Oh man, what a day yesterday was. I felt exactly like a rubber band stretched to the snapping point. Too many patients, too few doctors. And it’s not even monsoon season yet! I’m told it gets much busier than this, with patients overflowing our 160-some-odd beds and out into the hallways. So my long absence from the blogosphere is not for want of material, as much as time – and mental energy. I hate feeling this way, because just like a tight rubber band, I do snap – usually at patients, with snarky remarks and rushed impatience. (Yes, I now know enough Nepali to be snarky. Not necessarily a good thing.)
Generally I love this work. I hear from friends back home about how soul-robbing their jobs’ demands can be, with endless paperwork and administrative duties. Yet I find that as difficult as this sometimes is – physically, mentally and emotionally – I really do still enjoy practicing medicine. Perhaps now, in this setting, more than ever. But it can be hard to remain pleasant and caring when the stack of charts is piling ever thicker on my desk, the hallway outside brimming with patients pressing to be seen, and the woman sitting before me asks the same clarifying question for the eighth time.
Then there’s that part about helping to cross-cover patients with the ER resident. For instance, my morning started out with an urgent call to help with an umbilical cord prolapse at 35 weeks. Crisis Mode: Stay Calm. I elevated the presenting part (just like all the textbooks say; of course I’ve never actually done this before) and we rushed down the long corridor to theatre (the operating room), where two surgeons were scrubbing in and getting things prepped. They had to put the cloth drapes over me too, of course; I just asked that they give a holler when they were about to cut into the uterus, so I could remove my hand to safety. Amazingly, the baby lived, with Apgars of 8 and 9 (not bad, on a scale of 1 to 10!)
Later that same day, another baby was brought in by her parents just hours after delivering at a local health post. She hadn’t cried since birth, and was laying floppily on the ER gurney with a very strange look about her. Then it occurred to me that her corneas were opaque; she wasn’t even blinking her (very dry) eyes – a sign of profound neurologic compromise. Probably from invasive Group B Strep (GBS) meningitis, with a pulsating fontanelle (another thing I’ve never actually seen before). The parents had lost a previous infant in the same way last year. In a world where routine GBS screening and intrapartum antibiotic prophylaxis is still not routine, this is one of the unfortunate outcomes of “playing the odds” in the hopes that these babies will do alright, since most do.
It feels at some point like the tension has to vent somewhere – often as tears awkwardly fought on the way home, past crowded shops just beyond our hospital’s gate. I took the long way home today, winding up through Shrinagar Forest. It’s been my favorite place ever since arriving in Tansen. There, I was able to reflect for a while on this morning’s Psalm, which really struck me:
Remember Your word to Your servant, in which You have made me hope.
This is my comfort in my affliction, that Your promise gives me life.