Broken Clutch

I don't even know where to go with this one...

It's something related to shifting gears. There I was, sitting the the Liberty, back at DIA. Upset that my time in Haiti was cut short, unable to stop thinking about my friends, and my patients at JP and trying to justify why it was that I had changed my ticket, yet again--and had flown back early so that I could make sure that I would get back to work in time.

And ironically, as I started the jeep, tired/exhausted/frustrated, my clutch went out. I was stuck in neutral. Unable to maneuver into reverse, let alone into a forward gear. That was -me-. Stuck.

And I just sat there. The fucking jeep started. So why not just sit there and listen to music, let the heat run. I even contemplated just sleeping in the fucking thing. My friends in PaP knew I'd left, but outside of that very few people knew where in the world I was. I wasn't sure where I was. But -this- was defeat.

The irony wasn't loss on me. Jeep donated 8 Jeeps to JP. Four Jeep Laredo's and four Jeep Wrangler--and the clutch had burned out on three of them. As I was walking to my Jeep, the thought crossed my mind that I needed to get AAA-- my clutch was showing signs of fatigue. The universe beat me to it. My clutch was dead. I didn't have AAA.

I felt stuck in neutral. I didn't want to be there. I didn't want to be here. I'm in a state of lateral movement. I'm gaining skills and confidence as a physician, I'll start my MPH (Masters in Public Health) in a month, I'm putting money away for future rainy days, but every day I don't see the progress forward... progress toward finding that niche where I'm meant to be; be it in Haiti, South Africa, Sudan, Cote d'Ivoire, Lesotho.

People ask... but how do I explain. How do I explain what it is like to show up to PaP and see the level of fatigue on your friend's faces. How do I explain how phenomenal it is to see the amazing expansion of the medical services at clinic. H0w do I explain how fucking pissed off I feel that Haitians are lying on cholera beds puking their fucking guts out while having diarrhea--in TOTAL LACK OF PRIVACY AND DIGNITY, and even worse, families have survived the earthquake, shitty existence sine then, and then died from a completely fucking curable and avoidable illness???? How do I explain that tomorrow I'm rounding on a 91 year old female who has an incurable cancer, but whose family wants everything done to prolong her life?? This kills me.

And so, I'm stuck in neutral. I'm not making forward progress. I'm not slipping in reverse. I'm just iddling. A necessary evil til I can get the pieces in order to go forward. (And trust me, every single day when I wake up I look toward that next mission).

Ironically... Ironically as I was sitting in the back of my ride as we headed toward the airport in Port-au-Prince, we passed innumerable decapitated vehicles on the road. And I wondered about the owners. Some of those vehicles had tires missing. Some had the engines torn apart. There was likely little hope that those cars would ever get back into moveable shape.

And so I turned off the radio. I'm lucky. I got on my iphone and booked a rental car. I have the means to fix my fucking clutch, and I this is a minor annoyance, but totally manageable.

I'll be stuck in neutral for a bit... Til then, I'll continue to admire my pals who are moving forward and making the world better (Jack, Beth, Phil, Melissa, Maeve, Jeff, The National Docs, Pete, Bruce, and on and on)...

On the Eve of World AIDS Day...

Who gives a fuck?

Have we forgotten that there are 35 million people living with HIV/AIDS?

Have we forgotten that there are 2.1 million children living with HIV/AIDS?

Have we forgotten that more than 2 million people die each year from AIDS?

Have we forgotten that there are 14 million AIDS orphans?

Do we not realize that there are 7,000 new infections every single day?? (Oh yeah, 1000 of those are in kids under 15 years of age).

Have we forgotten about the HUGE number of people worldwide who cling to hope that they may get access to life-saving antiretroviral medicines? I have seen people literally beg to start these medications...

For days now, I've been looking for a World AIDS Day event in Denver. There are paltry few events. December 1 will pass here as an ordinary day. And, I suspect that will be the case in most other cities in America.

