First Day

What I really need to do right now is go for a nice run to let some thoughts settle, but dusk is approaching, and I have a lot of stuff to read tonight, so Instead I've decided to sit on the back porch and jot down a few thoughts.

 

My schedule: Talked to Prof this am, and looks like I'll be spending 2 months on wards, then a month in the HIV clinic, and then a month in neonatology (I'm going to justify this in a later post because many remember the lack of love I felt for NICU back in January), and then back on wards for the final 2 months. I'm working on setting up some vacation for those final 2 months, and think that will the the trip to Kilimanjaro--for those who want to join.

 

Today: I rounded with one of the ward teams, which won't be the team I'm working with starting tomorrow Ward Teams consist of 2 Interns (these are second year interns-internship is 2 years of 4 month rotations in core disciplines), 2 MOs (medical officers, akin to SHOs) and 2 registrars (Senior residents specializing in pediatrics), and then there are 3 Consultant attendings to a ward. Intake/Call is q 4 nights. So today I rounded with a team post-call/intake. The consultant saw all the new patients from intake, and I was just awe-struck by the thoroughness on rounds. Fantastic teaching (give me a second and I'll tell more about the kids on the ward). After ward round w/ the attending, the post-call reg left, and then the registrar and the intern and MO who weren't on call rounded on all the old patients and made a list of things to do. When that was done we grabbed a bite to eat, then went back to the ward to complete those chores--which consisted mostly of blood draws, restarting IVs etc.

 

Blood Draws: I've made it know that this is a skill which isn't something we do well. Although, I figured give me a butterfly needle and I may be able to hold my own. Alas, no butterfly. Also, routine phlebotomy from arterial sticks rather than veins. Also from external jugular veins. Going to take some getting use to this practice. And for those back home, certainly no child life..

 

Kids we're taking care of: First off, pediatrics is defined as up to age 14. That's a little bit different. I want to avoid the gross-guess what I saw statements that often come across in writing...

 

As expected, lots of kids are HIV+ and lots of problems related to this as well. I did see a pretty routine bronchiolitic kiddo, and one or two with gastro. But the others have issues such as Potts Disease (TB of the spine), Reyes Syndrome (Traditional healers crushing up aspirin, acetaminophen, motrin, and using in traditional medicine preparations), multiple kids with meningitis-including one with a strep species. There are sick kids right now on the ward who would be in the PICU back home. Sadly, though, getting into the ICU is limited here.

 

I kind of hesitate to write more at this point, because I don't want to lose sight of the big picture which is that I'm uber-impressed by how smart the docs are, and in the context, I think the care is really good. I'm not sure how to write without making my point seem more of "look at this suffering." And since blogs are in a public domain, I don't want things to be portrayed unfairly. SO I'm going to leave it at this for now.

 

Cheers.

Driving "home" with Cat Stevens

Today has been a lighter studying day, after days of cramming, my brain was feeling saturated. So I headed off to one of the larger malls, with the goal of hitting larger book store to find a better Jo'burg guide. (no luck). What I did find, though, was that Sex and the City was playing, which is quite a relief, since I want to catch it in the theatre..

It was a beautiful day today, in fact quite a few people in shorts here. (Don't forget it's winter here, we're far south, and high in elevation-it gets cold). I started to make my way home, kind of thinking that this is the evening best suited for meeting with friends and laughing and enjoying a beer. Though, I don't know where I'd go for a beer, and I be going out solo. A moment to discuss the sunsets, which have been spectacular. I don't know if it's the winter sun, or what, but the way the light strikes the buidlings and surrouunding hills, the area lights up in this golden and then amber color, and it's beautiful.. I got home, thinking about the topics I have to review tonight, and deicded to pop on some Cat Stevens while eating dinner (thank god for itunes and having my entire music collection here-though that being said I have been listening to a lot of local talk radio-fascinating stuff w/ the SNAFU in Zimbabwe).

And Cat Stevens started to sing "On the Road to Find Out." A song I know word-for-word, as it's been very practical at other times in life. Fitting that it should come up now.

