Off to the A&E to sort records. I was a little bummed to miss rounds this morning, especially since we actually had two new admissions – it was Team B’s admitting day, but if a patient comes in who’s been admitted to a different team before, they’re readmitted to the same team. Quasi-continuity of care.
I forgot to take pictures of the A&E records when I first started, but as I think I’ve mentioned before, they’re a disaster. I volunteered to reorganize them so I wouldn’t have a coronary every time I walk in there, especially since I’m missing a third of April. Supposedly all the charts from a given month and year are in one box, but as soon as you start digging through them you realize that they’re all mixed. They’re also extremely dusty, and half of them are torn, folded, crumpled, curled, moldy, and/or have unidentified stains on them. For whatever reason I chose to wear a white blouse and white jacket this morning, knowing that I was going to be working with the charts. Needless to say, this was revealed very early on to be a bad decision.
The area that I was working in was an open reception-type desk, which is usually empty, next to the A&E waiting room and triage room. Unfortunately, the first thing the patients think when they see me standing there sorting papers is that I’m either a doctor or receptionist – either way, every 5 minutes people kept coming up to me and asking for help. I could only lamely reply, “I don’t work here,” and explain in a mixture of Setswana and English to go talk to the nurse. The nurses, meanwhile, looked at me like I was a crazy person. Especially since one of the areas where the files are stored is the triage room, so I would skulk outside the door when they were with patients, then shoot in to grab as many boxes as I could before they brought another patient in. I was pretty pleased with my progress by lunchtime, because I had already found one of the missing April days!
I broke for lunch with Dr. Kung, Tiny, and Dr. Joseph (our new medical officer from the DRC), because Dr. Kung was treating all of us since it was Tiny’s last day in paeds. Apparently she’s actually only a first-year resident (a fact which shot her even higher in my esteem when I found out), and she’s taking vacation next week before moving to radiology. We went to Fresh Café, another very expat-heavy locale, but with delicious food. I got a salad (the first in a while – Botswana is not a very agriculturally inclined country) with chickpeas, chicken, and feta, and freshly squeezed mango juice. YUM. Lunch was nice, although Dr. Kung spent a lot of it in conversation with Tiny, which left me to make some very awkward conversation with Dr. Joseph. Like Chengi, he concluded that I’m a godless heathen, and was appalled to hear that (to my knowledge, anyway) I’m not baptized. Oh well, can’t please everyone.
Back to work on the files after lunch – it went by quickly, and before I knew it it was already dark. I headed home, and Lina and I had a combi adventure to get to Riverwalk to join Olivia and Julia for dinner (they had gone ahead to get groceries). Our directions went a little like this: “Take the Broadhurst 5 to the T-junction. Then take any combi until you see Riverwalk.” Great, except what’s a T-junction? And which way is it?
Two combis and 6 pula later, we made it to Riverwalk, and had a DELICIOUS Ethiopian meal with real cappuccinos. We ate til we were stuffed full of the best quality meat we’ve had since we’ve been in Botswana (I would have taken a picture but I left my camera at home), then had coffee cake for dessert. We felt disgustingly full but happy afterwards, and we managed a 20 pula cab ride back to UB. Score!
Packing for Serowe and sleep.
Tuesday, 21 June 2011
Monday, 20 June 2011
Last Week in a Nutshell
Days 28 - 32
Cliff Notes version:
Monday – long report from the weekend; finished data entry on the May charts; got the April charts from the A&E to start
Tuesday – clinic in the morning, charts in the afternoon. Fairly routine day.
Wednesday
I anticipated that today would be a long day, because it was our admitting day. It was pretty uneventful for most of the day – I went to clinic for the first few hours with Dr. Kung, and saw some REALLY cute twins, although it was kind of creepy too because they dressed exactly the same – but right after Dr. Kung came back from clinic, around 4:45, she came out of the office saying that there was a really sick new admission. I was in the middle of entering charts, but I really wanted to see the patient, so I jumped up and followed her.
It was an almost textbook case of congestive heart failure, which, oddly enough, does happen in kids, though it’s relatively rare. The baby lived with an aunt, and the mom only visited on weekends, but she could tell that something was wrong with the child over the weekend – a cough and puffy extremities, which progressively worsened over the beginning of the week to shortness of breath and rapid breathing. The baby had initially gone to SLH, a regional hospital near their home, but they had referred to us when they saw how sick the child was.
