, crying and moving and sucking.
Scared the life out of me, little guy.
*******
Last night I was rounding with the doc in the labour ward. Two young ladies had come in but had not yet been assessed. One looked very familiar.
And she looked at me and frowned and said my name.
It was Alicia, a young lady who was a student of mine for three years while I was here in the past.
And she had a boy.
You can still rely on curios sellers to lie about their names, and to speak passable English, and to help you out for a few kwacha. I paid one of the guys to escort me through the bus station which had been utter madness in the past. I was astonished at how it had changed, and the guy put me on the right minibus to get to Blantyre. And then I had to find my own way. And here I am.
It's gorgeous. In some ways, it has changed a lot, but not in others. There's a pizza place in Chitakale that does lovely thin-crust wood-fired (obviously) pizzas. You can have your choice of Coke or Fanta, or for a couple of Kwacha extra someone will run next-door and buy you a beer.
There's a paved road from Mulanje Boma up the side of the mountain, leading to a posh hotel, Kara O Mula. The sunsets are spectacular, but the likely superb view down to the Boma is blocked by the enormous trees-not a complain, as trees are getting rarer. Apparently they are building a swimming pool as well.
Emmy works at tourism Mulanje, above the pizza place. Miriam has become such a lovely big girl, from being a babe in arms.
The Mulanje Golf Club has a small pool which, when I went, may as well have been my own private pool.
I am saying with my preceptor, a gynecologist who has been here for eight years, and a gracious host.Here at the hospital. The operating theatre is incredible. Everything you need: Light, AC, a basic table that raises and tilts and splits, whatever. A small supply of suture material. Very basic anaesthesia: spinal (bupivacaine) or ketamine.
I assisted at a C-section, a couple of TAH's and some open evacuations of TOAs. I was present but not scrubbed for an emergency C-section on Saturday evening. I have to thank Joey in Montreal, the peds resident who helped me through NICU, because I was handed a blue baby from thick meconium and a nurse and I had to resuscitate him. I could hear Joey's voice saying "Suction, suction. Ok, good, now we have to stimulate the baby." Calmly, quietly.
Bradycardia.
I can't feel a heartbeat.
Bag, chest compressions.
Suction.
And suddenly, the baby pinks up. I have a heartbeat! He's breathing!
He didn't cry until later that evening but now he's perfect, crying and moving and sucking.
Scared the life out of me, little guy.
*******
Last night I was rounding with the doc in the labour ward. Two young ladies had come in but had not yet been assessed. One looked very familiar.
And she looked at me and frowned and said my name.
It was Alicia, a young lady who was a student of mine for three years while I was here in the past.
And she had a boy.
2006-11-20
Lilongwe, Malawi
So, I'm here. At the Korea Garden Lodge and heading to Mulanje in the am.
Fewer trees. Stiflingly hot. I feel very out of place but I suppose that's because I am. I don't feel as safe as I used to, which is a real shame. But maybe it's me.
Some changes for the better, though. Less outright begging. Less garbage heaped in the streets. The informal market is now a more formal one, though too small.
Lilongwe is haunted for me though, with the people I spent my time with. I can't close my eyes but I see them. I miss you, Marta and Jo and Jovie and everyone. It's hard to be in a place that was HOME, and know nobody.
Miss you, Jim, my lovely. Wish you could be here.
Fewer trees. Stiflingly hot. I feel very out of place but I suppose that's because I am. I don't feel as safe as I used to, which is a real shame. But maybe it's me.
Some changes for the better, though. Less outright begging. Less garbage heaped in the streets. The informal market is now a more formal one, though too small.
Lilongwe is haunted for me though, with the people I spent my time with. I can't close my eyes but I see them. I miss you, Marta and Jo and Jovie and everyone. It's hard to be in a place that was HOME, and know nobody.
Miss you, Jim, my lovely. Wish you could be here.
2006-11-15
2006-11-14
Pharmaceutical fun
On the label of my antimalarial:
"...it may produce side effects in some patients."