But December 1, and the thought of World AIDS Day, causes me to stop in my tracks. I can't but help to think back to my experiences at Bara. Patients appear in my mind; their names may no longer be easy to recall but their faces and stories will never leave my memory. I will never forget KR's face--he was the most angelic 4 year old child I have ever seen; and I will never forget how shocked I was when I came to work one morning and found out he had died (http://javamania75.blogspot.com/2008/07/kr.html). While there were innumerable deaths, there were great success stories as well--mainly because those were the people who were able to get on ARVs. (Yes, that includes you JC- every time I think of you I recall our first meeting in clinic, and how amazing you are doing now).

As I try to write this, I flip back to old blog posts, and I get lost in this overwhelming feeling of hopelessness... Not helplessness, but hopelessness. I don't know where to go with this, but would hope that on December 1 2010, you think about those whom you know who have died from HIV/AIDS, or are living with HIV/AIDS, or think of how fortunate you are to be in a place where you would have access to treatment, or attend a World AIDS Day event, or find a way to donate (even a few bucks) to any of the bigger organizations (either those supporting events at home, or abroad). This year, I'm inspired to participate in the AIDSLifeCycle Ride (http://www.aidslifecycle.org/) in June (god willing, and i still need to buy a bike--you can also make a donation to me, but probably better to wait til spring to make sure I get a bike and get time off to ride).

That's my contribution until I can bet back to my South African home and resume my work there...

Peace.

Sticking Out

 

Our eyes lock. Now I am sure it is going to happen. Confrontation is set in motion. I am not in the mood to play this game. I didn't mind playing it while I was living here, but not today.

"See them?" JC nods behind me. I don't turn around, it would be obvious. "Time for them to make some money. The end of the month is a long way off."

 

I resist the urge to turn around and look. I had seen the police truck slowly go down the road, and had seen it make a U-turn, now I could only assume that they had set up a road block directly behind us. I thought I could do it inconspicuously, turn around, see where they were. But I didn't do it conspicuously, it was obvious. And then as he had pulled over a car for no reason, he looked at me. I don't know if I really saw it, or sensed it, but there was a grin.

 

I equaled money. I bet he was certain I would pay the bribe.

 

Maybe it was all imagined, but I knew I stuck out. What white person would be hanging out in Soweto on a Sunday afternoon? What white person would be standing outside, next to his shitty Mazda rental, talking to another foreigner. A Zimbabwean. Was I a xenophobic-fighting sympathizer? Maybe I was a lawyer working for human rights, in which case the policeman needed to calculate his risk carefully. In my green Carharts, worn Asics, and t-shirt, I didn't fit the look. But still, I knew I was being targeted.

 

I remember the night I asked my friends how exactly I was suppose to approach bribing the cops. Ironically I asked at dinner one night, and then a few days later I was pulled over. I didn't need to flash some cash, in stead when the officers saw my stethoscope, I was immediately let off. Even though I had a valid drivers license, a fully registered car that was insured, as well as a car which has recently passed a safety inspections, I knew that none of those would mean shit if I were pulled over, and said policeman needed some drinking money. But I soon learned that having my hospital ID card, and a stethoscope would keep the cops respectful. Perhaps it was simply bad Karma to detain a doctor. Though, I should mention that my colleagues had plenty of stories of speeding at night, being pulled over, and simply lying that they were on their way to the hospital, often to try and save the life of a dying child, or a sick pregnant lady. While living here, I did learn how to manipulate the truth.

 

But I had no desire to lie today. I didn't have a stethoscope or my old Bara ID to back me up. (Though I almost brought it with me for just that reason).  I had no desire because I was looking forward to spending the day with a friend and his family. I also was annoyed at having been pegged the sore thumb. It didn't seem odd to me to be here in Soweto. I had long grown accustomed to being the only white person at the gym, at the mall, or even deeper in Soweto. But all of a sudden, I was acutely aware of how much I stuck out; I knew I was going to be targeted. Fucking cop.

 

In my time here, JC taught me a lot. The focus of our conversation often went to politics. As I tried to figure out how the hell it was that Mugabe has kept such a long rein on Zim, and wondered why MDC hadn't been able to overthrow him, or why the people hadn't risen up against the government, JC would explain the deeper issues which precluded these actions from happening. I had deep admiration for him, and his wife. Would I have the smarts to flee my home, and figure out a way to survive in a foreign country? Not just survive, but to rebuild a life in a country in which a year earlier the local has sought to actively kill foreigners. Xenophobia was alive and well. And sadly xenophobia is alive and maybe still well? Ug. Months ago JC emailed me that he was working, as a teacher. This man continues to humble me. I couldn't wait to see him and his family.