Things were complicated a bit because a sibling at home was currently three months in on anti-tuberculosis therapy, which fit the time frame for the baby to have contracted it and be showing symptoms. Unfortunately, our X-ray was still out of commission, but we had a film from SLH, and lung sounds pretty clearly pointed to fluid build-up in the lungs. Combined with the edema, the child’s respiratory distress, and weak distal pulses, everything pointed to heart failure.
Luckily, the head of the pediatric department, Dr. Mazhani, is also a cardiologist, and he hadn’t left for the day yet. We called him in to consult, and he performed an echocardiogram on the spot, after some rearranging of the beds to find an outlet that worked in a spot that also had an oxygen hook-up. The best ejection fraction he could measure for the child’s heart was 33% ☹
After the echo, I placed a TB skin test, in case the child could be stabilized and also needed TB treatment, then Dr. Kung started an IV. I secured it and bootlegged an arm board (made of tongue depressors, tape, and cotton swabs for padding) to tie to the baby’s arm to keep it straight. The mom didn’t speak much English, but a combination of pantomiming and two-word phrases seemed to communicate pretty effectively that I wanted her to keep the baby from pulling the IV out. She was very scared, so I tried to reassure her, but the situation was pretty bleak. The baby needed to be in an ICU and get a dopamine drip to maintain systemic blood pressure, because as the heart tired it would bottom out the child’s BP. PMH doesn’t have a pediatric ICU, and Dr. Kung explained that the ICU is run by anesthesiologists “who don’t like kids,” and they didn’t have any beds anyway. The nursing support in the paeds ward is too inconsistent for them to continuously monitor the baby if we were to start a drip ourselves, so we had to make do with diuretics and oxygen. Tiny and Dr. Kung also called a cardiologist they knew to see whether they could transfer the baby to a private hospital with an ICU. He was “still eating his supper” (it was well past 6:30 by this time), and not in a hurry to come in, so Dr. Kung gave me a ride home.
Thursday
Came in early to do a gastric aspirate on the sick baby from last night, but miraculously, Tiny had arranged the transfer overnight and taken the child to Bokomoso, a district hospital about an hour away. We got updates throughout the day that the baby was improving on dopamine, though not out of the woods yet. Yay!
MK and Lina presented their designs during morning report; Finished April chart entry!
Cliff Notes version:
Monday – long report from the weekend; finished data entry on the May charts; got the April charts from the A&E to start
Tuesday – clinic in the morning, charts in the afternoon. Fairly routine day.
Wednesday
I anticipated that today would be a long day, because it was our admitting day. It was pretty uneventful for most of the day – I went to clinic for the first few hours with Dr. Kung, and saw some REALLY cute twins, although it was kind of creepy too because they dressed exactly the same – but right after Dr. Kung came back from clinic, around 4:45, she came out of the office saying that there was a really sick new admission. I was in the middle of entering charts, but I really wanted to see the patient, so I jumped up and followed her.
It was an almost textbook case of congestive heart failure, which, oddly enough, does happen in kids, though it’s relatively rare. The baby lived with an aunt, and the mom only visited on weekends, but she could tell that something was wrong with the child over the weekend – a cough and puffy extremities, which progressively worsened over the beginning of the week to shortness of breath and rapid breathing. The baby had initially gone to SLH, a regional hospital near their home, but they had referred to us when they saw how sick the child was.
Things were complicated a bit because a sibling at home was currently three months in on anti-tuberculosis therapy, which fit the time frame for the baby to have contracted it and be showing symptoms. Unfortunately, our X-ray was still out of commission, but we had a film from SLH, and lung sounds pretty clearly pointed to fluid build-up in the lungs. Combined with the edema, the child’s respiratory distress, and weak distal pulses, everything pointed to heart failure.
