Since
I've gotten older, I have come to appreciate my mornings more and more, the
daily routine of awaking refreshed to a brand new day. The possibilities
of a new start are endless. There is nothing better than easing into the
day just as the sun is coming up over the horizon with my cup of coffee in one
hand and my Bible in the other. Even here in Tanzania, where coffee is
not a part of the normal wake-up routine, and definitely not the drip coffee
that we Americans have grown so dependent upon, I have found that our kitchen
is equipped with a proper coffee maker, and our house mom Witness has realized
how important my coffee is to me each morning. She brews a half-pot that
is ready for my consumption by the time I even walk down the stairs. I'm
quite thankful for this small gesture! My coffee along with the fresh
fruit (mangos, pineapples, and watermelon) served at every breakfast as well as
the warm summer sun shining in through the open window makes me so thankful to
be here. I hate winter and being cold, and this place is the exact
opposite, perpetual tropics. I am settling into the natural rhythm of
life, having adjusted to the 9-hour jetlag weeks ago. I get a great night
sleep most nights, and try to maximize my day in and out of hospital. And
I feel blessed. The house has been somewhat full (12 people total this
week and more dudes (about half and half now), so balance of the sexes
restored!) Most of them with the
exception of 2 are Aussies who are all quite enjoyable people...I'm just
getting to know some of them. So bottom line, things are good, and I have
so much to be grateful for!
However, the
challenges of the hospital ensue. Since
starting Gen Med I have realized that this hospital has very little resources
to spend on its patients. Internal medicine is a field highly driven by
imaging (XRAYS, CTs, MRIs) and labs (CBCs, BMPs, CMPs, UA); if these basic tools
are not available to the physician, medicine becomes very much a guessing game
(and a frustration!) Thus is the case here at Mt. Meru, where patients
must pay for EVERYTHING before it is actually ordered and done. No money means one less resource from our very
limited toolbox. I am finding that anemia and thrombocytopenia are quite
common on the floor. While they are able
to get a FBP (full blood picture) here apparently, they can't do the
differential, at least not these past couple of days. The machine is
broken or they just aren't doing the diff in the lab for whatever reason.
No one seems to know, nor do they seem to care. Case in point, we have a patient who came in
with the chief complaint of bleeding from the gums and fever. She was
anemic (a Hg of less than 5, normal in women is 12 or 13) and thrombocytopenic
(platelets around 20,000 normal being above 150,000 so pretty low!) We
have no means available to determine why she is thrombocytopenic, but the
anemia is probably secondary to her bleeding.
We have no platelets at the hospital to replace the ones she is lacking.
Instead, the attending told us to give Vit K and whole blood (to help her
anemia) and let's hope for the best. I’m sorry, but if there are no
platelets, you can push as much Vit K as you want, and the result will be quite
unsatisfactory. Whatever. Our hands are
tied. I felt that modern medicine in the
States is lacking at times. This is just
downright ridiculous. Furthermore, this
patient has fever with her bleeding, so hemorrhagic fever is on the
differential (not that we can do a proper work-up to prove or disprove.) I found it quite odd how nonchalantly
everyone was throwing around the possibility of Ebola without any thought to
maybe doing infection control, moving the patient, doing some kind of isolation
if it were Ebola. Nope, she remains on
the women’s ward in a room filled with all the other patients. At least she has her own bed unlike
some. Maybe that’s enough infection
control to keep everyone satisfied…
Needless
to say, I’m trying to stay positive, but with the situation being as above, I
had a difficult time yesterday. God has
brought me here for some good purpose, and I’m still trying to work it all out. The best I can do for now is to continue to
be thankful for all the things I’m enjoying and even be grateful for the
challenges that seem like thorns in my side.
What doesn’t kill you only makes you stronger, character building :
)
I should
have known something about yesterday was just off; the day felt weird from the
start. The annoyance at the hospital
only put fuel on my fire, and it all culminated yesterday evening when I got
word that my friend and landlord in Crossville had just passed. He had been sick for a while, chronic kidney
failure, and while I know that his suffering in this life is over, it doesn’t
make the grieving process any less difficult.
I’m more grief stricken for his wife who married him even before she
left high school. Gosh, they’ve been
together for nearly 56 years! My mind is
filled with wonder of how she might get on without him now when he has been her
whole life for practically all of it!
Also, I’ve never had to do this from such a far distance, confront
death. Thankfully I was able to get
ahold of my mom who will be sending cards and flowers for condolences, but I
feel quite helpless here. I knew that he
had been sick and getting worse, but I never thought he’d pass while I was
away. I will admit that for now, from
here, it is much easier to deal with than if I was actually back in
Crossville. I can be somewhat distant
from the whole situation for the present time, but my mind still wanders to
those age-old fears of loss and change and wonder of what the future will look
like now for me and mostly for his surviving family.
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