November 17th, 2019 by Burton Adrian

On May 31^st, 2018 I walked away from the medical clinic in which I had spent the past 20 years, left the town in which I had spent the last 28 years of my career  practicing Internal Medicine without a trace of apprehension, only a benign dose of “been there, done that”.   I had no thoughts about what medicine I would or would not practice in the future.  I was not burnt out, not upset nor anxious. I had only the feeling of just “been there, done that”.

If you had asked me “are you passionate about practicing medicine?”  I would have answered “probably not”.  If you had asked “were you once?”  I would have thought back to the first ten years of my career in private practice in 1990 and said “yes, I was once”.  But again, I would not have felt a need to ask the question to begin with so why answer it?  I did spend some time wondering if the choice to be a physician had been a good one. There were various conclusions to varying degrees of certainty.

But at the age of 63, I have also learned “God made the world round so that we could not see too far down the path”.  That path, the details of which are of no particular importance, lead me to pursue the curriculum through INMED for the DIMPH.  The path led me to Baptist Medical Center in Nalerigu, Ghana.  When it comes to what I thought was a medical career, I could have said “been there, done that”.  But I have never done anything like this.  This is medicine, and this kind of medicine requires passion.

“We are not in Kansas anymore”, are the famous word of Dorothy to her dog Toto in the movie “The Wizard of Oz”.  Much were my thoughts in the first few days at BMC.  The demand for medical care in both volume and severity are profound.  The resources for lab and diagnostic technology extremely limited, close to non-existent.   You cannot cover up a lack of diagnostic and therapeutic skill by ordering a bunch of lab and x-ray test to “make sure you did not miss anything”.  The only thing standing between you and a bad patient outcome is you the clinician, in that regard quite naked and alone.  The volume is huge.  Not only do you have to be good, he have to fast and efficient.  No AC to keep you refreshed.  No breaks for a coke and a doughnut. Just dim light bulb in a room large enough to be my bedroom closet and a noisy ceiling fan against the heat and humidity.  Bottled water against dehydration.  And hunger, I have already lost 5 pounds in two weeks. Typical day – 7 cases of malaria two of which two were severe.  One intrauterine demise, to an internist, that is an unusual day. One critical aortic stenosis in an 8 year old, previously undiagnosed and multi-lobar pneumonia presenting in shock.   Then you can drop by maternity and help with three vaginal births and start treatment for two with pre-eclampsia.    Remember, I am an internist, so this is really challenging.

At the end of each day I am either exhausted or nearly so, but my wife is here, beautiful and loving.  The local cook is great.  My emotions are recharged. My body refueled and ready to be rested. And I have passion again.  It is required.