"...if you develop a sudden onset of unexplained anxiety, depression, restlessness or irritability, or confusion (possible signs of more serious mental problems), or you develop other serious side effects, including a persistently abnormal heartbeat or palpitations...."
Okay, this is giving me palpitations just reading this stuff.
The dreams it gave me last time were wild... a friend of mine, a sweet little old Sikh gentleman in a Santa suit standing in his dining room which had somehow transmogrified into a ballroom featured heavily in one series of them.
A friend of mine had a dream that his grandmother had died. And then he realised that he was dreaming, and someone was waking him up to tell him that his grandmother had died. Then he realised that this too was a dream.... and it kept happening all night.
Most people didn't have any problems. Fingers crossed.
"...it may produce side effects in some patients."
"...if you develop a sudden onset of unexplained anxiety, depression, restlessness or irritability, or confusion (possible signs of more serious mental problems), or you develop other serious side effects, including a persistently abnormal heartbeat or palpitations...."
Okay, this is giving me palpitations just reading this stuff.
The dreams it gave me last time were wild... a friend of mine, a sweet little old Sikh gentleman in a Santa suit standing in his dining room which had somehow transmogrified into a ballroom featured heavily in one series of them.
A friend of mine had a dream that his grandmother had died. And then he realised that he was dreaming, and someone was waking him up to tell him that his grandmother had died. Then he realised that this too was a dream.... and it kept happening all night.
Most people didn't have any problems. Fingers crossed.
Flu shots
I got mine yesterday and my arm still hurts.
*whine* *pout*
And you're thinking, oh, shut up. Yeah, fair enough
The fat doctor says it best. Get it before it gets you or someone you love, like your asthmatic spouse or your Grandma, who might just get more than two weeks off work.
*whine* *pout*
And you're thinking, oh, shut up. Yeah, fair enough
The fat doctor says it best. Get it before it gets you or someone you love, like your asthmatic spouse or your Grandma, who might just get more than two weeks off work.
2006-11-12
Ready for it
We fly on Thursday. Do family stuff in England. And then I get on that plane.
The first time I went, I really, honestly, did not know where Malawi was. I did not believe it actually existed until the plane landed.
And you know, that feeling was not so far off.
That there and here can exist in the same reality is not quite believeable. In some ways I felt like a time traveller. A Time traveller. Or National Geographic, actually. That people still live in thatched mud huts and wear rags and cook on three stones TODAY as in RIGHT AT THIS MOMENT is difficult to swallow while I consider whether I want to have raspberries or strawberries with my chocolate crepes and then worry about fitting into my jeans.
When I first arrived in Malawi, when I realised that alternate reality or not, this is where I was going to be living for the next couple of years, the culture shock threw me back hard. The staff at VSO were undoubtedly laying bets on whether I would ask for my ticket home this week or next.
I cried my way through the language lessons. I worried about my housing situation, because nobody I met could say to me they had actually seen my house. I couldn't face the pit toilet with scorpions and cockroaches and god knows what all. I was terrified of spiders. I had nightmares about giant mosquitoes and about being lost in the dark and about all the unfamiliar faces.
And I hate to say it, but everybody looked the same to me. I had never considered myself a racist, but I was from small town Newfoundland and I simply had no experience discerning black faces. I had no clue what to look for.
Terrified. Why ever did I leave Canada?
So eventually our training period was over and we all had to go to our various placements. My employer came to fetch me, and surprise, surprise, there wasn't a house for me (it would take six months to sort out a permanent one).
And where I wound up staying had a pit toilet.
And I had a tree frog living on my door.
And I learned the names of all three hundred of my students in the first six weeks.
And I got my neighbour's house-boy to teach me Chichewa.
And I made so many great friends.
And I stayed for three years.
And I still had nightmares about spiders, but I wasn't lost in the dark anymore.
The first time I went, I really, honestly, did not know where Malawi was. I did not believe it actually existed until the plane landed.
And you know, that feeling was not so far off.