 

The night before, I was having dinner with Juno, who had been one of the ID consultants that I worked with. When I told her I was going to be seeing JC the following day, she asked for his number, saying they had lost contact since she had left Bara. Ironically, when I saw JC earlier in the week, he said he hadn't been able to get in touch with Juno, and though he has lost her number. I didn't hesitate to give patients at Bara my personal mobile phone number, but I felt this made me stick out—almost as an overly sympathetic doc. This was frowned on by many of my co-registrars (residents), but to those in the HIV clinic, it was a standard practice. The ethos was that as their clinicians, the patients needed to be able to get in contact with their physician should problems arise—day or night, or even weekends. It was an ethos that I firmly believed in. For years I had told my clinic patients back in Massachusetts how they could get in touch with me via the hospital operators, who would then send us a pager method. It would happen, from time-to-time, that they would call for advice, for medication refills, and on rarer occasion when something else was going on, like depression or domestic violence. The pager, though, added an extra barrier level; they couldn't directly get in touch with me, and it afforded me a certain ability to screen their needs as well. But when my patients at Bara had my mobile number, the same number that my family, friends, and everybody that I knew had, it made me feel vulnerable at first. What would I do if I were constantly harassed by a patient? Would I go through the headache to change my number. The possible abuse that I worried about, never materialized. And after a while, it just felt natural that my patients had my phone number. And in fact, my patients knew that when they were hospitalized, that if I hadn't seen them by the afternoon, they were to call me, and tell me which ward they had been moved to. If I hadn't seen them by the afternoon, it was because I couldn't find them!

 

And so there I was, standing outside with JC; a white foreigner talking to a black foreigner, in a neighborhood in which "I didn't belong" while under the watchful eye of one of Johannesburg's-less-than-finest, looking to make some extra cash. I didn't want anything to interrupt my afternoon to catch up with my friend, and his family; but I was expecting confrontation. In the back of my mind I kept thinking of the story Carlos had told me days earlier when he had been pulled over. A Spanish National, driving with his Spanish drivers license was almost arrested when he didn't pay the bribe to the police officer. How was I going to spin the possible story that was developing??

 

JC, his wife, and daughter and I got into my Mazda, and backed out into traffic. The policeman was in the middle of the road. I felt my heart rate pick up; the adrenaline was certainly flowing a bit quicker in expectation of the confrontation which was moments away. Our eyes locked for a second time. Where my actions came from, I'm not sure, but I simply waved and smiled as I rolled down my window and said hello and just kept driving…  Confrontation averted, that time.

 

 

 

 

BPB

Reflections from Jo'burg

[It has been a long time since I felt compelled to write. This is overdue, and a culmination of the influences of many friends, people, places, and experiences.]

 

At one point just over a week ago, I just sat down alone to contemplate the mess that I felt I had gotten myself into. "Mess" is a somewhat pessimistic word, but that is what it felt like. I was unsettled. There I was, in Port-au-Prince, doing the exact work that I want to do as my career, surrounded by some of the most unselfish, hardworking, fun people that I have ever met, working in a true humanitarian disaster, and I needed to figure out where I would be the following week.

 

I had a ticket booked to Johannesburg. I had a medicine board exam to take that I hadn't really been studying for. I had an apartment reserved in Denver. I had a job lined up in Denver. I had finally stopped panicking every time a pregnant woman, in labor, came into the clinic. I had received a phone call a day earlier from my recruiter at the locums agency who informed me that she had plenty of options for short-term contracts in Aspen, Vail, Denver, and elsewhere in the Colorado--I just needed to let her know when I wanted to start, and how long I would work for.

 

I tried to figure out which principles should guide my decision: professional goals/obligations, financial goals/obligations, my own ethos (the fact that I had basically given my word to a future job that I would be there on Sept 7). There were multiple options. Go back to the US, take boards, cancel my Jo'burg trip and return to Haiti for 2 more weeks. Go to the US, take boards, email my future job telling them I had changed my mind, call my locums recruiter. Not go back period?? I had already made one unexpected decision this summer (that being to return to PaP), and making another unexpected decision would not really raise eyebrows amongst family and friends. I could not come to a decision that day. I needed to sleep on a few things.

