Can't quite find the synapses

Well to say the least it’s been a week. As a Batswana physician I am required to know and to prove that I know something about HIV. As >80% of the inpatients we see have HIV as a baseline with some other co morbid problem, it of course makes sense. The national health care system here has fashioned a number of what are called “KITSO” courses (Knowledge Innovation and Training Shall Overcome) in various AIDS related disciplines; adult, peds, advanced, and the like. As the country has specific protocols with specific antiretroviral meds (ARVs), and as I’m a nincompoop about this disease having lived quite happily and naively in my professional cocoon as I have for the last 2 decades, the course was invaluable. It was four long days of lecture and group dynamics then a test Friday. Just sharing a large hall with a bunch of bright Batswana was inspiring, if not a touch intimidating. Upon completion of the exam Lynne and I went to the bank to establish some accounts before I could get to the hospital and join my team…..only to find we were admitting on a Friday afternoon and as happens, the Medical Officer (MO) had taken some unannounced personal time.

The teams here for medicine are six, three each for male and female medicine. I have one of the male teams with a crackerjack third year Penn medicine resident, Emily, and an equally eager and hard working third year student, Mike. They (we) admitted a gentleman with a stroke (L hemi-paresis with a P=40, BP=90’s/40’s, long history of HTN and of multiple meds but none had been fully dosed). Emily started on the latest outcomes based data on how best to approach this and I of course find myself standing there with little to offer other than the awe of listening to young bright docs and students go at it for our patient. My natural tendency will be to treat so I need to first learn to stand back and guide. I don’t possess the cognitive brilliance of a newly minted Penn Med IM resident but I’ve made enough mistakes by now that I can offer some wisdom from experience.

We have been helped immeasurable by the generosity of the Jones family here. We are living in the home of Gil’s father, a minister here in country for years, as he visits his family in the UK. This gives us a semi permanent home from which we will move to the condo at the end of the month. It’s nice to have turf that is not shared for a period of time and to be together.

I have lots of catching up to do before my tour of the inpatient side of thing is complete in three months. The pathology is neck deep. Yesterday I saw a gentleman with confluent Kaposi’s Sarcoma of his leg, a 32 y/o man with slight shortness of breath and a complete white out of his left lung from a gigantic pleural effusion and offered some ideas to Mike as he drained 1.5L of fluid before we stopped, a child with retinoblastoma pre enucleation, severe wasting syndrome from HIV everywhere, etc. All in an afternoon!

Urban living is problematic for me. Lots of city noise, effluent, traffic. No clean kills yet as I am becoming use to left sided driving and have been told just once that I was “Number One” with the middle finger of a Beemer driving south Asian. I of course replied in kind, from my generic Toyota Corolla that the Jones tribe has so generously offered for use that, no, it was really he who was number one…..

I LOVE hearing from family and will get back to you as soon as possible. Just know; Eli, Aven, Olivia, Forrest, and Shannon, and Bethany that your letters are sincerely loved and appreciated.

Well off to find a vehicle. Should be some real horse trading, good thing Lynne’s along. She is steel to my straw.

And we found one! If all goes well we will have a 2004 Hyundai Tucson, front wheel drive, in which Lynne feels comfortable so we feel quite fortunate. Buying a used car here is a bit of a flail, not unlike the States with lots of car places lining a district street all or most operated by south Asians from South Africa. We didn’t bargain hard or fast as we need a vehicle ASAP as the Jones been most generous with theirs. Once we live closer in town most of my “commute” will be by bike or foot as we’ll live about 10m from the hospital.

I’ll conclude with some random thoughts:

-This is where I need to be and I am going to be practicing medicine consistent with why I became a physician. It will be FULL of frustrations to be sure, and it is time for me to be more patient, as if I have a real choice.

-I got a tattoo and when I can be on a faster computer and have divined how to do it I’ll put a picture of it up on the site. I did it the Friday before we left Jax. In the process of accomplishing what follows I and my sons went to a local tattoo place. I had an iconic profile of Mt. Hood with a river in the foreground placed forever on the inside of my right upper arm. I’ll post a picture of it later when I have a better connection to the web.

-Lynne had misplaced her rings and they seemed to have evaporated into the ethereal void. I couldn’t let a hot babe like her go to unclaimed as it were so I secretly got her a new wedding band. OK so it wasn’t so secret. ALL the women in my life lead by our daughters in law “suggested” that it would be nice if I got a wedding band before we went to Bots. So Eli, Forrest, and I went to a huge mall (they have those in Florida) got her one and presented it to her at the family dinner we had at a local restaurant, to the tearful approval of the entire XX chromosome contingent.