Luckily, the head of the pediatric department, Dr. Mazhani, is also a cardiologist, and he hadn’t left for the day yet. We called him in to consult, and he performed an echocardiogram on the spot, after some rearranging of the beds to find an outlet that worked in a spot that also had an oxygen hook-up. The best ejection fraction he could measure for the child’s heart was 33% ☹
After the echo, I placed a TB skin test, in case the child could be stabilized and also needed TB treatment, then Dr. Kung started an IV. I secured it and bootlegged an arm board (made of tongue depressors, tape, and cotton swabs for padding) to tie to the baby’s arm to keep it straight. The mom didn’t speak much English, but a combination of pantomiming and two-word phrases seemed to communicate pretty effectively that I wanted her to keep the baby from pulling the IV out. She was very scared, so I tried to reassure her, but the situation was pretty bleak. The baby needed to be in an ICU and get a dopamine drip to maintain systemic blood pressure, because as the heart tired it would bottom out the child’s BP. PMH doesn’t have a pediatric ICU, and Dr. Kung explained that the ICU is run by anesthesiologists “who don’t like kids,” and they didn’t have any beds anyway. The nursing support in the paeds ward is too inconsistent for them to continuously monitor the baby if we were to start a drip ourselves, so we had to make do with diuretics and oxygen. Tiny and Dr. Kung also called a cardiologist they knew to see whether they could transfer the baby to a private hospital with an ICU. He was “still eating his supper” (it was well past 6:30 by this time), and not in a hurry to come in, so Dr. Kung gave me a ride home.
Thursday
Came in early to do a gastric aspirate on the sick baby from last night, but miraculously, Tiny had arranged the transfer overnight and taken the child to Bokomoso, a district hospital about an hour away. We got updates throughout the day that the baby was improving on dopamine, though not out of the woods yet. Yay!
MK and Lina presented their designs during morning report; Finished April chart entry!
Sunday, 19 June 2011
Day 27 - 12 June 2011
HAPPY BIRTHDAY MOM!
Slept in, SO glorious, except that I woke up at 9:30 – work is ruining my college student’s talent for sleeping half the day.
Brunch at Newscafe with Lina, Julia, Becca, Sarah, Kat and Jose was nice, though in addition to my bank card currently not working, my credit card decided to peace out too. Great. Luckily I had cash.
Lazed the rest of the day – the power went out briefly while we were gone, so poor MK lost part of the med school application she was working on. Botswana imports something like 80% of its electricity from South Africa, so there are scheduled outages in most parts of the city, though we were told that UB is generally exempt from them. This was the first time the power had gone out for us, and it was back on by the time we got back, so no complaints here.
Slept in, SO glorious, except that I woke up at 9:30 – work is ruining my college student’s talent for sleeping half the day.
Brunch at Newscafe with Lina, Julia, Becca, Sarah, Kat and Jose was nice, though in addition to my bank card currently not working, my credit card decided to peace out too. Great. Luckily I had cash.
Lazed the rest of the day – the power went out briefly while we were gone, so poor MK lost part of the med school application she was working on. Botswana imports something like 80% of its electricity from South Africa, so there are scheduled outages in most parts of the city, though we were told that UB is generally exempt from them. This was the first time the power had gone out for us, and it was back on by the time we got back, so no complaints here.
Day 26 - 11 June 2011
Before I begin this post, let me apologize, my dear readers, for the long lapse in communication. The work days seem to be getting longer and longer, and the weekends and evenings shorter and shorter. I was also feeling a bit under the weather this past week, so I decided to be lazy. I will fill you in in due time, I promise!
We got up super early, because Boitumelo wanted us to be ready to go at 8, which meant that we didn’t actually leave till 8:45. There was a bit of a conundrum about our clothes, because I wanted to wear my dress, which was fairly conservative, plus I wore leggings underneath it, but Boitumelo said that it had to be below the knee, which it wasn’t. I really didn’t want to wear my work clothes yet again, but they’re the only nice clothes I have other than the dress and two skirts. Harumph.
Poor Olivia was up half the night throwing up – food poisoning or the flu, we weren’t sure – so we plied her with medicine, DVDs and magazines, and promised to take lots of pictures for her.
