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

Losing Clarity

In the periods last year when I didn't keep a blog, I kept a travel journal. The writing is vastly different from what made it on the pages of the blog. The writing is more focused more like making notes to document what I was thinking at that time.

 

While sipping some Johnnie Walker, I decided to flip open the travel journal, and pinpoint where I was a year ago. Where was I in my thinking about where my life was headed. And where in Nepal was I?

 

I was in Bardia National Park. I had spend the day on a rafting trip. It had been cold. We didn't see much in the way of animals. I would be leaving early the next morning for Lumbini, the home of Buddha. I sat outside my room in the cool evening, writing a few pages as night settled in, finally writing by candle as I waited for the generator to come on.

 

I wrote some poignant things. About my future as I saw it then. After days of trekking, being stranded on a bus strike, and floating down a river for a day, I'd had enough time to reflect on what it is that was driving me. I'd felt this incredible enthusiasm for work, for medicine. And I wrote my plan for July 2010. I wouldn't be working in the US. There were some possibilities. NGO jobs. Baylor Pediatric AIDS corps. Locums and MSF. It's a decision that was made with complete clarity.

 

I've set January 1 as my arbitrary date to make a decision as to what I will be doing on July 2010. The plan that I had made a year ago got lost in the confusing period after Randall died. This past week I've discussed the job situation with many close friends (ie, my advisors), and I've narrowed it down to 2 possibilities. I have come up with a new plan, maybe plan z by this point. And I'd finally become comfortable with that plan. But reading back to what I wrote exactly a year ago from today, and made me lose, once again, that clarity. Argh.

 

I read on in the journal. It's the day before Randall's birthday. And I knew that I had some clarity at that time about things.

 

I can't help reading about where I was a year ago, when I seemed to have had answers; answers which are now gone.

 

The decision I am making in January 1 isn't going to be ideal, in many ways. I'll be making a decision to give me a path to follow for the short term, while I wait for some clarity...

 

 

-

I'm not just picking a job

I'm not just picking a job. I'm defining myself-to some degree. I can't recall the last time I agonized so much about a single decision. Choosing residency was easier than this. The decisions for university and medical school didn't have much competition.

 

May 28th, 2008 I took a hike. It was a Wednesday. I had been on night float the night before. Had gotten off of work. Been to the dentist. I must have taken a nap at some time. And it was a gorgeous day, so I made a break for a trail. Just a chance to get out and get some fresh air, and maybe a fresh perspective. I stopped into a bagel shop, grabbed a bagel sandwich, popped into a liquor store and grabbed a cold beer, and hit the trail. I ended up sitting down on a rock in the middle of a small river, and watch as the water crashed over a waterfall hitting a pool below. And I just sat, enjoying the solitude contemplating.

Contemplating bigger issues.

 

Why did I go into medicine.

What did I want to do.

 

I made a list of the things I wanted to do:

-work with MSF

-work on Everest Base Camp for a season

-work in a rural hospital

-work in an inner city hospital

-complete a tropical medicine course

-volunteer with UNICEF

-have a faculty appointment somewhere

-work in Alaska over the summer

 

And there are a lot of things that aren't on that list, that have crept into my thoughts since then. I'm trying to juggle income, finding the job which will allow me to take care of kids and adults, the patient population I want to take care of, the ability to have time off to get back to Southern Africa/Central America/South America.

 

[Courtesy of White Snake]:

 

Here I Go Again
I don't know where I'm going
But, I sure know where I've been
Hanging on the promises
In songs of yesterday
An' I've made up my mind
I ain't wasting no more time
But, here I go again
Here I go again
Tho' I keep searching for an answer
I never seem to find what I'm looking for
Oh Lord, I pray
You give me strength to carry on
Cos I know what it means
To walk along the lonely street of dreams
An' here I go again on my own
Goin' down the only road I've ever known
Like a drifter I was born to walk alone
An' I've made up my mind
I ain't wasting no more time
I'm just another heart in need of rescue
Waiting on love's sweet charity
An' I'm gonna hold on
For the rest of my days
Cos I know what it means
To walk along the lonely street of dreams
An' here I go again on my own
Going down the only road I've ever known
Like a drifter I was born to walk alone
An' I've made up my mind
I ain't wasting no more time
But here I go again
Here I go again
Here I go again
Here I go again
Cos I know what it means
To walk along the lonely street of dreams
An' here I go again on my own
Going down the only road I've ever known
Like a drifter I was born to walk alone
An' I've made up my mind
I ain't wasting no more time
An' here I go again on my own
Going down the only road I've ever known
Like a drifter I was born to walk alone
Cos I know what it means
To walk along the lonely street of dreams

 

-

Guns and Russian Food

It wasn't even about the guns. It was about doing something different. Must of us don't own guns. But to tick that box that says "has shot a gun at the smith and Wesson factory," that seemed worthwhile. But I was wrong. Nobody showed up. Nobody.

