Somethimes you eat the bear...

Sometimes the bear eats you....chews you up into little bite size pieces, sucks the marrow out of your bones, and spits out,...well, you get point. This was one of those weeks where I truly wondered whether I was making a difference that was worth more than a bucket of warm spit. Was I truly "capacity building" or just thinking so.

I began the usual road trips to the usual district hospitals and basically heard the same song and dance at each one. Now Matt and I have emphasized the early diagnosis and emergency treatment of sepsis at least twice a month. It is rampant here what with a huge HIV prevalence and other impediments to care. Given the nature of some hospitals here one is at more risk in one than out. So Wednesday we heard about a man admitted with an unrecordable temperature (that means under 35.5C), an unrecordable blood pressure, and pulse of >110. I exchanged a look with Matt, one of "are you effing kidding me??!!" After everything we have tried to emphasize about this disease?! And here we are listening to the vital signs of a patient circling the drain, from three hours ago?! I have made some sweet saves from this disease, mostly in kids. Adults are easier. And no one got up and went to this guy's aid. It was cold outside about -5C, the rooms are unheated and after the ABC's come warmth! There is no way this guy could have warmed himself up with a blanket.

I went off to round in peds as I thought I'd just go ballistic if I went to the ward of this guy. Matt went and started the requisite lines and meds on this guy He even sent me an SMS to let me know he was on it. Regrettably is was probably too late. That steam from peds? Me.

Then yesterday I heard the same song and dance at another district hospital and found the same mess, except I had the privilege of watching him take his last breath. We had a nurse come into the docs room asking for help with an emergency in the OPD. No one moved, including me as I wanted to see if ANYONE was interested in the entreaty of this triage nurse. Nope. And this happens everywhere; the US, some of the-off-the-grid places I've been, everywhere. So I stepped outside and went down to the OPD. I had given a presentation on status

epilepticus (seizures that don't stop) that morning, just 20m prior, and low and behold the guy there was in status! A great teaching case but for the fact that there weren't any other docs there.

The nurses had done a fantastic job with this guy, had assessed that he was in status, and had given him first line therapy. They even had performed a rectal and found a worm which in essence made the diagnosis . I congratulated them and they sighed that they could really use a cup of hot tea. I told them I had some hot coffee (can't have caffeine dysregulation doncha know) and they drank it with relish.

Then today another place another patient with the same HIV and same unnecessary sepsis. She, a beautiful 16y/o with HIV, will die. That coupled with a Monday wherein I was a small part of one of the worst medical experiences I have had (I simply won't/can't bear to get into it) and a Tuesday that was equally awful, and the bear had me good. Hope the bastard enjoyed every bite. Maybe he'll get septic, wouldn't that be justice.

" Mike, do you believe in God?"

Again first things first. I had a gas in Atlanta. Swam lousy but really loved seeing my swimming friends and community. And getting away from medicine is always healthy in a weird sort of way.

There are some certifiably FAST master swimmers out there. The so called fast suits are tight girdles from which oozes well marbled flesh causing, as Bill so aptly puts it, wives to laugh themselves silly and children to run into the night. And they really don't make a difference. I, again, got vertical in the 100fly, a big no-no, and was headed to the light. My teammates were all lined up to cheer/groan as I dropped my by now leadened legs and couldn't get my arms, or for that matter brain, to cooperate.

Bill, MJ and I finished up the experience with a great carnivorous meal at "Fat Matt's" rib place. Picture a shoe box shaped building you can smell before you can see. You get in line and order, and enjoy some live blues from one end of the place. You see two guys enter the back door each with 12 loaves of Wonder Bread; truly authentic. Bill and MJ ordered big meals o' meat and I ordered my favorite, a pork sandwich. It tasted fantastic and I was having a great time, until my manhood was questioned, again, by my "friends" and for that matter the staff. It seems I only ordered a "small" sandwich. The woman behind the counter shot me a "you'll be back honey" look. And I was. Conversation stopped as I dove into some amazing ribs. That and beer. Did I mention the beer? So much better than here, and there you have it.

Seeing Eli, Amber, Aven , Beth, and Belle was fantastic as well. Watching Belle, 15 mos (I think and hope), entertain herself with a basin of water and have Uncle Eli encourage her to "wash your bachachas" was hilarious. Beats any digital toy out there.

Then the long flight home and to SOS that week. I sometimes walk out onto the dirt field to see the starry ski and did so this night as I was hitting the jet lag wall. Out there I met Thabong, a 13yr old guy with whom we have taken a mutual shine. He was staring into the night and came over to me. I could see this might be an interesting time as he truly had a look about him that I hadn't seen.

With inquisitive and.......what, a very disarming facial expression, he asked 'Mike, do you believe in God" I did the shake and bake as I didn't want to answer before we fleshed out where this came from. He attends a private evangelical school on a very generous scholarship, one for gifted kids. So I put it back to him. "Do you?"

"I don't know." "Why?" "I can't see him." A perfect place for a thirteen year old wrestling with the angst of youth to be in my opinion. "Do you need to SEE him?", say I. And on went the conversation. He wanting proof. So I stepped behind him on this absolutely beautiful night and said, "Do you see me?" "No." "Then how do you know I'm here?" "Do you feel me close to you?" I said as I was stepping away from his turned back. "Yes." "Even now?" "Well I think so." "So you know I'm here but can't see me..." He laughed and said to the effect that he knew where this was going. And we became silent, in the cold night air, he enjoying the company of an old man. And the old man enjoying and marveling at the emergence of a young one.