ahhhhhhhhhhhhh!

Ahhhhhhhh!

Made it through week one.

I went to the hospital for the first time on Monday and got shown around to all the pediatric units. There are many: Moyo (malnutrition), High Dependency Unit (or HDU, a step-down ICU more or less), special care unit, medical unit, chronic medical unit, nursery (for patients less than 6 mos old), Chitinkha (the newborn unit which includes a NICU, a kangaroo mother care unit, and a newborn nursery), oncology, the emergency room, plus a variety of surgical units and an ICU where the pediatric consultants routinely have to go to check on some of the pediatric patients being managed by surgeons or anesthesiologists there.  Throughout all these units, there are about 300 or so patients, and this is not the busy season. On the day-to-day, various residents, students, and consultants are spread throughout the units, but when you are on call, you cover ALL of them and just try and keep things from going horribly wrong. 

Just figuring out how to navigate this. Looks pretty easy, right???

This week I thought a lot about how it feels to be in a completely new environment and feel like I have no idea what is going on.  I spent a lot of time in the HDU and saw some horrible things.  We had some patients arrest and need resuscitation and I didn’t know where to find things or what capabilities the unit even had.  There are no monitors, crash carts (where the necessary medicines are kept for a patient who is coding) are haphazardly stocked with drugs needing to be measured, diluted, and drawn up before they can be given.  Patients are crammed all over, sometimes more than one to a bed (and like I said, this is the low season…), so other children and families are looking on as you try to bring someone back from the dead (which here is hardly ever successful).

Luckily we do have a good number of students, residents, and consultants.  It is busy, and patients are very sick, but I learned that some of my colleagues elsewhere are up against far worse.  Some of them have no students right now because they are on strike to protest fees, no residents, and are managing similar numbers of patients on their own or with only a few other clinicians, unable to even speak the local language.  So resource and personnel-wise, I learned I am actually probably in a decent set-up.  Which is good for me, considering I had to rely on the residents, students, and nurses to show me where everything was and help me remember things like how to dilute adrenaline and what concentration we stock in the middle of giving CPR.

I went home feeling defeated and was being really hard on myself. This is my orientation period to get me exposed to all the units for a couple of days, but I wanted to know the system and be up and running RIGHT NOW.  I wanted to be managing things and familiar with the ins and outs of the units and dealing with sick patients.  I wanted to feel competent about everything. I realize that is insane, but I think as doctors, it is so difficult for us not to be good at something.  Even if it is completely unreasonable expect that I just jump in and know everything after 2 days.  I was thankful to have some good reality-checkers back home who told me to stop being ridiculous as I argued that I was the dumbest doctor ever and will never be able to do anything useful. 

So I am going to do my best to be patient with myself and the system. I have started to keep track of the little things.

Small victories for the week:

Hey, the power is back on (kind of a daily occurrence that it goes out for a few hours)

Hey, this 1600 gram baby actually is doing ok and gaining weight

Hey, this medical student just gave a great demonstration of a newborn exam

Hey, not everyone fell asleep during my first lecture

Hey, I found the post office only after getting a little lost

Malawi huevos rancheros. Had to make tortillas myself, si se puede!

The mountain by my house