Last Saturday while killing time driving around waiting for a party to start, I found a Russian restaurant. Which wasn't such a surprise because I live in the Russian/Polish part of the city. But this place was open late. Very late. And there were people inside. This place looks authentic (and like a mafia hang out). And I am desperate to go. I suggested it to a few co-workers, a few of whom seemed interested, but more than one said "but I don't even know what they eat."

And that's the point. I don't know what it feels like when you shoot a handgun. I don't know what it feels like to sit down in a Russian restaurant (where I may damn well stick out like a sore thumb), and order something that I may have no clue about. That to me, is the reason to do both.

I was able to leave work early this afternoon, a damn rarity these days. And all I really wanted was to be in Johannesburg. Thinking of the time difference, I knew that the guys would already have decided where to go for dinner. It'd be too early to eat. Maybe I'd be in the gym, or out for a run, thinking about which of my few shirts I'd wear to dinner. And then a few hours later we'd be gathers, and would be out for ages, trying new places to eat, enjoying a night out. Later on, as I was tempted to call my pals in Jo'burg, I realized it was getting a bit late. But as I thought about it, I imagined a Friday night in Jo'burg, it's summer, I bet they were sitting outside on the patio of S&S, on the umpteenth bottle of wine, listening to music, and just making the most of the night.

Fuck. Why can't I be there. Every single day I find myself thinking about where I was a year ago at this time. And every single day I wish I could go back. I have these great friends here, but the confines of residency, plus the effects of perpetual fatigue, and a cohort of friends who are mostly married/partnered (+ kids) doesn't allow for the randomness and social scene which I so dearly enjoyed last year. And that, I have realized was sustaining. This is not. I'm slightly disappointed in myself though, I must confess. I am a solo traveler, and so often have been more than content to strike out on my own, be it for a day, a week, or a month. I use to find things to do, places to go, and do them, and go there. But being back here, where I have a few great friends, and know tons of people, I end up feeling that it's not worth my time to go solo. When in fact, it would be much less disappointing to strike out on my own..

Recently, I've realized the need to take the above into consideration for jobs... The job that pays a boat-load, in the middle of nowhere sounds attractive, but the long term longevity of that job would be poor. Unfortunately one of the jobs which I thought was a sure deal has hit a bit of a snag-and that caught me a bit by surprise. I'm very close to tossing in the towel on the job search, talking to my locums (aka travelling fill-in doctor) agent, and going that route which will allow me the freedom to travel.

In the meantime, I'm going to go shoot some guns and eat some borsch. (Maybe on my own).

-

Running, Again? Running, Away?

I don't think it was a whim, but I don't know why I stopped out of the blue to buy new running shoes. I hardy run these days. But I did, and I shelled out the bucks for the new shoes (the current version of the shoes I've been running in since August 2004), as well as some fancy socks and a shirt. And then I came home, chatted with my flatmate, had a glass of wine, and pondered going to bed. Realizing that I should put those new shoes to use (if anything to justify the ridiculous price of 75 US$, I mean that'd do a long way for some friends back in SA), I abruptly stood up from the table, finished a generous gulp of wine, and went and changed to go running.

I put on my ipod to my running mix, the same mix of 164 songs that I've had for years, and set off. I turned the corner and headed down Route 5. I don't know what it was that took me back in an instant to that first night I ran in Dublin. Maybe it was running along a busy road (there, it had been South Circular Road), maybe it was the cool, misty night air. Maybe it was knowing that my legs were going to be sore in the morning, as I was biting off more than I should by hitting the pavement, but I felt like I'd gone back in time. And for a few blocks, maybe a mile (I wish I could say a few miles), I kept having flashbacks to my running progress in Dublin. After that first run, I couldn't run for a week. And then I ran around a park for a while, a meager few blocks, and then I was running more. Running along the River Liffey. Running through Dublin-no longer embarrassed to be out running. As I changed my running route, I discovered new areas to run in Dublin. New Parks I had never explored. New pubs which I made a mental note to check out, though usually forgot about once I got home. When a certain song plays when running, I can recall exactly where I was in Dublin during certain runs...