That there and here can exist in the same reality is not quite believeable. In some ways I felt like a time traveller. A Time traveller. Or National Geographic, actually. That people still live in thatched mud huts and wear rags and cook on three stones TODAY as in RIGHT AT THIS MOMENT is difficult to swallow while I consider whether I want to have raspberries or strawberries with my chocolate crepes and then worry about fitting into my jeans.
When I first arrived in Malawi, when I realised that alternate reality or not, this is where I was going to be living for the next couple of years, the culture shock threw me back hard. The staff at VSO were undoubtedly laying bets on whether I would ask for my ticket home this week or next.
I cried my way through the language lessons. I worried about my housing situation, because nobody I met could say to me they had actually seen my house. I couldn't face the pit toilet with scorpions and cockroaches and god knows what all. I was terrified of spiders. I had nightmares about giant mosquitoes and about being lost in the dark and about all the unfamiliar faces.
And I hate to say it, but everybody looked the same to me. I had never considered myself a racist, but I was from small town Newfoundland and I simply had no experience discerning black faces. I had no clue what to look for.
Terrified. Why ever did I leave Canada?
So eventually our training period was over and we all had to go to our various placements. My employer came to fetch me, and surprise, surprise, there wasn't a house for me (it would take six months to sort out a permanent one).
And where I wound up staying had a pit toilet.
And I had a tree frog living on my door.
And I learned the names of all three hundred of my students in the first six weeks.
And I got my neighbour's house-boy to teach me Chichewa.
And I made so many great friends.
And I stayed for three years.
And I still had nightmares about spiders, but I wasn't lost in the dark anymore.
Malawi
It's a small world sometimes.
Last night I was sitting in my favourite cafe, Croissant de Lune on St-Denis, having savoured strawberry+chocolate crepes with coffee. I was attempting to work on my final CaRMS stuff with their fab free internet...
And I saw someone wearing this on her T-shirt.
I couldn't help saying out loud "Oh my god, that's the Malawi flag."
Anyhow, this started a whole conversation about Malawi... turns out this couple had just returned a few months earlier from a two-year contract with WUSC.
Oh, it was fun. We had a great deal of comparisons to make. They warned me that the place has changed a lot: even fewer trees, more talk about bauxite open-casting on Mulanje Mountain.... which would make extinct the Mulanje cedar, ruin a beautiful environment, and provide huge amounts of money to a few very wealthy people while the rest of the money left the country and provided no benefit whatsoever to the local population, because of course the aluminum cannot be processed in a country without a good supply of electricity, so it would be exported (likely to SA) and most of the profit would go there.
What, me, rant?
Anyhow, we had a great conversation, and she put me in touch with some people in Malawi who might be able to help me out with transport, and it really helped to get me in the mindset to be going. Only a week now.
Thanks, Nicole. You'll hear from me.
PS: Check out this post on the American health system from the point of view of a med student.
Last night I was sitting in my favourite cafe, Croissant de Lune on St-Denis, having savoured strawberry+chocolate crepes with coffee. I was attempting to work on my final CaRMS stuff with their fab free internet...
And I saw someone wearing this on her T-shirt.
I couldn't help saying out loud "Oh my god, that's the Malawi flag."
Anyhow, this started a whole conversation about Malawi... turns out this couple had just returned a few months earlier from a two-year contract with WUSC.
Oh, it was fun. We had a great deal of comparisons to make. They warned me that the place has changed a lot: even fewer trees, more talk about bauxite open-casting on Mulanje Mountain.... which would make extinct the Mulanje cedar, ruin a beautiful environment, and provide huge amounts of money to a few very wealthy people while the rest of the money left the country and provided no benefit whatsoever to the local population, because of course the aluminum cannot be processed in a country without a good supply of electricity, so it would be exported (likely to SA) and most of the profit would go there.
What, me, rant?
Anyhow, we had a great conversation, and she put me in touch with some people in Malawi who might be able to help me out with transport, and it really helped to get me in the mindset to be going. Only a week now.
Thanks, Nicole. You'll hear from me.
