Rhythm and pace

A little about the rhythm of my day…

I awake to my watch alarm at 0600 and get up quickly as Lynne enjoys this time of day with her eyes closed. I have breakfast which generally consists of cold oat flakes with fruit, yogurt, and milk. The milk has a shelf life of months here and is sold in a small carton with an airtight mechanism. The fruit is all from South Africa and is papaya, strawberry, apple, banana, or the like. I usually will watch CNN or BBC to catch up and am looking forward to enjoying OPB on the web as soon as we move. After about 30min of this I generally check email, get ready for work in clothes that are the same ones as at CGFM and drive an old but trusty Toyota Corolla about 8km to Princess Marina Hospital. The commute is complicated by countless “kombis”, Toyota vans that are licensed to carry 11 passengers plus driver to various places in the area. One can ride for P3.00 or about $0.50. The drivers are aggressive, but the flow, once one “gets it”, is generally forward. It is much different than a quick bike or scooter ride down May Street however, and I’m sure that I don’t enjoy it. This will change when we move and are a quick walk (bike ride) from the hospital.

On arrival there I park and walk to the Male Medical Ward where I am the attending for the Pink Firm (team). We usually have 10-20 patients with a wide variety of disease processes that are typically associated with HIV/Tb. As an example we have a guy with esophogeal pathology for whom we have attempted to get a barium study for the last 1 ½ wks. Today I finally went to the radiology area and inquired why it was taking so long only to discover that they don’t do them anymore as the fluoroscope died. Nice of them to let us know. Also we have been waiting the same time for a lateral of the T-spine on a man with paralysis of the legs and cryptococcal meningitis only to hear today that the X-ray machine can’t generate enough kV to penetrate the body on the guy. Moral; walk all requests to radiology and become a thorn in the side of the tech so we’ll know right away.

Where was I, oh yeah. The morning begins at 0730 with morning report, a quick summary of the patients admitted by the medical officers during the afternoon and night. The patients are admitted by MO’s (medical officers with a single year of training post med school) but cared for by the men’s and women’s admitting firm for that day. So today we got a 15y/o with HIV/AIDS since birth (so called vertical transmission) who has MOTT (Mycobacterium Other Than Tb), read MAC, a 32 y/o man with a sudden change in mental status and some variety of intracranial process awaiting a CT of the brain so we can do an LP, A patient, HIV+ and wants it kept confidential from the family, who had gastroenteritis, and the like. We will often have a quick talk about the work up of something like anemia that Nicola can give off the top of that genius brain of his then it’s to the ward at 0900.

We round and write notes on all of our patients with a coffee/tea break at 1100 to bring the attending’s caffeine level up to therapeutic. These are fun as we get to know each other and discuss cases we have or have seen. During rounds we make a list of scut (read procedures, iv’s, lab, consultations, etc.) that is needed and begin that after break. This ends promptly at 1300 as visiting hours begin. This is one of the more moving times of the day as extended family will arrive to bathe, dress, feed, and otherwise care for the patient(s). We eat lunch around this time. The cafeteria lunch is more Sunday dinner style, based on a LARGE helping of rice, maze meal, or mashed potatoes drenched in soup-gravy, covered by an equally large helping of meat with a side of vegetables and beets (currently). This costs P14 or about $2.35. I usually go home for lunch.

The afternoon is occupied by helping and teaching the student or M.O. I don’t have the brilliance of a Nicola but have done a lot of procedures and can teach how not to screw up. I try to find just the right length of rope to give the team. It gets longer by the week.

Records are hand written with orders put on the front and iv rates in the progress notes or on a computer system that has been broken for the entire time I have been on the wards. Nursing runs the spectrum from outstanding to passive aggressive. Chocolate helps.

Then home by about 1700 unless I’m on call in which case I may get consulted on into the evening.

And I’m loving it, realize I’m fortunate to be living the dream, and look forward to more with the love of my life at my side.