 

Somewhere over the Atlantic, I was two-thirds of the way through Where Men Win Glory¸ Krackauer's book about Pat Tillman. I was absorbed in the book. Furious at the US government/military, but also engrossed in the way Tillman made decisions. He was a man guided by his own set of principles, and when making decisions, it was his own dogma which dictated what he should do. And that is why I was on a plane headed to Johannesburg. The following day, after contemplating what do to, I realized that I had made a commitment to my future job and bailing out this late in the game wouldn't uphold the commitment which I have given. This was combined with the fact that my financial obligations really require some of their own disaster management. I had also planned this trip to Johannesburg long in advance, and since I wasn't sure when I would have time to visits Jo'burg down-the-road, it felt important to come back and spend time with my friends here.

 

As the plane started to descend, we flew just to the east of the city, in a path that went south past city center and then made a u-turn coming into the airport from the south end. Before making the curve back to OR Tambo Airport, I got one of the best overviews of Johannesburg. I could see the slow morning rush hour traffic on the M1 as commuters headed into the city center. Even better, I could see the new soccer stadium, and the famous water cooling towers of Soweto. And then Bara became visible. I tracked the road down from Bara, and saw Southgate Mall where I did use to go shopping, an even spotted my old gym. We flew just over my old neighborhood, and I was able to look down into the nature reserve where I use to run and hike.

 

And then it hit me, I was home. This is home. This is where I had the best year of my life (well, aside from the year I was 5, which was a pretty great year too). Some of my best friendships were made here. Some of the most meaningful work experiences happened here. I still picture many of my patients from Bara, and often think about how they are doing or if they are even still alive. Some of the most heart-wrenching deaths happened here, like the death of four year old KR. Some of the most bizarre things I have ever read happened here (cops vs. cops in shootout was a newspaper headline).

 

I felt an urge to get off the plane, get into my car, and just drive, at once, to all my favorite places. Instead, Andrew and David met me at the airport and then we went to lunch and had a great time catching up. When it took me two hours to get a new SIM card so I could have a SA phone number, I just had to laugh at the annoyance of going to 8 different stores in 2 different malls to find one. I was home.

 

I think that, somehow, I knew I needed to come back to Jo'burg for other reasons. My friends here would have understood had I bailed on my trip. But I knew that being here would give me some down-time to go back to those issues from above and to figure out my next game plan. I also needed to be here to spend time figuring out what the fuck happened in the year since I had left.

 

When I left, I knew I would be back. I was so certain of this, that I almost didn't bother to sell my car. I wasn't sure I would be back in South Africa; it could have been Lesotho, Botswana, or Swaziland, which would allow me quick regular escapes to Jo'burg. But I was sure I would be back in this area. If I hadn't needed the cash from selling the Bakkie (SA slang for a small pick-up), I'd be driving it now.

 

Days before I left South Africa, Randall and I had a really meaningful conversation. I remember it with perfect detail. It was Saturday morning. I had just made coffee, and was reading the NY Times on-line. Randall came onto skype, and we decided to catch up. We talked about his life in China and my impending departure to Massachusetts. He told me about the difficulties he was having in his personal life, but it seemed that things were getting better, and he was making plans for some changes. I whined that I wasn't ready to leave, and that I was envious that he had extended his contract in China. It had been a long year and then some for him, for me, and for us. I don't know how or why it happened that day, but during our conversation we seemed to have really re-connected. We actually decided it was time to fix things. He was no longer mad at me for asking him to not visit me when he had a vacation. I was no longer mad at him for abruptly ending things. And somehow we started to talk about future plans, dancing around the issue of other future possibilities. He wanted more time in China, maybe two years he said. I would spend a year finishing residency, and then I would work for a year in South Africa/Lesotho/Swazi/Bots . And then the following year we would both be back in Colorado. Two days later, as I departed South Africa, I knew I would be back in one year.  A week later, Randall died. In the confusing time after his death, my plans to return here, to South Africa, died as well.