PS: Check out this post on the American health system from the point of view of a med student.
2006-11-10
All better... or not
Canon in D, on violin, by two volunteers, makes everything feel better just for a minute. Beautiful.
The residents are angry, at the staff and at the government for forcing the hand of the staff to this point. The senior residents have worked like dogs for five long years, and now they receive no teaching, no evaluations, are just ignored. Some are losing sight of the fact that any protest HAS to be against the government, but I think reason will prevail and work action will be taken against the government rather than against the staff.
Unfortunately, this will make the lives of the staff even harder, because any workaction by the residents will obviously make their workload heavier. I don't knowhowmuch pressure the government really wants to place on specialist docs, but their situation is currently untenable. I will update later with more info, but I need to get back to work.
UPDATE:A few excerpts from Bill 37, which is a law passed June 13, 2006 which binds the medical specialists to a 2% per year increase (while inflation is about 2.4% and medical specialists in Quebec already make on average only about 60% of what they do in the rest of Canada):
"The Master Agreement is renewed and binds the parties, with the necessary
modifications, until 31 March 2010.
"However, the provisions in the schedule relating to the remuneration of
medical specialists also bind the parties until 31 March 2010.
"No medical specialist may participate in concerted action to stop, reduce,
slow down or modify his or her professional activity or to become a professional
who has withdrawn.... Any notice of withdrawal or non-participation concerning a medical specialist sent to the Board after 12 June 2006 is null unless the medical specialist proves that the notice was not sent as part of concerted action. [emphasis mine]
"No person may, by omission or otherwise, prevent or impede the provision
of medical services provided by medical specialists.
"No person may help or, by encouragement, advice, consent, authorization or order, induce a medical specialist, the Federation, an association or any other person to contravene any provision of this division.
"A medical specialist who participates in concerted action to stop,
reduce, slow down or otherwise modify his or her professional activity commits
an act derogatory to the dignity of the profession covered by section 59.2 of
the Professional Code (R.S.Q., chapter C-26)."
Or you can read the whole thing here (if you click it, it downloads a PDF file from the Quebec Federation of Medical Specialists, 12 pages, no fancy graphics).
It's a bit like living in 1984, and I'm not talking about the year here. Particularly that bit I highlighted. Is this post then illegal? If you don't hear from me for a while, worry.
The residents are angry, at the staff and at the government for forcing the hand of the staff to this point. The senior residents have worked like dogs for five long years, and now they receive no teaching, no evaluations, are just ignored. Some are losing sight of the fact that any protest HAS to be against the government, but I think reason will prevail and work action will be taken against the government rather than against the staff.
Unfortunately, this will make the lives of the staff even harder, because any workaction by the residents will obviously make their workload heavier. I don't knowhowmuch pressure the government really wants to place on specialist docs, but their situation is currently untenable. I will update later with more info, but I need to get back to work.
UPDATE:A few excerpts from Bill 37, which is a law passed June 13, 2006 which binds the medical specialists to a 2% per year increase (while inflation is about 2.4% and medical specialists in Quebec already make on average only about 60% of what they do in the rest of Canada):
"The Master Agreement is renewed and binds the parties, with the necessary
modifications, until 31 March 2010.
"However, the provisions in the schedule relating to the remuneration of
medical specialists also bind the parties until 31 March 2010.
"No medical specialist may participate in concerted action to stop, reduce,
slow down or modify his or her professional activity or to become a professional
who has withdrawn.... Any notice of withdrawal or non-participation concerning a medical specialist sent to the Board after 12 June 2006 is null unless the medical specialist proves that the notice was not sent as part of concerted action. [emphasis mine]
"No person may, by omission or otherwise, prevent or impede the provision
of medical services provided by medical specialists.
"No person may help or, by encouragement, advice, consent, authorization or order, induce a medical specialist, the Federation, an association or any other person to contravene any provision of this division.