I turned the block, and ran past an Indian restaurant. And that triggered a flashback to a night when I went running during my intern year. A cold night. I'd run from my flat, down to the hospital, and around a neighborhood. I'd run past Gabby's house- and saw she wasn't home, and I wasn't sure why she and I had not talked in a few days-both busy I'd suspected. The Indian restaurant I was passing is where she took me for my birthday, and the conversation that night is permanently etched in my memory. We were going to make the world a better place. She wouldn't let me sell out, and as I ran, I thought what advice she'd be giving me now. "Fuck those job offers, are you kidding me, there are people out there who really need our help." She didn't hold back. And I miss that. She gave me coffee and a tie for my birthday. I don't wear that tie nearly enough. Maybe I'll wear it tomorrow.

I was lost in thought. Am I running to somewhere? Or am I running from something? For months I've agonized where my paths is going. I've solicited (both bluntly and circuitously) the insight from friends, sometimes hoping that one or two of them would pin me down and spell it out for me. Because I cannot see the path anymore. When my world crashed in July and August, all I could think of was Denver. On more than one occasion in the past 4 months, I contemplated flying out to Denver the following morning, fuck residency. Having the support from my family when I did see them in July, and the joy of hanging out with nieces and nephews, combined with the awesomeness of Denver made it clear, that Denver is where I thought I needed to go, and the ball was set in motion. On a Saturday in September, after Randall's memorial, I was sitting outside drinking margaritas and chowing down Nachos, surrounded by a great group of people; it was again evident that Denver is where I was headed.

I was lost in thought, until I saw a dodgy person on the sidewalk with a German shepherd. I'm in a residential neighborhood, in a safe part of town. This is not Johannesburg. I am safe here. He nods as I run past. More than once, in Jo'burg, I had crossed the street, or taken a turn and changed my path when I was running and saw a group of people on the street at night. It had taken me months to work up the courage to run there. I miss running in the nature reserve; I miss seeing zebras and wildebeests on runs. I miss Jo'burg, period. And then I heard Gabby again, and I wonder if I am running from the thing I really want to do, to oblige the banks who loaned me the vast sums of money so I could get to this point.

As I reach the driveway, the only Jewel song in this mix, Who Will Save Your Soul starts playing. I smile as I stretch. Maybe the answer is neither. I'm not running to nor from somewhere/something.

I'm just running...


BPB

90 hours

I worked 90 hours last week.

 

Tonight I was re-reading some old posts, and I looked through old pics posted on here (and on the link to old photos). I miss where I was last year. I miss my Jo'burg pals. I miss working at Bara...

 

I'm meandering along the status quo route right now. Just keep plugging along... I have some interviews lined up, a few in Denver a few elsewhere. Balancing a calling back to the Rockies.. but also a fear of settling down, waking up in 5 year, 10 years, wondering why my passport is blank, and how it is I ended up settling down. That's my fear.

 

I'm back to work in a few hours, I suspect sleep, not pondering life, would be good for me at this point. So, I shall abruptly cease this post, and cave to fatigue and the comforts of my flannel sheets.

 

 

BPB

False Start

I hope this isn't another false start.

 

I feel compelled, all of a sudden to get back on track. No in a manic get a million things done at once, but slowly getting caught up on things like email, going through a mounting mail stack (it's all junk) etc. But also trying to get back on track academically... trying to settle down, get back in the groove of reading about my patient's conditions, preparing for upcoming exams, and just trying to be a better doctor.

 

I don't have much to show for the past 2 and a half months. A few extra pounds thanks to ice-cream and wine, a few more grey hairs, and a reminder that life is precious.

 

I did manage to send off my CV to a few random sources. Just kind of testing the waters really. I have one more place to send it, and then my first tier will be complete. There is no longer a definite post-residency game plan. There were plans A, B, C, D (and maybe an E-G). Kind of an if this happens, then go with this plan. If A doesn't pan out, then B.. but most days, A-D all seem great. Last week B was my favorite, and then for a bizarre reason plan C jumped to the front of the queue on Friday afternoon. The anxiety about being clueless in July when everything was happening no longer freaks me out. None of the above plans have to be permanent.