We took a combi to the bust station, because pretty much our whole group was going (minus Olivia ☹). None of us really knew what we were going to be doing, just that there had been vague promises of “dinner at Boitumelo’s house” and “a wedding.” We were excited though, and enthusiastically piled onto the bus to Ramotswa (roll the R’s, it’s really fun to say). Jose had overslept and said he would meet us at the bus stop, and he made a dramatic entrance by running after the bus and jumping on it as we were pulling out. We all cheered, like the obnoxious Americans we are.
The buses can be combis for shorter trips (like a minivan), but since Ramotswa is about an hour outside the city, we took a big tour group type bus. It’s very comfortable, though some of the seats have questionable smells (like any other public transportation…), and people walk up and down the aisles selling candy, water, and trail mix. One guy was selling plastic folders, which was a bit bizarre. Julia, MK, and I played “I Spy” and “I’m going on a picnic and I’m brining…,” and we got up to an impressive list of about 50 items (for those of you who don’t know this game, you’re missing out). Yes, we are easily entertained.
We got off the bus in Otse, which is where Boitumelo’s family lives. We went to a pottery places, which wasn’t as interesting as Gabane, but it was in a nursery which was pretty (see pictures, when I get around to posting them). They also had orange trees with the biggest oranges I’ve ever seen. They were delicious, and free(ish).
Next, we piled into Boitumelo’s parents’ car (an older model Mercedes!), and truck. We went to her house, which they just build a few years ago and was super nice. I would have taken pictures, but I thought that would be kind of weird/rude. Her parents own some kind of cattle company, which is one of Botswana’s main exports and therefore means that her family makes a fair amount of money. They also grow peanuts and things – we had some freshly picked peanuts, which taste kind of like uncooked green beans. Then we had boiled peanuts, which are super yummy (I don’t know why I’ve never liked them at home). Boitumelo also picked us prickly pears off a cactus in her front yard, and cut them up for us. They apparently have pretty wicked thorns, and their juice stained all of our fingers, but they have a really interesting tart flavor.
Next we piled back into the various vehicles – I joined the contingent riding in the bed of the truck, which was way more fun than cramming in the backseat of the car. We went to vulturary outside of town, and Boitumelo’s dad passed around handouts from the reserve nearby, about vultures. They live in these very dramatic cliffs above the town, but they’re usually only out in the morning, so we didn’t see many. People also were starting to get hungry and tired, so we looked around for about 10 minutes, then headed back to the cars.
We stopped at the village kgotla (prn. ho-t-la), a traditional meeting place, on the way back. We took pictures, but the group energy was definitely ebbing. We were relieved when they apparently decided that they had showed the tourists enough of the sights, and took us back to Boitumelo’s for tea, coffee, and tea sandwiches with cheese and tomato. It was very sweet, her family had like 12 mugs set out and boiled water for all of us. Our tea time was fairly uneventful otherwise, though at one point I did somehow manage to lock myself in the bathroom. Awesome.
We sat around chatting (a few people dozing – and yes, I still have the pictures, mwha) for a few hours, until Boitumelo and her family were ready to go to the wedding. Weddings here are full-day affairs lasting several days. It was already 3, so we had missed a lot of the ceremonial parts, but we went to the reception. They showed us around, and basically the entire village was there, so they were cooking massive amounts of food. Boitumelo explained that weddings are considered to be open to everyone, so a lot of the expense for the wedding is related to making sure that you have enough food for everyone.
They seated us in the middle of the dining tent, so that everyone could stare at us, basically. They gave us gingerbeer first (not actually alcoholic), which is a traditional drink at weddings. Next, they brought us huge bowls of meat, coleslaw, beet salad, and papa (a cornmeal dish). We tried everything, but unfortunately a lot of the meat here is very fatty, so we mostly ate papa and boiled peanuts that Boitumelo’s mom sent with us. The wedding party made a few turns through the tent, changing outfits in between. Boitumelo explained that a blue cloth is considered traditional Batswana attire, and it’s how other Africans identify a Motswana, because each country has a different color/pattern. In South Africa, for example, red cloth is the tradition. Once I figure out how to post videos, I’ll share the recording I made of the wedding party singing as they walked through the tent. It was super neat, and Boitumelo said that they came into the tent just so we could see them, which was really nice. We congratulated the bride, then took our combi back to Gabs, because it was getting dark. It was a little disconcerting when the combi had to be pushed for the first few hundred feet by a couple of guys before it started, but after that we were good to go.