"A medical specialist who participates in concerted action to stop,
reduce, slow down or otherwise modify his or her professional activity commits
an act derogatory to the dignity of the profession covered by section 59.2 of
the Professional Code (R.S.Q., chapter C-26)."
Or you can read the whole thing here (if you click it, it downloads a PDF file from the Quebec Federation of Medical Specialists, 12 pages, no fancy graphics).
It's a bit like living in 1984, and I'm not talking about the year here. Particularly that bit I highlighted. Is this post then illegal? If you don't hear from me for a while, worry.
2006-11-09
Shock
We have just been told that the only recourse the Quebec doctors have to the measures forced on them is to stop ALL teaching and administration duties.
As in: no formal teaching.
No reference letters.
No evaluation forms.
So, now what? I have a feeling I am about to be told that I am royally screwed, as will be anyone else who is depending on their elective supervisors to give them a letter.
Bye bye surgery.
As in: no formal teaching.
No reference letters.
No evaluation forms.
So, now what? I have a feeling I am about to be told that I am royally screwed, as will be anyone else who is depending on their elective supervisors to give them a letter.
Bye bye surgery.
2006-11-07
Two weeks
I will be on a minibus, trying to breathe in the stifling heat of Malawi's tropical hot season.
1 Canadian Dollar = 125.941 Malawi Kwacha (when I was there it went from about 1:30 to 1:55).
The mangoes will ripen around the end of my stay, about the end of December. Bananas are year-round. As are passionfruit. And guavas.
I will be wearing sunscreen and a Tilley hat (oh so high fashion). I need to buy new sandals because I just realised I threw out the ones I was intending to take with me. Where in Canada sells SANDALS in NOVEMBER??? Ye Gods.
I have to get an appointment with someone who will prescribe me some lariam or something. But the dreams are super-wild. Not really nightmares, just way too real for comfort. Particularly for someone like me, who without benefit of psychoactive substances already regularly gets, as my mother calls it, "the Hag."
I will be attempting to convince myself that I am not REALLY afraid of spiders (of course not, that would be silly, they are usually harmless) even if they ARE the size of dinner plates. Yes, I have actually seen spiders that big. I have no idea what sort, I called them banana spiders because they lived in the banana trees. And they barely moved, and they spun the most amazing webs made out of tempered steel or something, you could practically hang your laundry on them.
Nor am I afraid of:
giant field mice
snakes of various colours and sizes
three-inch-long-flying cockroaches
Etcetera.
What me, getting a little nervous? What makes you say that?
1 Canadian Dollar = 125.941 Malawi Kwacha (when I was there it went from about 1:30 to 1:55).
The mangoes will ripen around the end of my stay, about the end of December. Bananas are year-round. As are passionfruit. And guavas.
I will be wearing sunscreen and a Tilley hat (oh so high fashion). I need to buy new sandals because I just realised I threw out the ones I was intending to take with me. Where in Canada sells SANDALS in NOVEMBER??? Ye Gods.
I have to get an appointment with someone who will prescribe me some lariam or something. But the dreams are super-wild. Not really nightmares, just way too real for comfort. Particularly for someone like me, who without benefit of psychoactive substances already regularly gets, as my mother calls it, "the Hag."
I will be attempting to convince myself that I am not REALLY afraid of spiders (of course not, that would be silly, they are usually harmless) even if they ARE the size of dinner plates. Yes, I have actually seen spiders that big. I have no idea what sort, I called them banana spiders because they lived in the banana trees. And they barely moved, and they spun the most amazing webs made out of tempered steel or something, you could practically hang your laundry on them.
Nor am I afraid of:
giant field mice
snakes of various colours and sizes
three-inch-long-flying cockroaches
Etcetera.
What me, getting a little nervous? What makes you say that?
2006-11-05
"He's Peeing!!!"
Sometimes, medicine is truly surreal.
The above quoted from one of the ward nurses to our senior resident (affectionately known as Xena Warrior Princess). And everybody, myself included, smiled happily and said, "Oh, that's amazing!"
So, the transplant went well, and is taking. Fingers crossed.
