Snapshots

Geek is Chic.  Thanks, Erika!

Sisters.

Just give up now, you're going' down!

I've just finished a few weeks in the hospital of intense every-other call.  Now I'm taking a few days of time-off to spend with Laura, the children and my parents.  The contrast makes me realize just how hard I was working.  I'm not entirely certain I was easy to live with or always present for the children.

But having these days is lovely.  We played frisbee this afternoon and yesterday I kicked a soccer ball with AE (who is surprisingly good!).  I had the chance to look up and around once or twice and to look down at a face that's smeared with a bit of mud and a big smile.

Pachyderm

What nobody's talking about.

A night in the life...

Two call nights ago, after I got home at 9:20pm, I received no further calls all night.  Last night was a another kind of night:

22:30 - go to sleep.

23:47 - the phone rings.  Walk through the fog to the hospital to see a patient with a tender abdomen and discuss the case with the junior doctor.  Order an abdominal Xray (we have no CT scan).

Get called to see two other patients.

Look at the film on a lightbox.

Film shows dilated bowel loops everywhere.  Clinical impression before was probably ileus (temporarily paralyzed intestines after surgery), Xray is consistent.  Discuss why repeating the exam hourly is better than having a CT scanner - you feel the change in abdominal tension and sense whether the pain is increasing or decreasing: "Your hands are better than a CT."

Walk home through the fog at 01:17.  Lay down under the net, but sleep is taking a while...

02:30 - ...nope.  Eyes closed, but no sleep.  Phone rings.  35 year old with very low oxygen levels despite administering more oxygen.

Run while zipping up jacket.

02:37 - teach junior doctor how to intubate (put a breathing tube in the windpipe).   Impressed: junior manages it first try!  Patient extremely ill - frothy pink secretions are bubbling up the tube: Diffuse Alveolar Hemorrhage (DAH) likely.  Requires constant suctioning to keep clear.  

02:45 - a little more story, apparently was drinking some homemade rice alcohol.  Quite a lot of it.  suspect it was adulterated with other chemicals - some pesticides cause DAH.

02:50 - troubleshoot suction machine.

03:12 - one of the guards looks in to see what the excitement is.  Stays to watch a few minutes.

03:30 - patient temporarily stabilized.  Bedside ultrasound confirms it's not the heart, so DAH it is.

03:52 - check on guy with the tender belly.  Improving.

04:00 - DAH again.  Trouble with secretions clogging the tube.  Attempt re-intubation with larger bore tube - won't fit, revert to original tube.  more suctioning.

05:00 - eventful hour.  Patient quite unstable - now on IV pressors to keep blood pressure up.  Having trouble maintaining saturation even with ventilation.  This bodes ill.

05:15 - realize two patients on the ward can see through the door into the ER and have been watching us work the last few hours.  They appear fascinated.

05:32 - we can do no more than we're doing.  As I head home to sleep for an hour or so, I hear the mosque turn on it's PA system and begin the 5:30 Azan (call to prayer).

08:00 - patient with chest pain rolls in, swallow the last of my coffee...

Thanksgiving

Jennie Brownscombe's 'First Thanksgiving'

Happy Thanksgiving!

Tonight I was asked, with about 10 minutes warning, to give a short speech about the history of Thanksgiving in the US in front of about a hundred people with a purpose of tying together the themes of unity and gratitude.  I thought about Peter Willard saying, "Always be ready to....."

Gratitude, in Bangla, is 'shogotom'.   To say, "I'm grateful", you say, "Amar onek shogotom ache."
The interesting thing about the grammar is, were you to try and translate it back to English literally, it would be roughly: "There is a great deal of gratitude of/to me".  What fascinates me about this is that gratitude is external to us, as though we are recipients or conduits of this other thing, this gratitude, that we are experiencing.

The Osler Hearing Aid

Sir William Osler was the father of modern medicine; he wrote the first western medical textbook and founded several major training programs that still exist today - including mine.  He was dedicated to medicine to a degree we seldom see, but he was also a man of letters with a broad knowledge of literature, classical languages and a knack for pithy aphorisms.  One of my favorite is, "Look wise. Say nothing, and grunt.  Speech was given to conceal thought." (You must imagine facing a new patient with a very peculiar story - you need time to think - so pinch your chin, looking thoughtfully over your glasses, and say "hrrmmm.'').

