A Day at Nkhoma Mission Hospital
(so many people ask “what’s an average day like? Do they really want to know?)
6:00 Wake up (actually, I woke up at 5:00, that was a good day, it’s been closer to 4:00 or 4:30 lately; but this time I stayed in bed until 6. I was going to get as much rest as I could!)
7:30 Bible study; Breakfast of oats, granola, mac nuts, coconut; cup of tea (I tell Greg we need to get more creative about things to do together. Life these days seems so monotonous, so draining)
7:00 Handover (I wanted to shrink away when they asked about a medical patient I didn’t know. Lately I’ve just been checking in and consulting about the patients the clinicians ask me about. But the group seems to hold me responsible for knowing everyone on the ward. Embarrassing) Instead of teaching about medical topics after handover today, the chaplain talked about pain and suffering, using Job and the teachings from Jesus. I thought that was nice. The community is still recovering from the death of so many children and adults in the accident last week.
8:00 – 12:30 Seeing Patients in the Medical Ward and Outpatient, with multi-purpose tea break at 10:00-10:30 (Okay, so first I had to corral the four medical students so they could do their observed consults with Dr. Miriam who drove up from Lilongwe. Then I popped into general medical ward but didn’t have time to help because I was called to private ward to see some VIP patients. Sent one home, one is getting better. My resident didn’t come to work today which made my job of discharging the first patient difficult. And I wasn’t able to teach him that he shouldn’t give two of those medications in someone over 60. Next time? I stopped in my office to grab my things - and drink 2 cups of tea, and pray - when the charge nurse came by to tell me that the accreditation committee was here and wanted to review our charts and death audits, had to break into Amos’s office to use his copies since we couldn’t find the others. I was heading back to the general ward when I got a call from outpatient to see a patient – his blood pressure was improved but gout was worse and sugars were worse, probably because he didn’t like taking his medication. I was just about finished with him when my clinical officer intern came in to tell me about a patient who was really sick on the medical ward. It sounded bad so I wrapped things up and went to see him He had swelling – fluid everywhere in his body except where it was supposed to be – in his blood and his bladder. What could we do? Maybe the surgical team could tap into his bladder and get fluid out? No such luck. They said it was a medical problem. Darnit. Next patient had terrible meningitis, wasn’t getting better after a week of our strongest medication. He looked close to death. I had to check with the HIV specialist around here to see what we could do next. Turns out steroids and stopping the HIV meds for now. Who knew? Had to tell the family that they shouldn’t take him home just yet. Give us an other day. Then another patient walked in with hepatitis, we weren’t sure why, My resident ordered the tests but he wasn’t around. Called him, he was supposed to be back by now. He called me right then to tell me he would be another few hours. I had to hang up on him because they rolled a patient in who had stopped breathing, no pulse. We did CPR for 10 minutes, but she never came back. Greg texted me, asking when I was ready for lunch. “when I stop CPR and pronounce this woman dead” I texted him back. That woman had a fight with her husband and then poisoned herself. I couldn’t think of anything else to do for her. I had to tell the family that we had tried but things weren’t looking good. Then I pronounced her dead 30 mins after she arrived at our facility, 15 mins after she was on our ward.
12:30-1:30 Lunch with Greg – The private restaurant on Nkhoma hospital campus is keeping us alive. $1.50 for a plate of rice, veggies, and today, crispy BBQ chicken. (today was really nice because Greg was visiting with 3 pastors, and we talked about the Bible and about healthy eating, the amount of sugar in their staple food nsima. Only later did I realize that two of the pastors were high-up in the CCAP, which runs our hospital. As they were leaving, I joked that they should of told me sooner, that I would have told them they could eat anything they liked. After saying goodbye to Greg, I wanted to go to my office and reflect until starting again at 2:00, but I was intercepted by a nurse. He had borrowed $15 from us last month, and I told him he was free to keep it and not worry about repaying, but if he wanted to borrow from us again we might not be able to help him next time if he didn’t repay this time. That led to a 15 minute discussion about his business idea which he might be asking us to help with. It sounded like a good idea, but I told him, if he wanted another loan, he probably should repay the first beforehand.
2:00-5:00 Patient care and Quality Assurance (actually we spent the first half-hour reviewing the death before lunch and talking about what we could have done differently. I didn’t realize that she was agitated when she arrived and received a sedative in our outpatient department. What if that was what tipped her over the edge? Should I have given epinepherine when we were doing the resuscitation? I’ve never given those meds without watching the heart rhythm first. Maybe I should have just gone for it. Was it my fault she died? Was it the one who dosed the sedative? Could this have been prevented? These death audits are always such fun. But out team is pretty awesome and we got through it. Then I went with my students and interns and saw some more patients. Swollen bodies, scarred lungs, possible tuberculosis, so many who weren’t getting better and I’m not sure what I could do to help. Well, the guy with the swollen joints was getting better at least. The new clinician came to me with a question about a patient, that was great, she usually doesn’t ask me. Chest pain for a month. I thought it was from acid reflux, but WOW – that ECG sure looks like a massive heart attack. Do we have a protocol for that? Sure we do, but we don’t have the medications or the testing listed in the protocol. Sigh. Time to cut a nitroglycerine tablet into quarters and dissolve it under a patient’s tongue – will it fall out because she doesn’t have teeth? Then I have to check in on the private patient again. I have a medication that could help him, but his blood pressure is lower now, is it still safe? Stop back in at the general ward, need to make sure that patient with a heart attack is doing OK.
4:50 Go Home (Actually, I’m supposed to finish my day at 4, but it’s rarely I’m home before 5:00. I am still working on boundaries. But at least I’m using discipline and not working from home as much. Whatever I don’t finish in my office, doesn’t happen. That was even true for today, I had two patients I saw yesterday who need recommendations on starting and switching their anxiety/depression medications. I resisted the urge to send them an e-mail, I knew they would be gracious waiting another day or two.
5:00 – walk dogs (actually even though we walk most days, today Greg and I decided not to do much of anything. We rested on the couch, listening to book on tape and playing puzzle games on our devices. I didn’t even get 5,000 steps, but that is okay on days like today.)
6:00 – dinner – we had leftovers from my visit to a patient’s house yesterday. It was part house visit, part social visit, and her cooking was delicious. (any day I don’t have to cook is a win. It was a great end to rough day)
9:30 – bedtime – (power had gone out yesterday and water ran out at 7:00, so after spending the evening trying to save every drop and fill up our drinking water, we figured out how to switch to our tank. Then we went to bed. What more was there to do? Glad tomorrow was a planned day off)