 

The highlights from the past year pale in comparison to the previous year (Bara, Nepal, Kilimanjaro, Ethiopia, Cape Town trip, backpacking trips and on and on). There was the wedding in Hawaii last July which included a luxurious stay at the Four Seasons in Lanai. There were some great dinners with friends scattered around New England. There was an impromptu road-trip to the cape, as well as to Maine. There was the joy of trick-or-treating with my nieces and nephews on Halloween. There was a great trip to California to see some of my dearest friends. There was the fact that I had finished residency, finally.

 

By far, the best highlights were my trips to Haiti. In February, working in Milot with earthquake survivors, had been one of the most challenging experiences I had encountered as a physician. When I was re-assigned to an adult tent (and pulled from the pediatric ward) , those 35 female patients were solely under my care. I was charged with managing their infections, their blood pressures, making sure they were getting their wounds managed appropriately, making sure they were scheduled for their cast changes, skin grafts, and revision amputations. The days were long, but the work was incredible. It re-affirmed that this was the kind of work I wanted to do.

 

My experiences, thought, in Port-au-Prince trumped Milot. Maybe it is unfair to compare the two. The services in Milot were entirely medical. While in PaP, I was part of a bona fide humanitarian mission. The organization I was working with, was responsible for managing a camp with 52,000 internally displaced persons (IDPs). The NGO had to provide/coordinate shelter, security, water, and medical services (among other things).  The team in PaP was loosely split into "medical" and "non-medical." There seemed to be an honest admiration for the work that the other team was doing. Neither was more important; both were essential to providing for the people of the camp. And that was refreshing. To know that there was a larger mission than just medical care enhanced feeling like part of a greater team. I felt lucky, that in my month in PaP, the "non-medical" and "medical" teams enjoyed having dinner together, hanging out on Sundays (the day off) and drinking together.

 

What was most impressive though, was the almost-sacrifice-type commitment that people had made to be there. People were volunteering there because they wanted to be there. Everybody had paid their own airfare to be there. Some were using vacation time. Some were on summer breaks between college or masters programs. Yet others came to PaP in-between careers, and one made a career change partly influenced by being in PaP. Upon that background, volunteers slept in tents (either on cots or sometimes just sleeping pads), often showered under a garden hose, and spent most of the time confined to the camp where we were working. It was a pleasure to work with that crew, they were perhaps the most down-to-earth hardworking team I've ever worked with.

 

There was another element which I hadn't experienced, and that is one of the full humanitarian roll-out process, and working amongst the presence of so many different aid organizations, both governmental and NGO. At times I was amazed at the lack of coordination amongst the large groups, all working in their own microcosm in the middle of this city which has been destroyed. The allure of the UN was also enjoyable.  Meeting UN soldiers from Bangladesh, India, Brazil, Nepal, Morocco, Philippines, and hearing their stories about being away from home, often away from families was inspiring. One of the best parts was being the invited guests to one of the Indian UN base camps, meeting their commanding officers, and being wine and dined for a night, which included fresh, authentic Indian food. Delicious.

 

I departed PaP on a Friday, arriving late to my place in Massachusetts that night. On Monday I was sitting in front of a computer screen, trying to answer questions about medicine, in the hopes of becoming board certified. A minutia question of differentiating the cause of anemia popped onto my screen. Are you kidding me? I know I'm suppose to look at this picture of red blood cells under a microscope and know if this anemia is from  B12/Folate/Iron deficiency, Thalassemia, or some other cause based on how the cells look, but I don't care. This is not practical. A few days prior, as I pulled down the lower eyelids of malnourished, feverish child, and saw how pale the conjunctiva were, I diagnosed the child with anemia. I didn't know how low the hemoglobin was, I'd guessed less than 10, easily. I didn't need a microscope to know the cause of anemia… Malaria. Malnutrition. Why wasn't this on my test. I kept thinking back to my pals at J/P, knowing that it was Monday, they were short staffed, and they would be getting swamped that day. What the fuck was I doing in Massachusetts, taking this ridiculous test?

 

Less than 48 hours after the exam, I was on a flight to South Africa.