The above quoted from one of the ward nurses to our senior resident (affectionately known as Xena Warrior Princess). And everybody, myself included, smiled happily and said, "Oh, that's amazing!"
So, the transplant went well, and is taking. Fingers crossed.
2006-11-04
The Downside
I was checking out a few of my fave blogs, and came across this post by an American ED doc.
Scary stuff, looking into the future. The thought that you could do your best for someone, using every professional resource available, and they, upset with what is probably an unchangeable outcome, decide to mount a lawsuit is one thing. The idea that as a doctor I could come to see each patient as "the enemy" is the most discouraging thing I have ever heard.
From another medical student we get this sort of attitude toward the patients he sees. And this.
The dinosaur points to a blog which has a great comment on the relationship between docs and patients.
For me, I guess I can see both sides. I once had a case where I was involved with the trauma team activation for two patients brought in one after the other. The first was a man shot by police. The second was the man he stabbed.
I did chest compressions on the stabbed man while the team looked desperately for reversible causes and signs of life, but unfortunately, it was too late.
I had to be involved with the care of the man who was shot for the next ten days while he recuperated from his injuries. It was a relief for me when he was well enough to be discharged (to his court appearances and police custody).
Scary stuff, looking into the future. The thought that you could do your best for someone, using every professional resource available, and they, upset with what is probably an unchangeable outcome, decide to mount a lawsuit is one thing. The idea that as a doctor I could come to see each patient as "the enemy" is the most discouraging thing I have ever heard.
From another medical student we get this sort of attitude toward the patients he sees. And this.
The dinosaur points to a blog which has a great comment on the relationship between docs and patients.
For me, I guess I can see both sides. I once had a case where I was involved with the trauma team activation for two patients brought in one after the other. The first was a man shot by police. The second was the man he stabbed.
I did chest compressions on the stabbed man while the team looked desperately for reversible causes and signs of life, but unfortunately, it was too late.
I had to be involved with the care of the man who was shot for the next ten days while he recuperated from his injuries. It was a relief for me when he was well enough to be discharged (to his court appearances and police custody).
2006-11-01
Zebras
I was given a short-notice project, which got postponed (possibly cancelled if I don't push to do it) on *zebras in abdominal pain.
I have come up with 10:
TB of the GI and GU tracts
porphyria
viscerotropic leishmaniasis
abdominal migraine
eosinophilic gastroenteritis
toxocariasis
familial mediterranean fever
lead poisoning
Henoch-Schonlein purpura
rectus sheath hematoma
Any other suggestions? I'd appreciate it.
Oh, there goes my pager (see below).
*zebras = the last thing you should think of when given any symptom complex. "When you hear hoofbeats, think horses [not zebras]
I have come up with 10:
TB of the GI and GU tracts
porphyria
viscerotropic leishmaniasis
abdominal migraine
eosinophilic gastroenteritis
toxocariasis
familial mediterranean fever
lead poisoning
Henoch-Schonlein purpura
rectus sheath hematoma
Any other suggestions? I'd appreciate it.
Oh, there goes my pager (see below).
*zebras = the last thing you should think of when given any symptom complex. "When you hear hoofbeats, think horses [not zebras]
A Kidney
Kidney transplant meant to happen tonight. I have been up since 4am due to a presentation I was told to give today, yesterday, which, I might add, got postponed. Just as well, it would have been pretty cursory.
So what's my plan? Attempt to nap with pager in bra, set to vibrate, natch.
When called, dash in to hospital to (hopefully) scrub in. That way, even if I can't DO anything, (because, be real, there will be a staff, a fellow, a senior and a junior) I can at least squeeze in and occasionally have a good view of what's going on.
Right, nap time.
So what's my plan? Attempt to nap with pager in bra, set to vibrate, natch.
When called, dash in to hospital to (hopefully) scrub in. That way, even if I can't DO anything, (because, be real, there will be a staff, a fellow, a senior and a junior) I can at least squeeze in and occasionally have a good view of what's going on.
Right, nap time.
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