Mad

>
> This has been one of my worst days yet. Believe me, I've had my
> share of them. But this definitely ranks (as in stinks) up there
> with the "best" of them.
>
> I could find plenty of excuses for my behavior. For example, we've
> done more surgeries the last 3 weeks than the last 2 months combined
> (including one 7 day stretch where we did 46 major operations). Or
> I could cite the fact that I've had amebic dysentery for the first
> time over the weekend making me feel nauseated, anorexic, fatigued
> and generally miserable for three days.
>
> But I'm tired of excuses, that's all I hear all day long and that's
> what started this day off so badly.
>
> "Enock left at six without giving sign-out, but he said he HAD to go
> to Kelo."
>
> "We don't know why the kid didn't get his blood transfusion, Enock
> left for Kelo and didn't tell us."
>
> "The father left four days ago. He said he'd be back with
> provisions and to donate his blood, but he hasn't come back. Can we
> go home now?"
>
> "Ma'am, your child has a hemoglobin of 3.3, he'll die if he doesn't
> get that blood, besides you've already paid for it anyway and the
> father has the same blood type."
>
> "But he's gone home. It's far away. We have no money."
>
> "Madame, do I need to remind you that you don't have to pay anything
> and we'll find one of our staff to give."
>
> "But my husband isn't here, he went home to...." I cut her off in
> midsentence. Michelle gives blood and soon the child is on his way
> back to health.
>
> "I don't know why this guy's still in the ER. I wasn't the one who
> hospitalized him 4 days ago."
>
> "Haven't you had a night shift and a couple of ER shifts since
> then? You just let him stay even though his wounds were sutured and
> they weren't severe enough for him to need to be hospitalized? What
> about his relative who was also beat up who didn't even need
> sutures? He's also occupied a bed for 4 days in the ER."
>
> As we inform the two nomads who had been beaten up because they
> tried to steal rice and then cut off a guys arm who tried to defend
> his rice, as we tell them they have to leave the hospital now they
> start muttering under their breath.
>
> "YOU didn't do anything for us! Four days in the hospital and
> nothing!"
>
> "What about the 4 wounds we sutured closed and the pills that you
> have been taking and still have?"
>
> "But we didn't get any IVs or shots or anything. Next time, we're
> going to the hospital in Lai!"
>
> "Doctor, the patient is writhing in pain!"
>
> "I have his carnet here for an ultrasound."
>
> "But he's really in bad shape!"
>
> I go outside, a barefoot man covered in dust is standing calmly to
> the side. We walk him over to the ER where I can examine him. I
> look in the carnet, nothing written except abdominal pain. The plan
> is to have him see the doctor and get an ultrasound.
>
> "Ok, let's find out more about his pain."
>
> I start to ask questions but none of the nurses know his dialect.
> They call in a translator who starts translating. It's pain-
> staking. I'm frustrated and walk out yelling over my shoulders.
>
> "Find out all you can about his pain and then come see me!"
>
> Somehow, before I can even get back to my office to do other
> ultrasounds, Sarah is there to present me with the same man's
> carnet. The nurse had managed to stop doing what I asked almost
> before I started and somehow managed to bypass me to get to Sarah
> before I could walk the short distance from the ER to my office.
>
> I storm back yelling at anyone and everyone in my path. I'm totally
> out of control.
>
> A small sampling of my day is sufficient. Needless to say, I'm
> pretty much yelling and shouting and flailing and insulting and
> making a fool of myself all day long.
>
> I get called back to the ER. A man with abdominal pain for 5 days.
> He hasn't pooped in five days either. No vomiting, he ate some
> porridge yesterday but didn't feel like it today. He's lying
> comfortably on the bed. Sounds like constipation to me. A real
> problem here. He has a fever so probably has associated malaria. I
> tell the nurse to prescribe quinine and treat his constipation. As
> I'm about to move on a small urging tells me to examine him more
> closely. I can't explain why. A still, small voice perhaps.
>
> I bend over him. His belly doesn't look too swollen. NOthing you
> wouldn't expect from constipation. If he had a bowel obstruction or
> appendicitis he would've been vomiting by now after 5 days. I push
> and tap. Somewhat tender but doesn't seem to have peritoneal
> signs. I'm still not satisfied. Something inside says that my
> initial impression is wrong. I get a glove and stick my finger up
> his butt. He's more tender on the right side than the left. Maybe
> he does have something.
>
> I decide to operate.
>
> Sarah calls me when the spinal has been done and Samedi and Abel
> have scrubbed and draped the patient.
>
> I enter the OR and notice a pool of yellow fluid on the right side
> of the patient next to the OR table on the floor.
>
> "What's that?"
>
> "Maybe his foley has come out."
>
> Samedi lifts up the sterile drape so we can look. I pull back
> instinctively as I see a huge puddle of liquid stool with floaters
> between his legs. It's been dripping down the drape to the ground.
>
> "Well, I guess it was constipation after all! Looks like the
> relaxation from the spinal was all he needed."
>
> I turn to walk out of the OR. Again, something deep within,
> something that has almost been repressed from my full day of self-
> righteous, angry behavior, that little something makes me turn
> around and speak to Samedi.
>
> "Well, since he's already anesthetized and prepped, we might as well
> have a quick look around inside his belly."
>
> "C'est bon." Samedi nods in agreement. I go outside and scrub.
>
> As I open the belly, nothing jumps out immediately. The intestines
> aren't swollen or inflamed. There's no rush of blood, pus or
> fluid. I start to poke around inside. I"m looking for the appendix
> on the right. I can't find it. Everything looks ok...boom...out
> gushes some thick pus. I open the incision for better exposure and
> peel away the inflamed bowel. With a scoop and a flick of my index
> finger, the ugly looking appendix pops into the surgical field. An
> obvious perforation is at it's tip.
>
> I remove the appendix, irrigate and aspirate the abdomen, place a
> drain and close up.
>
> I spend the rest of the afternoon and evening listening to the night
> shift team bombard me with questions about things the morning team
> didn't do or follow up on and seeing two patients that don't want to
> heal and keep having stool come out of places it shouldn't and
> wondering what I'm going to do as I pass hours in the prep room with
> Samedi, Sarah, Abel and Abre searching for IV access on two infants
> with anemia needing blood transfusions. I spend most of the time
> yelling and throwing things as I can't find the vein or can't thread
> the catheter. Finally, Samedi gets the last one in.
>
> "Halleluia!" I shout and try to go home.
>
> As I close up my office, Rosine is there looking at me sweetly as
> she innocently asks, "Can you help us find an IV? We've been
> searching all afternoon and the kid needs blood..."
>
> How could she have known what she did as I bite her head off with a
> snarl.
>
> "Don't bug me with that. That's not my specialty. I don't find IVs
> very well. That's nurses work. Go find someone else and what ever
> you do, don't call me!"
>
> I go home. As I walk through the door I pause and sobs begin to
> wrack my body. I am filled with anger that want's to explode out of
> me. I don't want it but it's there. I feel betrayed, overwhelmed
> and extremely ashamed of my behavior today.
>
> In spite of this, somehow God spoke to me and made me save a man's
> life instead of relying on my own skills which would've sent a
> perforated appendicitis home to die with a couple of laxatives.
>
> I think I'll ask for forgiveness tomorrow.
>
>