I served on the Osler medical service in inner city Baltimore from 2000-2003.  Serving on 'the O' was exhausting, often difficult, occasionally cruel, but never, ever dull.  Inner city Baltimore was, while not quite as poverty-stricken as Bangladesh, quite similar.  Oh the stories...

We had bright blue and yellow disposable stethoscopes on the 'O' used for patients in isolation due to 'superbugs' - multi drug resistant bacteria.  We used to use these stethoscopes to talk to particularly hard-of-hearing patients, like this:

The Osler Hearing Aid, imported to BD

It worked remarkably well.  I particularly recall one elderly african-american gentleman who I could get no straight story about - I'd been told he was demented.  Family was not around and he seemed apathetic - he would neither answer a single question nor even look at me.  I learned later that he'd sunk into this apathy because he'd not been able to have a single conversation in the previous ten years due to hearing loss.

I grabbed an 'Osler hearing aid' and, placing it in his ears, asked, "How are you today, Sir?"

He looked up, startled, and said, "I'm fine, thank you!" and what followed was a relatively standard interview, albeit through a stethoscope.  At the end of the interview, he looked at me, with tears brimming, and asked how much a stethoscope cost and where he could get one.  

I answered, "This one is yours to keep when you leave the hospital."  Several months later I saw him walking down the street in East Baltimore, with a bright blue stethoscope jauntily tossed over his shoulder.

Caffeination

Nothing...nothing quite wakes you up like a running-out-the-door-"Hi and goodbye, kids!"-first-thing-in-the-morning resuscitation.

Look around

Looking up 

Homework 

Twighlight

No Exit

Dude.  Far out.

  I was talking with a friend about 2 weeks ago who came here to do conflict resolution training.

  Discussing how often conflict here runs to violence, often lethal violence, we reflected that when someone tries to take what you and your family need to live (like a plot of land the size of our bedroom) what do you do?  They've only taken it because they already bought off the police, and by the time a court case could be heard you'd've long-since starved.  I understand.

  We, on the other hand, always have an exit.  We have a western passport.  Affluence affords the luxury of gentleness and idealism.

Dr. Jekyll and Mr. Hyde

Best light in the morning is in the hall for Dr. J

  Not really, of course.  J is a pretty upbeat friendly guy no matter the situation.  It's just that sometimes he looks like a studious Dr. J and other times like...

Mr. H

  I wrote in 2011 about how we must permit our children some of their heartaches (and, I might add, their failures!).  It's part of what will shape them and give them compassion for others.  Don't imagine, though, that this means we point them in a general direction and then sit back and watch!

  It is equally important to equip them to handle heartbreak and difficult situations.  Ever been a new kid in a new school, especially where everyone else has known each other for years?  It's really tough.  Though J has a couple of good friends, he's had a few rough spots too - other children have been pretty unkind, "You're so bad at volleyball, you stink!" (he'd never even seen a volleyball before), "You don't understand even the simplest Bangla! (said in Bangla, translated by his friend)", and "If you didn't exist, I wouldn't care."  That last still almost brings me to tears.

  

  A few years ago we worked with Jack for a while on social interactions & cues (and still are) but his response then would have made things so much worse for himself.  Now,  instead, he's experimenting with the things we've been trying to teach him, "I tried just laughing along with them and saying, 'yeah...I don't understand, it's true' but they just pinched me and ran away."... Boy, that worked, huh?.  You know all that, "Sticks and stones may break my bones but names will never hurt me." stuff?  It ain't true.  

  Nor can you expect an 11-year old to have the degree of self-confidence it takes to truly shrug off direct insults the way we adults (sometimes) can.  So instead we work on compassion, "Can you imagine, Jack, why he says things like that?  Who do you think said that first to him?  Was it someone important to him?"

  This doesn't diminish the hurt.  It doesn't change how it feels when somebody crushes you.  To say it just 'smarts' doesn't cover it - you never forget this sort of thing.  But maybe it does change how you feel about them afterward, and maybe it will change the future adult.