--On the Road to Find Out-- Cat Stevens
Well I left my happy home to see what I could find out
I left my folk and friends with the aim to clear my mind out

Well I hit the rowdy road and many kinds I met there
Many stories told me of the way to get there

So on and on I go, the seconds tick the time out
There's so much left to know, and I'm on the road to findout

Well in the end I'll know, but on the way I wonder
Through descending snow, and through the frost and thunder

I listen to the wind come howl, telling me I have to hurry
I listen to the robin's song saying not to worry

So on and on I go, the seconds tick the time out
There's so much left to know, and I'm on the road to findout

Then I found myself alone, hopin' someone would miss me
Thinking about my home, and the last woman to kiss me, kiss me

But sometimes you have to moan when nothing seems to suit ya
But nevertheless you know you're locked towards the future

So on and on you go, the seconds tick the time out
There's so much left to know, and I'm on the road to findout

Then I found my head one day when I wasn't even trying
And here I have to say, 'cause there is no use in lying, lying

Yes the answer lies within, so why not take a look now?
Kick out the devil's sin, pick up, pick up a good book now

I'd suggest listening to some Cat Stevens.. I'm way over my internet allotment for today (10MB daily). Tomorrow is Sunday, and it'll be the final day to get some preparation done. It's like before the first day of kindergarten all over again. I'm going to drive to work and make sure I know where to go. I'm going to lay out my clothes before bed. I'm going to make sure my stethoscope works (kidding).

Man, I feel damn lucky to be able to do this!

Cops vs Cops in Shootout

And this comes from... the headline on today's paper. I am not sure this link will work, but try: http://www.thetimes.co.za/News/Article.aspx?id=791079 for more information. And here I thought the cops were for safety...

 

Not much else really going on. Low key day. Went into Melville and scouted out a few restaurants, ended up hanging out on a coffee shop for a few hours and read a while. Speaking of coffee.. I've been back on instant coffee. And every more sadly, the instant coffee I bought is tainted (I use that word correctly) with chicory. I have coffee w/ chicory once before, and vowed to never drink it again. Well, that vow is up. I've been drinking it. So, imagine my delight when I found a single french press coffee maker in the cabinet yesterday! Woo-hoo. Don't get me wrong, I'll keep slugging the instant crack form of coffee, but sometimes ya just need a good cuppa. My stay here is too short to invest in a larger coffee press, and my budget this year won't allow for buying good coffee often, but I'll appreciate the occasional cup of single press when I do have it. Let me also mention what a great flatmate JW was for being a fellow coffee fiend and often times having a cup ready for me in the AM!

 

I got an email from the prof today, and looks like I may even be able to start on Monday. It that happens, will be more observational, as my indemnity insurance won't start until July 1, and as of right now, I'm still not licensed.

 

I'm getting a fair bit of reading done on HIV and other topics I don't know much about (malnutrition, congenital heard disease), and also reading a bit on pediatric infections. I'm using a SA text (which quite honestly I think it the best pedi text I have ever seen), and the antibiotic coverage is somewhat different. I think that is going to be one of the big adjustments is getting use to different meds. But hey, that's why I'm here.

 

I'm about to send off an email to our Pedi ID doc to ask her some questions about stuff back home. When was our last case of congenital HIV? What treatments do we use? How is it that I don't know the answers to these questions???? 2 months in the newborn nursery and this issue never came up? Oye!

 

Anyway, I'm sitting outside, the sun is going down. I'm going to make fresh cup of tea. I won't be out long, as soon as that sun is down it's chilly!

 

Cheers

 

 

Take your phone-in case you get mugged

[Disclaimer: Don't freak out, and I will apologize now if any of this seems like trite American in foreign place shit]

 

I actually didn't have any errands to run today. I'm pretty well settled in. I need to go back to the the med school campus one last time to get my staff card photo taken (exciting), and will combine that with a trip to one of the trendy-artsy areas (Melville).

 

Today, I decided I'd visit the Apartheid Museum. It was very humbling being in the museum, and to just know that human nature can be very cruel. The museum is full of photos, news clips, and stories. Sadly, I forgot my camera. There were exhibits of hanging nooses to represent people who were executed by the government (or who "committed suicide" in prisons or jails). Also, re-creation of solitary confinement. It was inspiring to watch clips of the Soweto riots as well. I left the museum, and then on my agenda was to explore another area of JHB.

 

So, I arrive in Newtown which is much different that what I had pictures, and quite frankly, different than my trusted Lonely Planet had depicted, and decided that the area was perhaps a bit out of my comfort zone to go walking around. Silly, possibly, but quite frankly I'm not bold enough yet to go places that I'm not entirely sure I'm good to roam around, solo.

 

This was similar to when I went driving yesterday afternoon. I needed a study break, and decided to actually drive down to Bara. I kept going down the road a bit, and after a few miles realized that I didn't see any other white people driving, or walking, or anywhere for that matter. 

 

This afternoon, while reading, I was starting to feel stir crazy. I needed to get out and expel some energy. I needed to go for a run or something. Incidentally, I did join a gym down here, but that membership doesn't start until July 1. So, I talked to Jemma, who lives in the house, and has grown up here. She said it was safe to run, and pointed me in the direction of a small park, and also of a close by nature reserve. I had known about the nature reserve, but didn't realize I was as close to it as I am. So, I decided the nature reserve would be great to check out. And it's literally a few minutes down the road. So, I'm headed out the door, and Jemma adds:

 

"Take your phone, in case you get mugged."