 

On another note, I eliminated a plan. The honeymoon phase of being back here is over. I have some great friends here. I absolutely love the hospital I am in. But this area is not for me. I'm not straight. I'm not in a relationship. I'm not one to sit idly by and be content at home. This area doesn't offer me the things I need outside of work. And so, staying here--which was the safe, comfortable option, is off the table. It is no longer an option. And I anticipate leaving here at the end of June. 9 months for now.

 

What's that song lyric, "I don't know where I'm going, but I sure know where I've been..."

 

I hope this isn't another false start.

 

 

-

Blogging in my sleep

I had a dream this morning, that I was writing a blog entry. It was a good post.

I'm getting caught up on "things" very slowly.

 

Getting some emails out (BK, OA, HG, JD etc etc etc-they are coming)

paying bills

doing taxes

laundry

unpacking

planning my life

 

There really will be more blog posts to come...

 

More soon.

 

 

BPB

A Bump in Karma. Rebounding.

Friday's call was not pleasant. 14 admission, 11 of those were between 1030 am and 7pm. I had to call in a back-up resident to help bail me out. Not that I should have had to do that.. I should have had an intern assigned to me, and then wouldn't have had to call for help. Also, if there were any sense of team work amongst the senior residents this month, it would have gone a bit more smoothly. But alas...

 

At midnight I finally felt caught up. All of the admission notes were done. I'd rechecked a few of the sick kids who had been admitted hours earlier. And I started the tedious process of starting the discharge notes for the admission that had come to by team. This use to be the expectation, that you'd stay up on call to get these things done, which would help facilitate the discharge, as quite a few of the kids who were admitted would be going home on Saturday, a few more I suspect will go home today. I found out, however, that this isn't really what happens anymore. The ethos of residents seems to have taken a bit of a dive...

 

We finished signing out to the team who would be on call on Saturday, and then I headed to the post-office. I had a notice for a package, and was glad to know that the computer battery I was expecting-shipped from Colorado by my computer guru (aka Dad), had arrived. The old battery would only last for about 30 minutes before dying. And so I took my slip to the counter and waited for the package.

 

Maybe it was the fact that I'd been up for 27 consecutive hours, had survived a painful call, felt like I'd provided good care to my patients and their families, and the realization that I have only one more f*cking week of this lame schedule, but as the post-man walked to the counter with my packages, and I realized that my "stolen" packages that I had mail from South Africa almost 5 months ago were miraculously before me, I felt an almost giddy euphoria. Maybe it was fatigue.

 

The past 8 weeks have been rough. Really rough. I had to move away from a place which I loved, leaving behind one of the greatest group of friends I've ever had. Randall died, and with his death ended mystery of knowing what the final outcome between us would be. And with his death ended the plans that I had made for the next year post-residency, that being to return to somewhere in Sub-Saharan Africa for a year of work. And on top of that, my residency program did an unprecedented move (to fill a hole in their schedule), and took away the intern on my team-so that I get the joy of doing the work of two people. There's also been a karma deficit which has affected some of my close friends. It's been a shitty 8 weeks, where the literal goal has been to get by on a day-by-day basis, and to not think about what the next day would hold.

 

I felt victorious post-call. I'd made it through a long night. My kids were doing well. The nurses let me know how glad they were that I'd been on call. Well, aside from the fact that I have a huge black cloud. And when I saw those packages, for some reason, the suffering of the past 8 weeks just seemed to melt away. As if the universe was aware that there'd been a huge Karma Deficit, and that this was a way to prove that things were going to be ok. And I raced home to open the packages. Months ago, when filing out police claims for theft, I couldn't remember the specifics of what was in those packages...

 

Taking out my Tibetan Prayer Wheel, and spinning the prayer wheel brought be right back to a chilly evening in Pokhara, when my friend Dilip and I were talking to the Tibetan Refugee women from whom I would eventually buy the prayer wheel. I open my Ethiopian Lonely Planet and looked at the pages on which I'd made notes about cool streets, and where I'd made note of hidden cafes.  I laughed that I'd mailed back a book which I doubt I'll ever read again. I'd come to accept that I'd never see these things again...