 

I'm envious of my friends who are still working in PaP, more envious of those who I know will be returning there before me, and still even more envious of those who are doing humanitarian work, as their career. I am humbled by those who are forging ahead and making it work.  I look forward to the day that I can rejoin my J/P pals, on a permanent basis, sleeping in the tent, wondering if the chicken we are eating were the chickens that were alive out back a few hours ago, bracing for the onslaught of another Monday clinic. I look forward to the day when Chris calls me from Darfur (or what ever conflict-du-jour is taking place) asking if I can come set up a mobile clinic for his IDP camp. I look forward to the day that Matt/Jack/Jeff/Andy are only a radio call away as I call them because the hospital electricity as gone off, again, and I need electricity for the nebulizer machine for the child having an acute asthma attack. I look forward to endless hours of Frisbee with Mark and Lee, maybe not on the LZ, but across a rice paddy, or on the savannah. I look forward to the day when a crashing patient shows up in clinic, and Paul/Andrew/Annette/Mellissa/Jodie/May/Lindsay/Beth/Lee are there to help.  I look forward to Sonia calling to say she is going to help bail me out, again.

 

And so, I find myself again contemplating where things are headed. This time, I am not sitting in the tortuous heat of Haiti. I am sitting on the back deck of Siza and Scott's house. It has taken me a few days to finally unwind and relax. The influence of good friends, and great wine have brought me to the point where I can finally sit back, in the warm winter Johannesburg sun, and realize how it is that I am here as a visitor, not as a resident. I am reminded that I am very fortunate. I have great friends (who are scattered around the world at this point- Sapna: where the hell on the globe is Chuuk anyway?), good health (even though my legs burn from running yesterday), a great family (who will be disappointed when I leave Colorado, but will always be supportive), and a profession which has plenty of job options. I still don't know for sure where the next move will be, but I know which direction I will be heading; it will be toward humanitarian relief work. It may be Haiti, South Africa, or it may be where MSF/UN etc places me. All I know is that as soon as I can, I'll be back out in the field.

 

Keep a tent open for me, I will be back.

Soon.

 

 

 

 

BPB

Passion. Is it Dengue or Malaria? 100 Days.

PASSION.

 

I couldn't sleep the first night. I was amazed that I was actually in Haiti, amazed that I was able to sneak out of residency for a week to actually contribute my skills in Haiti. I couldn't sleep because of the buzz about the place. How was it that I had ended up in Milot, working with some of my colleagues from Massachusetts. The buzz of new people arriving daily to help, of people I'd just met the day before who were now leaving. I'd walked into the pediatric ward, shocked to see a room crammed with not only 45 pediatric patients, but parents, siblings, aunts, uncles, and in some cases, complete strangers taking care of children. I'd picked up Jamesly, who had a "spinal fracture" and noticed that he was breathing way too fast for his age, looked at his spine xray, and seen that his lung fields showed a classis picture of PCP pneumonia. He had AIDS. The back fracture was Potts Disease (TB in the spine). This kid was in trouble. I was working with two pediatric ED attending from my hospital back in MA, but here I was, the expert about this child's condition, and treatment. Jacki was flown in from the USS Comfort missing a large portion of his skull, which was removed because of infection. The USS Comfort had sent him here with 6 weeks of an IV antibiotic. Fat chance of keeping an IV in this kid for 6 weeks. Maybe in a hospital set up to place more permanent IVs, but we didn't have that luxury. Looking over his notes, there was a better choice, which he going get as a once daily injection into the thigh (for when he lost his IV). I made the change to his chart (and later confirmed with 2 infectious diseases docs, who agreed). Our pedi team had gone back to the tent after our 8pm staff meeting, making sure that evening meds were given, re-examining the few kids with active medical issues (meaning those who had more than just orthopedic issue).

 

After the night round, we all hung out talking about what was going on. There were almost 400 earthquake victims here. The place was abuzz. We were all here, most having taken unpaid leave from our jobs, some paying their own way here, all with the same purpose. To provide what we could to those who were affected by this horrible earthquake. I couldn't wait for morning, for a chance to get back into the tent, to get a better understanding of what needed to be done for all the kids who had casts on, all the kids who had external fixation of their fractures, all the kids who had bandages covering their wounds and their skin grafts.