 

And it dawns on me, that if I do get mugged, the only thing they are going to get is my phone! Well, maybe my running shoes too. I point this out, and then Jemma convinces me to take it in case I get lost.

 

The run was great. I ran through the a neighborhood to the nature reserve, signed in, and ran until the park closed (5pm). It was nice and cool out. On the outbound portion there weren't any building to see, and the area opened up to this nice meadow. There are hills around Mondeor, which thankfully break up the skyline. On the way back the sun was hitting the horizon, and the hills took on a reddish hue. Running back, out of the park, I was greeted by the 4 or so white people who were out and about. This struck me as soooo unusual for various reasons. In Dublin no strangers say hi. In Springfield, no strangers say hi. I said hi or nodded to others who weren't white, and kind of got strange looks.. Interesting.

 

I'm sure I'll be sore tomorrow.  

 

 

 

 

Hats off to Bank of America

Hats off to Bank of America, for shutting off my cards after only one day! Thanks for the hassle of trying to get them back on. Oh so thankful for having good enough credit to have 2 credit cards. And yes, I did call them and tell them I was MOVING to SA, but that doesn't seem to have helped the situation. Bastards.

 

Wasn't planning on using this credit card anyway. Capital One doesn't have a fee for foreign transactions, but that card never arrived in West Springfield, and is presently being shipped this way...

 

 

 

 

Mantra

The mantra for today: "Stay Left."

 

It's really tough to make your brain continually do something the opposite way, when it has been doing something for so long. They dropped off my rental car this morning at 11 a.m. And initially, I was disappointed that it was an automatic. However after driving just a short distance, it was nice to not have to navigate shifting while getting familiar with driving on the left side of the road again. I managed to make it to two shopping centers, and to the medical school in downtown Jo'burg. On my taxi ride home last night, I spoke with the taxi driver about the cost of petrol. And, I think we figured it out in that it is about five dollars per gallon. It was a little bit painful to fill up at the pump this morning.

 

For those who want to now, both my bags made it. This is in contrast, to the little brother who's bags failed to reach their target twice on his recent trip with their family.  Having already unpacked.   am quite impressed this time. I don't think I packed anything to ridiculously unnecessary for this trip.

 

The house is nice. Right now, and the owner's daughter is staying here as well. Otherwise it is just she and I. There is plenty of space here. I will try and put some pictures up, but it will depend on the Internet situation.

 

Speaking of the Internet, I paid a small fortune for access to the Internet. I had to buy an adaptor which will connect me to one of the mobile telephone companies, and subsequently will pay per kilobyte of download. This is an expense which I suspect will be well justified. I went a time without home Internet access, and think that having home access to e-mail is essential. There are some downfalls, mainly there won't be much ability to surf the Web aimlessly (which may be a good thing), but also will affect my ability to upload lots of photos-well, at least from home. And, I don't think Skype will be all that great with the connection speed I will have.

 

I went to the medical school today to find out the next chapter in the saga of my quest to obtain registration with the Board of medicine here. To recap, initially, I was to have received my registration back in March. And then there were some minor issues which I will not bore you with, but suffice to say my license was supposed to be issued by June 13. It has not been done yet. Which, really isn't all that surprising. There is a good hope, that it will be done before July 1, and now that I am physically in the country, it seems to give some credibility that I actually deserve the license because I am here. Regardless, I will be starting July 1, and will have activities tailored to the presence or absence of a license.

 

It's nice to be back abroad. A change of scenery. Languages I don't understand. Constantly realizing I don't know the norm (whadda mean I don't pump my own gas).  I'm sure there will be more on this later.

 

PS -- Jo' burg is 6 hour ahead of Boston.

I'm in the airport at Abu Dhabi, and I'm TIRED! I managed to watch 3 movies. Etihad is a great airline. 74 movies to choose from. I have only slept in scattered 2-3 hours allotments the past few days..

 

Fri night was a nice round of sendoff drink w/ friends at my favorite restaurant:

http://picasaweb.google.com/brianpatrickbost/SendOffDrinks

 

Then Karin, Ted, Jackie, and Elsa drove me to NYC, where we crashed on Lucia's floor, arriving about 2:15 am. Lucia and I went for a nice morning stroll about 6am, and then it was off to the airport. It was nice to have the gang along for moral support.

 

I'm not sure the balance of this blog/website and my Bara blog/website (notesfrombara.blogspot.com), but I'd check both of them. I may at times post to both, and may at times just post the more personal stuff here.