 

I slept a few hours post-call, and then went to join some friends in NoHo for lunch. And then I headed to Boston to have dinner with a couple (H&R), one of whom is on my "panel of advisors" about my post-residency plans. I've had to debate where I'm headed, and what I plan to do. And in the past 2 weeks I'd spoke to a few of my advisors about things, and the possible evolution in my plans, and the algorithms which I've diagramed out. There is not a Plan A, with a back up of Plan B, etc. But rather there are Plans A, B, C, and D. All of which are fine, but none of which excite me to the level that they should. The plan that excited me the most, is no longer in the cards. Anyway, H&R and I had a great evening, gourmet burgers, good margaritas, and plenty of discussion about options.

 

And as I drove home on the Mass Pike, with a U2 CD blaring, things seemed to have finally started to pick up, as if I'm rebounding from all that has happened in the past 8 weeks.

 

Finally.

 

-

 

 

-

Flashback

Tomorrow is my first overnight peds call of the year. It's quite remarkable to think back 4 years ago to my first peds call as an intern. I never thought I'd hit the comfort level that I have finally reached...

I'm actually looking forward to the call...

Thanks Rob...

Aquarius Horoscope for week of August 13, 2009
(from freewillastrology.com)

In the days ahead, you may not realize what you're looking for until you find it. I advise you, therefore, to put into action the following five-point plan. 1) Suppress any know-it-all tendencies you might have. 2) Revive your childhood talent for being voraciously curious about everything. 3) Ask more questions than you've ever asked before. 4) Figure out how to be receptive without being passive, and how you can be humble without muffling your self-confidence. 5) Consider the possibility that you have a lot to learn about what's best for you.

My Horoscope from the infamous Rob Brezsny.

1-yeah sure, that sounds fine in principle
2-I don't have the energy for curiosity
3-There's already an overflowing list
4-think I have this one down
5-No shit, really?

I laid under the stars at Tanglewood tonight (www.tanglewood.org) thinking that I hadn't written in a while, that I should make a note of what's been going on since I got back to the US.

But it's just not stuff I really care to write about right now, so in a burst of insomnia, went back to my old friend Rob for some amusing answers to why the universe has been all outta whack... Think I'll check back week for a better response.

-

Square Peg

In a round hole.

 

I snuck into noon conference to get lunch yesterday (with no intention of listening to the talk-did I mention the lunch is free) and saw David. David who is now a real doctor. Making real money. Taking care of patient as a real doctor, not having to discuss his every plan with an attending. I couldn't help but have some slight envy when I saw him. Ok, I'm lying it wasn't slight. It was pretty good envy.

 

I have a small talk which I am suppose to give tomorrow, and a small talk to give on Friday.

I'm on call tomorrow.

I no longer have an intern assigned to me.

I'm making money, but squat compared to that attending salary David is getting.

I'm tired of having to precept my management plans with attending doctors.

 

But I guess this is a small price to pay for having been able to be away last year. If I could go back in time, I'd do it all again--in a heartbeat.

 

Everyday I see people whom I haven't seen since I got back. And they all ask the same question. "Are you glad to be back?" 

 

Am.

I.

Glad.

To.

Be.

Back??

 

It's a loaded question.

 

Recently the answer is no. Yesterday I was helping the intern do a spinal tap, and we needed more numbing medication (like the stuff the dentist gives). But in order to get more lidocaine, I had to take off my sterile crap, go out of the room to a computer, and put in an order which would allow the electronic-computer-controlled-medication dispensing machine release a vial of it.. all so that the charge would be passed on to the patient. They whole process took 5 minutes. Which was 5 minutes of more discomfort for the patient (and the intern who was already sweating).. and for what cost?? To save the hospital a few bucks.

 

Recently the answer is yes. On the rare time that we'd want to use lidocaine in SA, it would likely be impossible to find some. There was a secret stash in the ICU, which was used for more intensive things, like central IVs, but we wouldn't waste lidocaine for small things, like spinal taps.

 

It's hit and miss. And I feel like the square peg, fitting into a round hole. I can fit into the holes, but it's not an ideal fit... That's just one example. There are many, on a daily basis.. but as it is, I need to go finish these talks that I have to give this week..

 

I can't wait to be done. I just want to be a doctor.
Where-I'm not sure.

Doing what-I'm not sure.

 

-