 

The days quickly because 16 hour days. There were minor victories (no more bandage changes, seeing the physical therapists getting amputee kids up on crutches), and set backs (not being able to treat phantom limb pain, not having mental health counselors to deal with those most severely traumatized by the earthquake).

When word came that I was going to be pulled out of pediatrics and be sent to Tent 4 my colleagues from MA went to the director to protest. "He can't be pulled from peds, that's where he is needed, he knows what's going on with all those kids." But I saw Tent 4 as a challenge. 35 female patients. And a test to flexibility. That's the gift of being dually trained in internal medicine and peds, I can treat both. So when the schedule came out in the morning, I went to Tent 4, starting anew with women who had shattered pelvises, shattered femurs, nasty wounds, hypertension, diabetes, and one with extreme heart failure. (Tent 4 had been run by a doc from MA who had been in the first med-peds class where I do my residency. 23 years ago, she took a year off from residency to work in Kenya for a year. She and I are the only ones to ever take a year off from residency-we bonded quickly). The temperature in the tent approached close to 100 degrees on the worst days. But the work was so invigorating...

 

The 16 hour days continued. I'd pop into the pedi tent to check up on the few kids I couldn't let go of (was Jamesly getting any better?), and then head to Tent 4. After the evening staff meeting, one of the nurses and I were back in Tent 4 for an hour, giving meds, checking temperatures on the patients who were teetering on sepsis.

 

Getting back to the staff compound after rounds, it would be time for social rounds. After a few days, it felt like I'd been there for weeks.

 

I laid in bed the last night, petrified that I would sleep through my alarm and miss my ride to the bus station (to take the bus back to the Dominican Republic). I was beyond exhausted. But unable to sleep. What would happen if I showed up a week late to residency and stayed another week. How could I go back. How could I leave the most meaningful work I've done since I left Johannesburg???

 

It was painfully clear. This is the work I want to do with my life. I fight an overwhelming urge to call my future employer and tell them that I made a mistake, that I don't need an income, that I don't want to work in a fancy hospital with MRI available at all hours, and let them know that I'll be working in Haiti, or back in Sub-Saharan Africa. Sorry for the hassle. My bad. [Though, of course, the job is a done deal, and it's a necessary step for professional reasons as well].

 

I like the chaos. Chopper landing with new patients, our tent is basically full, but we're getting 2 more patients. No problem, we'll scoot the cots even closer together and make room for 2 more patients. What, we're going to get three patients?? Fine, we'll scoot the cots right next to one another.

 

I like the challenge. I went on a drug search for my patient in extreme heart failure. What drugs are available? The smallest lisinopril tablet is 10 mg? Fine, well cut them in half and start at 5mg. There's no spironolactone, anywhere? Fine, what other diuretics do we have (this is post lasix diuresis for NYHA Stage IV). Somebody thinks they saw carvedilol tablets a few days ago in a plastic bag in tent 1? Great, I'll go find a stash for my patient.

 

Watching a random group of doctors, surgeons, nurses, therapists, logisticians, translators, carpenters come together and work non-stop in less than ideal conditions, working for free, all to help out a group of people who have been marginalized for a long, long time, in a attempts to save lives and alleviate suffering after a horrible disaster, and meeting a group of patients who define resilience and have so bravely taken on the challenge to get better, and to go on with life was one of the most profound experience of my life, and I'm utterly humbled to have been able to play a small part.

 

 

Is it Dengue or Malaria?

 

It started the night I got back. The fevers were sky high. The chills so bad I couldn't keep from shaking. The sweats to bad I had to change clothes. The fatigue so bad I had to sleep in my Jeep before driving to clinic. Coming back from Haiti, sick, was not part of the plan. I'd been pretty careful. Had taken my malaria prophylaxis. Had gotten my typhoid vaccine (though a bit late). Had used plenty of DEET for the few mosquitoes that were around. But something was kicking my ass. Bad. The treatment for Malaria didn't help. The dengue labs would take a week. A bunch of my labs were outta whack. My doctor (one of my clinic attendings) was consulting an ID doctor, I'd seen an ID doctor the day she'd been out of the office, and that ID doctor was consulting the Chief of Medicine. Always a joy to be the mystery patient... my PCP, plus 3 specialist in infectious diseases... It took a week, and the verdict was Mono. Thankfully dengue was negative! Somewhat ridiculous to get mono at this age. And having mono during residency is less than ideal, nothing like adding fatigue to the picture, as if the job wasn't tiring enough. How I got mono remains a mystery, and of course the rumor is that there was some secret romance in Haiti... If only my life were that exciting. In a weird way, it was good being sick. It can be easy to minimize the symptoms that patients complain about, so it was a good reminder that it really sucks to be sick.