 

Cheers,

 

 

 

 

Failure of Ownership

In adult medicine, we talk about ownership. Of patients. Ownership of patients. Who "owns" the patient. A term which we use to bring a sense of personal responsibility to taking care of our patients.

 

On Friday, as I was sitting at the pedi graduation party, there was a comment made about how taking care of children is a special privilege and that children are the most important thing in the world to their parents, so when we take care of kids, we should not go about our job lightly.

 

To me, these are the same issues-presented in different contexts. It's about realizing the significant role we play in the lives of others, and the responsibility we have to provide the best care to those whom we serve.

 

I strongly believe in taking full responsibility for patients.

 

Patients

in

the

hospital.

 

At 4:30pm I logged on to the computer, and a message popped up. In my mind I was already out the door, trying to figure out where I was going to go get my haircut. But I had 2 orders to enter, and when I logged on, I noticed I had an inbox message. I let out a groan, assuming this was yet another medication refill request, and debated leaving it til tomorrow.

 

But the Aquarian curiosity got the best of me and so I opened the message.

 

RT was in the ER. And then things ground to a halt.

 

Four hours earlier, I had gotten word that RT was going through hell. His mom had called because she was very concerned about him. I had never met RT, but I am his Primary Care Physician. For over a year, I have been his PCP. And I have never met him, and now he is in crisis, in the ER, and I am his doctor-but only for 4 more days and what the hell do I do???

 

I believe in ownership.

 

He came to the ED because when I heard what had happened that nauseated-gut-wrenching-ill-feeling hit me, and I I was bound and determined to help my patient. At some point, a paternalistic-physician mentality takes over, and there is an outreaching to help. It's the core value of my profession. I scrambled to figure out who would be able to track down RT and make sure he ok.

 

I found him in the ED. It was easy. His bloodshot eyes showed the strain of days of tears.

 

I introduced myself.

 

"You're my doctor." He looked surprised to see me. Which was fair.

"Yes, I am. We've never met. But I know who you are, and what's been going on, and I came to meet you personally, at last."

 

I'm here because of guilt. I don't take ownership of all my patients in clinic. There are ones I know well, and I think I take ownership of them. But there are many, many more I don't know well, who I may see once a year, or have maybe met once or twice in 3 years. And there are those who are "assigned to me," and quite frankly, I don't have any clue who they are. RT and his partner (JT) were assigned to me over a year ago, but I have never met them; their infectious disease doc managed most of their needs. Managed their ID needs. But as their PCP, I am responsible for managing their health, which includes their mental health. And knowing that JT committed suicide a few days ago leaves me feeling like I failed to live up to "ownership." RT and JT were assigned to me for a reason, and knowing that I did not live up to my own standard of taking special care of, and interest in my gay male peers compounds this feeling of failure.

 

And there I sit looking at a broken soul.

 

We talk. There is a total lack of privacy sitting in the hallway of the ER, but oddly the rest of the world seems to go silent as we talk. 

 

I have gone into denial about what will happen when I am gone from the clinic for a year. I don't ask what will happen to my patients. I have taken a leap of faith that somehow "The System" will work and that my patients-those who I own, and those who are assigned to me-will be provided for in the year to come. But sitting, talking to RT, I realize that blind faith is a lousy plan.

 

I tell RT how he can get in touch with me, day or night. Fuck the system.

 

Today is a failure of patient ownership.

 

I know full well that the events that have happened were going to occur regardless of if I had ever met JT, but today serves as a reminder that I have a cadre of patients, whom I can serve better than my co-residents, and that ownership should extend equally to the outpatient world.

 

Final Week

Hard to believe that this is the final week at work, and then flying out on Saturday.
 
It was a whirlwind weekend with Heather flying in from Tacoma on Friday.
 
The two big highlights from the weekend was going to Dave Matthews concert on Sat night (thanks to heather), and seeing a great show. I'm sold. And then yesterday was the baptism for Ian and Emily, followed by a great party at Karin's.
 
Am working on the final to-do list, and I think for every one thing that I cross off, two more go on the list. Have yet to find a converter for SA, but suspect I can get one at JFK or in Abu Dhabi... Having a packing fiesta tonight, have enlisted a fellow glove setter to help with the final prep.
 
Cheers!
 
 

Reality...

Has set it.

 

It is crunch time. And I feel it.

 

The 2 week mark is here, and all of a sudden there is this overwhelming desire to try and do about a hundred things at once.

 

I've had many great attempts recently to jot down a few thoughts, but when I sit down to write, I get distracted by other tasks that feel more pressing.