We got up super early, because Boitumelo wanted us to be ready to go at 8, which meant that we didn’t actually leave till 8:45. There was a bit of a conundrum about our clothes, because I wanted to wear my dress, which was fairly conservative, plus I wore leggings underneath it, but Boitumelo said that it had to be below the knee, which it wasn’t. I really didn’t want to wear my work clothes yet again, but they’re the only nice clothes I have other than the dress and two skirts. Harumph.
Poor Olivia was up half the night throwing up – food poisoning or the flu, we weren’t sure – so we plied her with medicine, DVDs and magazines, and promised to take lots of pictures for her.
We took a combi to the bust station, because pretty much our whole group was going (minus Olivia ☹). None of us really knew what we were going to be doing, just that there had been vague promises of “dinner at Boitumelo’s house” and “a wedding.” We were excited though, and enthusiastically piled onto the bus to Ramotswa (roll the R’s, it’s really fun to say). Jose had overslept and said he would meet us at the bus stop, and he made a dramatic entrance by running after the bus and jumping on it as we were pulling out. We all cheered, like the obnoxious Americans we are.
The buses can be combis for shorter trips (like a minivan), but since Ramotswa is about an hour outside the city, we took a big tour group type bus. It’s very comfortable, though some of the seats have questionable smells (like any other public transportation…), and people walk up and down the aisles selling candy, water, and trail mix. One guy was selling plastic folders, which was a bit bizarre. Julia, MK, and I played “I Spy” and “I’m going on a picnic and I’m brining…,” and we got up to an impressive list of about 50 items (for those of you who don’t know this game, you’re missing out). Yes, we are easily entertained.
We got off the bus in Otse, which is where Boitumelo’s family lives. We went to a pottery places, which wasn’t as interesting as Gabane, but it was in a nursery which was pretty (see pictures, when I get around to posting them). They also had orange trees with the biggest oranges I’ve ever seen. They were delicious, and free(ish).
Next, we piled into Boitumelo’s parents’ car (an older model Mercedes!), and truck. We went to her house, which they just build a few years ago and was super nice. I would have taken pictures, but I thought that would be kind of weird/rude. Her parents own some kind of cattle company, which is one of Botswana’s main exports and therefore means that her family makes a fair amount of money. They also grow peanuts and things – we had some freshly picked peanuts, which taste kind of like uncooked green beans. Then we had boiled peanuts, which are super yummy (I don’t know why I’ve never liked them at home). Boitumelo also picked us prickly pears off a cactus in her front yard, and cut them up for us. They apparently have pretty wicked thorns, and their juice stained all of our fingers, but they have a really interesting tart flavor.
Next we piled back into the various vehicles – I joined the contingent riding in the bed of the truck, which was way more fun than cramming in the backseat of the car. We went to vulturary outside of town, and Boitumelo’s dad passed around handouts from the reserve nearby, about vultures. They live in these very dramatic cliffs above the town, but they’re usually only out in the morning, so we didn’t see many. People also were starting to get hungry and tired, so we looked around for about 10 minutes, then headed back to the cars.
We stopped at the village kgotla (prn. ho-t-la), a traditional meeting place, on the way back. We took pictures, but the group energy was definitely ebbing. We were relieved when they apparently decided that they had showed the tourists enough of the sights, and took us back to Boitumelo’s for tea, coffee, and tea sandwiches with cheese and tomato. It was very sweet, her family had like 12 mugs set out and boiled water for all of us. Our tea time was fairly uneventful otherwise, though at one point I did somehow manage to lock myself in the bathroom. Awesome.
We sat around chatting (a few people dozing – and yes, I still have the pictures, mwha) for a few hours, until Boitumelo and her family were ready to go to the wedding. Weddings here are full-day affairs lasting several days. It was already 3, so we had missed a lot of the ceremonial parts, but we went to the reception. They showed us around, and basically the entire village was there, so they were cooking massive amounts of food. Boitumelo explained that weddings are considered to be open to everyone, so a lot of the expense for the wedding is related to making sure that you have enough food for everyone.