 

100 Days

 

I have 100 days of residency left. ONE HUNDRED. It's so close I can taste it. The next phase is coming... and it's exciting. Back to Haiti for 2 weeks. 4 weeks to study for medicine boards (some pedi studying) and to figure out what will get moved to Denver. Medicine boards and then 2 days later back to Jo'burg for 2 weeks. Then back to MA and leaving the following day to drive to Denver. And in all honesty, as much as a part of me doesn't want to be in Denver (my adolescent side), part of me is really excited (my adult side); excited to be close to nieces and nephews, back to the Rockies, a place where I can walk to things (and maybe even bike to work here and there), and part of me is really excited for the job that I'll have-I'm going to learn tons and become a better doctor, and have flexibility to keep working abroad (most likely Haiti) a few times a year. It'll help me get to the next place in my career.

 

 

 

BPB

Please ignore the typos etc in the post below, i was slightly horrified to reread the message last night. It was composed on the bus as we pulled into santo domingo

Departing Haiti

I am on the bus, headed back to Santo Domingo in the DR.

For days i dreaded leaving Milot and the Crudem hospital. It was perhaps one of the most intense, moving, and meaningful experiences. I have been on the bus today napping, and thinking about "my" patients. The 50 kids we took care of on peds, and then the 35 women i took care of the past few days.

I dreaded saying the goodbye. Trying to imagine how it would feel top be in there shoes, a constant change of doctors and nurses coming and going. Building a relationship, and then then departing. I became quickly attached to many people, patients, fanmily, and Haitian staff.

I was afraid i would lose my composure when i announced to the peds ward, and theb my female tent that i was leaving. But by the time i made my last round at 8pm last night, i was so exhausted that it was a non-emotional goodbye.

I know it won't be long until I am back.

Impending Departure

I have a tough time describing the experience here. Moving is probable the best word.

I wont be ready to leave. It will be tough to say goodbye, and i will wonder what happened to the kids who have been orphaned-who have had their parents killed. I will wonder about our amputees and if they get their prostheses. I will wonder about the women in my adult tent with their pelvic fractures who are bed bound.

When i leave, part of me will remain. But I am sure it won't be long until I am back here.

Haiti

Will have lots to tell. Have ended up in milot, sacred heart hospital, run by Crudem (google it). About 400 + patients, will be working with some docs from baystate, doing peds for the next few days. Good supplies, lots of doctors. Pretty devastating to see so many kids who have had limbs amputated..

Off the Grid

I'm headed to Haiti. Cap Haitien specifically. Will be going with Haiti Marycare. Though I have just head that 2 pedi ED docs that I work with are in a town about 30 miles from where I will be. It's a small world!

 

It was a bit of a long shot to be able to get the time off to go, but somehow it worked out, so am headed out tomorrow. The blog has been pretty silent for a while, not sure that there will be a lot of posting from Haiti, but will see what I can do.

 

 

BPB

Decision

I made my decision on January 1, 2010. After months of agonizing, examining the decision from financial perspectives, career development perspectives, my own personal drive and desires, and the need to live somewhere sustaining (for a while), I decided to take a med-peds hospitalist position here in the US.

It's a 180 degree about-face from where I thought I was going to be that day I got on a plane to move back to America. I was certain I would be moving back to somewhere in Africa in the summer of 2010. I-Was-Certain. It'll be good to make some money to appease the student loan people. It will be good to spend some time growing as a physician. It will be good to spend some time with family (especially nieces, nephews, godkids and all the other kids). But it won't be long... Won't be long til I'm driving on the left side of the road, or taking off somewhere where I don't speak the language..

 

 

 

BPB