Indok’s Blog

Attitude and resilience

I’ve really enjoyed working here at S. Africa.  I don’t mind waking up at 6:30AM to go to work and find a hectic floor with 25 patients.  Which surprisingly enough, after a couple days I remember why that patient is here.   I don’t mind that there’s only 1 computer and that it’s communal care (all the nurses take care of everybody).

Even though in the States things run more smoothly, efficiently, and more effectively, I find that it’s the attitude of the team I work with that makes everyday enjoyable.  That and feeling like your presence makes a difference even if it is filling out discharge papers.  I feel lucky that I got a good team with a caring medical officer (junior attending), an efficient and kind intern, and that I get to work with my friend as well on the wards.  They rarely rare yell at their staff even though annoying things happen all the time, they try their best to manage patients on limited funds, and just make the best of what they have.

I know I get frustrated because I want to do more for patients - like CT scans and this lab, etc, but it’s really made me ask 1)why do I want to order this lab and  2)even if I order it, will it change my plan?  Patients are resilient and you don’t have to order Chem7s and CBCs all the time.  They’ll be just fine.  I look forward to coming back home and seeing whether I’ll implement what I’ve learned here.

A taste of the future

My awesome intern was sick this week. There are 25 patients on this floor and we can’t order things or sign things.  This past week gave me a taste of what next year will be for me.

A lot of maintaining your ward is about organization - a character that was mostly passed down to my brother than to myself.  Every morning I came in to print out new labs of our patients, then do morning rounds with the head attending.  Learning about the new admissions and then filling out discharge papers, ordering labs, and filling out any other paper work.  This is a lot of work before lunch.  Then after lunch, we have afternoon rounds and new admissions.  It was a bit overwhelming this week, but we did it and I’m proud of myself.

It’s a lot of work - the medicine floors is hectic and you always have to be on top of your game.  But I love it.  I wake up tired but happy.  The way medicine is practiced here is so great.  The internist really do most of the work rather than consulting some specialist right off the bat.  I love that!  It establishes such a great feeling of ownership and accomplishment.     However being short staffed comes with it’s frustrations. There are days that I feel like we’re not doing enough with a patient and I wish I could just have some time to read about this patient and really figure out what’s going on.

I had a patient like this not too long ago - one that was very confused and just continued to worsen.  I remember wanting to read her case more thoroughly but she died the next day.  I wasn’t necessarily sad that she died, but I was frustrated that we didn’t know what killed her.

Sorry to be so abrupt, but I have to go with friends right now.  Till next time my friends!

Dear Diary Moments

An update to what I like to call “Dear diary moments”

1) I got my first lumbar puncture and it went super well!!  I even had an audience.  A couple of nurses were watching as well as my intern.  I stuck the needle in her back and on my first try, I saw the brain fluid drip!  My patient didn’t even flinch and one of the nurses even said “that’s the smoothest lumbar puncture I’ve ever seen.”  Yes, this is a dear diary moment!  I said this outloud, but the nurse said don’t say that, cuz no one in S. Africa says that.  Neither do they have refrigerator moments.

2) Went to the Valley of a Thousand Hills where I also got to see different wild animals!  Wilderbeast, giraffes, zebras, and impalas.  Pictures will come soon.  We had the best tour guide.  It’s always nice to have people who are enthusiastic about what they do.

3)  Yes, there are such things as stupid questions. At the cafeteria they serve chicken or beef.  The other night I noticed they never serve pork and then I started wondering if they even have pigs - and wait do they have cows in S. Africa??  So I asked this question to my junior attending (who I admire) and he just laughed at me.

Me: “Is that a stupid question?”

JA:  (big smile) “Yes.”

awesome….

4) There was a young patient who just got diagnosed with AIDS and Non Hodgkin’s Lymphoma.  She was breathing super fast when she came to our floor and we didn’t know why.  While I went to go find a patient downstairs, she apparently died.  No craziness, CPR, or anything. Just an eerie calmness of death.

5) Today on an abdominal ultrasound, the report revealed a small superficial mass on the sternum.  So my junior attending got a 12 in gauge needle and stuck it in her chest to aspirate any fluid.  No ultrasound needed folks, just a needle.  He quoted House of God - “you can reach any body cavity with a 12 inch gauge needle and a strong arm.”  I just looked at him and said “Okay…”  in my Indok way.  He obviously doesn’t know my arm strength or lack there of.

Called it!

We had a patient who came in with acute psychosis = confused, crazy, thinking people were out to get her.  She said she had gone to a party and had a couple of drinks and didn’t entirely trust the men she was with.  Spiked drink??  We admitted her and the next day she had improved significantly but her renal function (creatinine) continued to worsen.  I thought it was rhambdomyolysis (breakdown of muscles).  But the staff said she didn’t have any big brusing.  I didn’t know if you had to have a big bruise to indicate the diagnosis, but she got transferred for acute dialysis cuz it worsened really quickly.   We ordered a CK that indicates whether there was muscle breakdown and it came back extremely high!  I called it!  Yay me!