They seated us in the middle of the dining tent, so that everyone could stare at us, basically. They gave us gingerbeer first (not actually alcoholic), which is a traditional drink at weddings. Next, they brought us huge bowls of meat, coleslaw, beet salad, and papa (a cornmeal dish). We tried everything, but unfortunately a lot of the meat here is very fatty, so we mostly ate papa and boiled peanuts that Boitumelo’s mom sent with us. The wedding party made a few turns through the tent, changing outfits in between. Boitumelo explained that a blue cloth is considered traditional Batswana attire, and it’s how other Africans identify a Motswana, because each country has a different color/pattern. In South Africa, for example, red cloth is the tradition. Once I figure out how to post videos, I’ll share the recording I made of the wedding party singing as they walked through the tent. It was super neat, and Boitumelo said that they came into the tent just so we could see them, which was really nice. We congratulated the bride, then took our combi back to Gabs, because it was getting dark. It was a little disconcerting when the combi had to be pushed for the first few hundred feet by a couple of guys before it started, but after that we were good to go.
Day 25 - 10 June 2011
This day in a nutshell: half-day at work because today was the day of our mid-internship lunch. Walked to the BUP office at 11, then we got driven to the Gaborone Game Reserve for lunch. We saw tons of monkeys (pictures to come) and more antelope, then had a lovely braai (their equivalent of BBQ) for lunch. Driven back to UB, and we did laundry during the afternoon, hallelujah! Walked to Riverwalk, spontaneously decided to have popcorn for dinner and see the new X-Men movie. (It was PHENOMENAL! I highly, HIGHLY recommend it!) Groceries, home, bed because we had to get up early.
Sunday, 12 June 2011
Day 24 – 9 June 2011
I woke up extra early so that I could be in to work by 7:15 to help Tiny collect the gastric aspirate on one of our patients. I was super excited, but nervous that the mom might have fed the baby or something, which had happened on previous occasions. Everything went smoothly, though, and Tiny showed up a few minutes after I did. She talked me through everything, and I managed to get the NG tube in without too much trouble, but when I pulled back on the syringe nothing came out. Tiny didn’t go through all of the things I’ve seen nurses in the States do to check whether the tube was in the right place – residents tend to cut corners, it’s a bad habit – so I hesitated a bit when she told me to flush the tube with saline. She ended up taking over, and after a bit of finagling we got the sample. I was bummed that I hadn’t gotten it, but I figured I just need to get a little more practice.
Dr. Kung didn’t have to worry about making it to clinic, so there was a little bit less of a rush to get through rounds, but our team was set to admit today, which meant that the afternoon might get pretty busy. Dr. Kung decided not to have the residents do pre-rounds, and we all just started seeing everyone together. We quickly realized that at least one of the new patients needed an X-ray, but apparently the X-ray machines had joined the CT scanner in whatever revolt they seemed to be staging, and we had to refer out to private for that too. Since we needed to pick up the paperwork from social work for the two kids from Thursday, plus a request that Tiny put in sometime yesterday, I headed over to the social work office to gauge the likelihood of getting our new requests approved.
The good news was that one of the kids from Tuesday and the one from Wednesday had been approved. The bad news was that we were missing the mom’s ID card number on one of the forms for the other child, so we had to resubmit the paperwork. They didn’t completely shut us down, though, because they said that if I completed it and brought it back, they could have it ready by 2. They also agreed to have the new paperwork finished by then (why so much faster this time, I have no idea). I didn’t want to walk all the way back to the other side of the hospital and back, so I dropped in to visit Kat in the A&E and called Dr. Kung to get the information I needed. I think I shocked the social work staff by reappearing in less than 10 minutes, probably a record here.
Ducked back into the ward to finish rounds, then took the new paperwork to the social worker’s office before they left for lunch at 1. Since Dr. Kung was going to the department M&M (morbidity and mortality report, not the candy), I decided to go ahead and take lunch myself. I had brought ramen, because there’s a microwave at work, but I realized that I didn’t have anything to cook it in, so I walked home. Julia goes home for lunch every day, so we chatted while I cooked my food. We had been planning to try to go to Serowe, another town a little further from Gabs that has a rhino sanctuary, this weekend. We called the sanctuary to reserve a chalet, but were told that they were fully booked for this weekend and next. Boo.
