Swan song.. Or as the Brits say, done and dusted

Before you begin this read the last post. What follows will make more sense.

Parenthetically, I have found that I need to be on guard for the "multiple somatic complaint" patients when they are really just in the clinic for a refill of blood pressure meds. Yesterday evening I saw an unfortunate soul who was profoundly demented. His daughter wanted him evaluated for his dementia and I did so. Unfortunately there is no treatment that makes a difference and she was so informed. She wanted "treatment" and again I advised there was none. Off she went only to come back and indignantly demand a refill of antihypertensive meds for her father. I looked deeper into his file and found out that he had been worked up previously for dementia despite her statement that I was the first one to see him for this. He did have HTN but didn't need the meds ASAP.

I had been suckered by the last patient of the day and, well, let's just say that during the drive home I was preoccupied with introspection regarding my impatient response. Before her father we saw a desperately ill woman with HIV and fever who had been queued up for 6 freaking hours! My impatience with all of this reminded me of my old man. Geez I hope this isn't genetic. It is however a slog and one that I fear won't abate when I "get" to see chronic pain, chronic narcotic use for somatic pain, and the likes of fibromyalgia again. Wish there was a med for being so impatient and a jerk to boot (me, not my dad).

While I have no regrets about going to the States I do have mixed feelings about leaving here. I love this country; the singing (much of it acapella), the land and fauna, the smiles and laughter. It has embraced me in its most remote corners where the true heroes of the HIV epidemic reside. And yet I look at pictures of Lost Lake and Mt Hood and think "have I squandered two and a half years?"

Yet foremost and tipping the scale away from here is my family. I'm a fortunate guy to have such an amazing bunch in my life. I'd like to take credit for it but that is in Lynne's purview; I helped but is was on her lap that those monstrous teens curled up and chatted. I was the one who inspired the fun and mischief. Sorry outlaws and in-laws that will trickle down to your kids, it's simply is too much fun.

Finally I've realized what my family seemed to have known for quite some time; that I'm an "end-of-the-road, whats-around-the-next-bend" kind of guy. I find myself at an age where I don't need to persist in something that I don't enjoy and that doesn't play to my strength as a doc; simple doctoring. I am indebted to my B-UP colleagues, each of whom are brilliant, and yet I find that I don't necessarily share the same professional language or value set. Not good, bad, right, or wrong as much as it is simply true.

Shortly after the 17th we will venture to Sodwana Bay along the north eastern coast of South Africa where I can soak my head in forty feet of clear water and Lynne can read on the beach. Then to the States to harass kids and grand kids. Then to, wait for it... Hawaii. I will be with Kaiser Permanente in Honolulu and will work locums. We'll teach, swim, dive, and toss Judah, Asher, and Cora around. Forrest and therefore Shannon, et.al. will be stationed there. Then when the Northwest and Midwest are at their gloomiest, the northwesterners and hopefully the Louisvillians can come and it will Belle's, Lue's, "and countings" turn. I have a special dispensation from the extended family Pendleton to leave every 15-18 mos or so I can scratch the medical relief itch for 3 months. The University of Botswana is starting a Family Medicine program here so who knows, maybe attend in the clinics for a time, if the country will have me back.

So this will be the last blog entry. If any of you want to flee the northern hemisphere winter in February, give us a ring (you all know our contact info). We'll have a room for you and will know where you can get some killer sushi!

Cheers,

Mike

Resigned to Resignation

Early in September, a Friday, I came home from a district hospital in a lousy mood. I had been discouraged all week that the MO's, with a few notable exceptions, weren't asking the right questions and therefore not practicing up to their potential. I know, I have written about this before but my toxicity meter was in the red zone. It seemed that nothing I had done to date had made any lasting difference in care. I had had a horrific Monday, involved in something that while medically necessary, decent and appropriate really shook me like I haven't been since my MSF days. With MSF I had to look through/past events and continue; "next". Here, I have been able to let my guard down and was totally blind sided. I felt depleted and ineffective and began to seriously question the true purpose of my medical presence here.

To the extent that we, or for that matter any expat organisation , make a lasting and true difference here appears to be simply out of reach. This is a young country that is in the process of emerging from adolescence and needs to find its own value system. I find it making the same mistakes, and encountering the same struggles that a more mature country has processed through. Hell, when the US was this "age" we were fighting a war, again, (1812 wasn't it?) and for what? It is generally agreed that we are at least two generations away from true reform in medicine. Were we placating the metaphorically "young teen" country such that rather than teaching one to fix the flat tire one's his bike we instead were buying one a new bike? We'll just have to wait and see I guess.

So on that Friday I found myself thinking if the above was true, what was I doing here, really, that was making more than a temporary impact? Was this just an exercise in pure narcissism and was I just collecting stories? I love the people and the primary medicine to be sure but B-UP has slowly moved away from point-of-care medicine at a primary level. We are responsible to those that fund us and it becomes difficult to quantify relationships or for that matter reliably assure that knowledge transferred makes a difference at the doctor-patient level. I had been worrying that at some level I and my organization were, perhaps, enabling.

I found myself a bit depleted and not a little frustrated. I had struggled for a while with the notion that I am different in numerous ways from my fellow faculty members; generational, primary specialty, medical terminology and priorities, etc. Even the term "faculty" is foreign, implying separation from my primary care colleagues. I have learned alot about health care in this setting and at the same time that information rarely related to my every day teaching and, with few exceptions, had little lasting impact on my those I mentor. All too frequently I found myself saying that "we have discussed this disease and its management before" and did he/she remember that? For the most part they didn't, or didn't care.

In any case after no less than two "interventions" on the part of my family ("Papa you need to get your shit together and enjoy your grandchildren and they you") and considerable introspection on our part I submitted my resignation a week later, effective 17 December. I have 5 weeks. I know, no state secret here, but I wanted to keep it quiet as it shouldn't be about me.