 That same afternoon I was with my attending who got called down for a resuscitation … on an 8 mo child.  We rushed down to the room and it was craziness as we attempted to resuscitate the baby.  I picked up on the compression while my attending did the intubation and called the shots.  I used my thumbs to compress the chest - that’s how big the chest was.  I switched over with my resident to pump the oxygen bag.  As I was pumping the bag, I looked around me.  Craziness to my left as nurses and staff tried to get an IV line on this baby that was gone by now and on my right, a window that faced a playground with kids playing jumprope.  It’s true -the world does not stop for people dying.  We called the time of death after 20 - 30 mins later.

I was sad for about a 1-2 mins and then left the floor and went back to work cuz really - I didn’t know what else to do with myself.  Still… something I won’t forget. 

Dizziness -> LP

A little bit of Durban and the stay here:

I hate to admit this but the impression I have of Durban is that it is like the Detroit of S. Africa.  It’s beautiful here - with palm trees, hills, TX summer like weather, and the beach not too far away.  Honestly haven’t explored too much of the place because it’s not the safest of cities either and it’s Day 3.  When the sun goes down, it’s unsafe to be out by yourself.  And since we (students) don’t have cars we sit around in the common area wondering what to do.  Durban isn’t some tribal- like rural area.  It’s an urban city and poor.  It’s a small city, with its mall that sell groceries on the ground floor, highways, neighborhoods, etc.  It’s close to the beach but not walking distance.  The doctors seem to be able to go surfing everyday if so desired.  But, like in Detroit, you need a Durbanite to show you around.  Which we haven’t quite acquired yet.  Working on it…

So my goal is to make the most of my medical student trip - learn, learn, learn.  We had a a patient today who complained of dizziness.  My attending then ordered a lumbar puncture.   I laughed in my head cuz in the States dizziness isn’t an indication for lumbar puncture.  But I guess here where cryptococcal meninigits, TB meningitis, toxoplasmosis are a concern - you’ve got to do it.  I made my first attempt today on a lady and was unsuccessful.  But I didn’t feel so bad cuz neither could my intern - and he poked her about 10 times and fished around in there.  Are you flinching as I write this?  Cuz I did and I’m so thankful the patient couldn’t see me squirm as I watched.  I am determined - I will do a lumbar puncture successfully!  Another attending suggested sedating the patient and I quickly asked if I could do it again when she’s sedated. 

By the way, the staff are great here.  They are just like us - laid back, waiting for the clock to tell them when to go home, struggling with the nurses to get orders done, compassionate with their patients, and happy to teach.  It’s a non-threatening environment.  I’ve really enjoyed learning here so far.  Thanks mom and dad!

Lumbar punctures and praise songs

Today was my first real day at work.  I’m doing an internal medicine rotation.  The hospital has 166 beds and five floors.  I work on the 5th floor.

The first sounds I hear when I walked into the hospital today was singing.  The main entrance which is on the ground floor is directly across the kitchen and the staff was finishing a praise song to God.  They were singing it in Zulu and I didn’t understand what was being sung, but just like in those traditional hymns the closing “Amen” chord was heard.  I smiled as I listened at the corner of a stairwell case so not to be seen although I was straining to watch them.  I walked up to the fifth floor where it looks like an adult nursery.  Rows of crib like beds where patients lie and flimsy curtains that are used for “privacy”.  Rarely anyone uses them.  There is one intern covering 25 patients = craziness!  Almost every patient has either HIV or TB.  (DAD- don’t worry, I’m being safe.)  The attendings treat it just like we would with CHF and COPD - it’s their bread and butter.   Words like Toxoplasmosis, Crypto meningitis, using abdominal ultrasounds to diagnose TB, LPs are used all the time with no flinch of panic.

I saw a lumbar puncture done with no anesthetics and I will soon be doing them as well.  My intern says I’ll be a master at them.  I hope so cuz that would be cool.  What I find interesting is that they ask their patients whether they can afford CT scans cuz you have to pay upfront before getting it.  If the patient can’t - well… you can’t get it.  Then you have to change your course of action.    Isn’t that interesting?  What would that look like in the US if hospitals integrated that policy??

Must go and grab lunch.  Hope you are all well.   

Pre-S.Africa

Look at me - I’m blogging.  Believe me, I’m the one most shocked at this fact.  I tend to be a private person and wouldn’t think anybody would really want to know my neurotic thoughts on anything.  But I guess going to Durban,  S. Africa as a medical student and working in an HIV clinic is something worthwhile to share.

I wanted to do an international rotation because I wanted to know if international medicine/medical missions is something I want to do in my future.  I hope that by getting my feet a little wet now will help me know with certainity that this is something worth pursuing.  Aside from the interesting diseases and the different practice of medicine I will get to witness in South Africa, I am also excited to witness spiritual healing.  I remember reading somewhere that the people at this hospital pray for their patients everyday.  How tangible of a difference does prayer make in a patient’s care?

I leave this Saturday!  Enjoy and leave comments!  I love affirmation.

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