I took longer for lunch than I meant to, because it’s a 15 minute walk back to UB, so by the time I got back to the hospital it was already 2. I went straight to the social work office, and seriously sat there for 45 minutes waiting to get my paperwork. The woman who had been helping me before took the papers and disappeared when I arrived, while the rest of the staff in the office did the following: the woman in one corner fell asleep, the guy next to me listened to music on his phone and read the newspaper, the woman in the opposite corner listened to music or watched some kind of video on her computer, and the other guy read the news on his computer. After a while the guy listening to music started chatting with me about sports. Seriously people?
I did finally get the paperwork I needed, so I walked back to the ward with a vague sense of accomplishment, tempered by a much stronger feeling of astonishment at the ridiculousness I had just witnessed. Once I’d handed off the paperwork to Tiny, I started on the second set of May charts that I had dug out of the horrid A&E storage room the previous day. Dr. Kung and I went over my questions over the first set of charts, then I stayed late to make up for the time I’d lost over lunch.
Home, dinner, early to bed because I had to get up early.
Dr. Kung didn’t have to worry about making it to clinic, so there was a little bit less of a rush to get through rounds, but our team was set to admit today, which meant that the afternoon might get pretty busy. Dr. Kung decided not to have the residents do pre-rounds, and we all just started seeing everyone together. We quickly realized that at least one of the new patients needed an X-ray, but apparently the X-ray machines had joined the CT scanner in whatever revolt they seemed to be staging, and we had to refer out to private for that too. Since we needed to pick up the paperwork from social work for the two kids from Thursday, plus a request that Tiny put in sometime yesterday, I headed over to the social work office to gauge the likelihood of getting our new requests approved.
The good news was that one of the kids from Tuesday and the one from Wednesday had been approved. The bad news was that we were missing the mom’s ID card number on one of the forms for the other child, so we had to resubmit the paperwork. They didn’t completely shut us down, though, because they said that if I completed it and brought it back, they could have it ready by 2. They also agreed to have the new paperwork finished by then (why so much faster this time, I have no idea). I didn’t want to walk all the way back to the other side of the hospital and back, so I dropped in to visit Kat in the A&E and called Dr. Kung to get the information I needed. I think I shocked the social work staff by reappearing in less than 10 minutes, probably a record here.
Ducked back into the ward to finish rounds, then took the new paperwork to the social worker’s office before they left for lunch at 1. Since Dr. Kung was going to the department M&M (morbidity and mortality report, not the candy), I decided to go ahead and take lunch myself. I had brought ramen, because there’s a microwave at work, but I realized that I didn’t have anything to cook it in, so I walked home. Julia goes home for lunch every day, so we chatted while I cooked my food. We had been planning to try to go to Serowe, another town a little further from Gabs that has a rhino sanctuary, this weekend. We called the sanctuary to reserve a chalet, but were told that they were fully booked for this weekend and next. Boo.
I took longer for lunch than I meant to, because it’s a 15 minute walk back to UB, so by the time I got back to the hospital it was already 2. I went straight to the social work office, and seriously sat there for 45 minutes waiting to get my paperwork. The woman who had been helping me before took the papers and disappeared when I arrived, while the rest of the staff in the office did the following: the woman in one corner fell asleep, the guy next to me listened to music on his phone and read the newspaper, the woman in the opposite corner listened to music or watched some kind of video on her computer, and the other guy read the news on his computer. After a while the guy listening to music started chatting with me about sports. Seriously people?
I did finally get the paperwork I needed, so I walked back to the ward with a vague sense of accomplishment, tempered by a much stronger feeling of astonishment at the ridiculousness I had just witnessed. Once I’d handed off the paperwork to Tiny, I started on the second set of May charts that I had dug out of the horrid A&E storage room the previous day. Dr. Kung and I went over my questions over the first set of charts, then I stayed late to make up for the time I’d lost over lunch.
Home, dinner, early to bed because I had to get up early.
Day 23 – 8 June 2011
Typical morning: early breakfast, then hauled myself in for morning report. The residents all had some kind of class this morning, so there were fewer people than usual there for report. Additionally, everyone was running late, so for a while it was just me, the attendings, and two interns sitting there twiddling our thumbs. Report took all of 5 minutes because there were very few admissions, and then the intern that was supposed to be giving a presentation didn’t show up and didn’t answer his phone when we called, so we gave up and headed to the ward for rounds. Epic fail.
Dr. Kung wanted to wait for Tiny to get back around 9 before doing rounds, so I spent a few hours working on charts. The class ran long, so Tiny didn’t end up getting back till 9:45, and we didn’t start rounds till about 10:30. Dr. Kung had clinic starting at 12, so we rushed through everything with poor MK trying to keep up. On the upside, the baby with intestinal obstruction had finally gone to surgery the previous day, and had had 5 cm of bowel resected, but seemed to be recovering well. I helped Tiny collect a gastric aspirate on one child, and she agreed to let me do it myself tomorrow morning – yay! For you non-medical folks out there, I will take a moment to explain – children who develop TB are actually much less infectious than adults, even when they have full-blown disease, because they usually can’t produce enough force with their coughing to expel any sputum. Whatever stuff they do manage to get out of their lungs they usually swallow. So to test for TB, we put a tube in their nose down into their stomach (an NG, or nasogastric tube), and collect some of their stomach contents early in the morning, before they’ve eaten. We usually take three samples, so it’s a bit of a drawn out process, even though the actual sample collection only takes about 5 minutes. It doesn’t hurt them, but it’s kind of uncomfortable.
Dr. Kung headed off to clinic, but I elected to finish entering the May charts I still had before joining her. It took me about 2 hours, but I did it. Then I carried the box of June charts that I still had back to the A&E storage room on my way to clinic. It was super heavy, and my arm muscles were quivering when I finally made it to clinic. Dr. Kung offered to let me do another skin test, but I was too shaky, and I had to offer a very embarrassed explanation to the patient and Dr. Kung. The rest of the afternoon was fairly uneventful, and we left a little early.
Julia had a film screening for a big conference that her organization was putting on, so we all just kind of chilled at home because we didn’t want to watch a movie without her. We basically just talked all evening. Somehow the subject of songs and games we used to play as kids came up, and we sang “Miss Susie had a steamboat” and various other things for over an hour. We’re such fun, adventurous people.
Dr. Kung wanted to wait for Tiny to get back around 9 before doing rounds, so I spent a few hours working on charts. The class ran long, so Tiny didn’t end up getting back till 9:45, and we didn’t start rounds till about 10:30. Dr. Kung had clinic starting at 12, so we rushed through everything with poor MK trying to keep up. On the upside, the baby with intestinal obstruction had finally gone to surgery the previous day, and had had 5 cm of bowel resected, but seemed to be recovering well. I helped Tiny collect a gastric aspirate on one child, and she agreed to let me do it myself tomorrow morning – yay! For you non-medical folks out there, I will take a moment to explain – children who develop TB are actually much less infectious than adults, even when they have full-blown disease, because they usually can’t produce enough force with their coughing to expel any sputum. Whatever stuff they do manage to get out of their lungs they usually swallow. So to test for TB, we put a tube in their nose down into their stomach (an NG, or nasogastric tube), and collect some of their stomach contents early in the morning, before they’ve eaten. We usually take three samples, so it’s a bit of a drawn out process, even though the actual sample collection only takes about 5 minutes. It doesn’t hurt them, but it’s kind of uncomfortable.
Dr. Kung headed off to clinic, but I elected to finish entering the May charts I still had before joining her. It took me about 2 hours, but I did it. Then I carried the box of June charts that I still had back to the A&E storage room on my way to clinic. It was super heavy, and my arm muscles were quivering when I finally made it to clinic. Dr. Kung offered to let me do another skin test, but I was too shaky, and I had to offer a very embarrassed explanation to the patient and Dr. Kung. The rest of the afternoon was fairly uneventful, and we left a little early.
Julia had a film screening for a big conference that her organization was putting on, so we all just kind of chilled at home because we didn’t want to watch a movie without her. We basically just talked all evening. Somehow the subject of songs and games we used to play as kids came up, and we sang “Miss Susie had a steamboat” and various other things for over an hour. We’re such fun, adventurous people.
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