Sunday, November 29, 2015

Internship snippet: Obs/Gyne

I was just thinking about how I never really managed to put out anything concerning my working experience during my medical internship during the time I was actually doing the internship (timing issues and not wanting to unceremoniously leak any confidential issues). Well, now, the internship is all but over, save for the issue of winding up and getting some signatures. I have to say that transitioning and finishing up for me has always been a bit of a difficulty. Anyway, I was talking to a friend the other day, and she asked me whether I had actually done any Caesarean sections. At the time, I told her that I had probably performed close to 100 as the primary surgeon; well, as per the official count in the OR log, it currently stands at 124 as the primary surgeon (there have been quite a number where I was the assistant, then there were also nights when I was just too tired to log in some entries).

It really has been quite the experience: Kisii Teaching & Referral Hospital, where I served my time is a really busy centre and referral cases come in aplenty. Nowhere does this sentiment ring truer than within the Obstetrics/Gynaeceology (Obs/Gyne) Department. I can remember nights when I’d hear an ambulance pull up to the hospital, say a prayer hoping that they were bringing in a case for the Surgical Department to deal with, and then rush up to the ambulance to confirm for myself. (Of course, I prayed the opposite prayer when I was doing my surgical rotation). :(

I must admit that Obs/Gyne is a hustle to deal with: due to Kenya's fascination with the Millennium Development Goals (MDGs), maternal-child health is a big deal; however, we embraced the ideals and goals, but have not exactly put in a step-by-step program to achieve them. What this did was create an untenable work environment where the onus for maternal death is put on the hospital (particularly the intern), regardless of the pregnant mothers' antenatal care history. On top of that, the work is tedious; I actually lost weight during my Obs/Gyne rotation.

Personally, I love practising surgery, and there’s no better teacher than lots of hands-on work. I still feel as excited stepping into the surgical theater as I did almost 10 years ago when I first volunteered at the Harrisburg Hospital. Performing surgery is art and science melded into one, a beautiful dance where everything enriches the experience: the anaesthetist with his/her real-time command of the patients condition, your assistants both at the operating table and those in circulation, and recovery; even the cleaners keeping the place nice and orderly are a massive help.

Obs/Gyne is not as varied a field as General Surgery, so there were very few procedures you get to perform; king of them all is the Caesarean Section. At this hospital, it's pretty much regarded as an Intern's procedure, unless there is a particularly extreme degree of difficulty inherent to a specific pregnancy. That is quite a lot of pressure to place on an intern; consider that (according to my friend in Australia) post-graduate students in other countries ONLY assist with the C-sections! The quicker you learn to be confident at performing a C/S, the better; my immediate superiors - the medical officers - were none too fond of being woken up in the middle of the night by an intern to come assist with a C-section. Knowing how to handle things at night with a skeleton crew is key.

All risks considered, a C-section is a pretty safe standard procedure; I have only had one mother succumb on the operating table (and that was because she had severe antepartum bleeding). I can't forget the near misses, though: on one occasion, a mother developed hypotension as soon as the spinal anaesthesia was injected and she just flatlined (breathing and heartbeat stopped cold)! Hence, before progressing to anything else, we basically started by resuscitating the patient; once the patients vitals were restored, we performed one of my faster C-sections. There doesn't seem to be anything written in literature sources, but it is a startling experience dealing with someone who has flatlined in the course of being anaesthetized: they pretty much seem out of their mind, overly emotional, unsettled, which in turn makes you question whether some sort of brain damage occurred. Thankfully, daunting as the experience is, the patient is in good condition when we review them the morning after.

I don't see a future for myself in Obs/Gyne, but I am at least thankful for the experience. Many a prayer were silently prayed over my patients as they lay on that table; prayers when I was starting out and the thought of being in-charge of systematically slicing someone open weighed heavily on my nerves; prayers when difficulties were imminent, and especially when complications arose. Thankfully, the Lord was faithful.

One downside to this whole experience is the sheer number of patients that we get to deal with. The intensity of the experience, at least on my part, meant that I formed deep relationships with mothers who I had to reassure and counsel on the best course of action for themselves and their unborn children. This occurred day in and day out; sadly, I can scarcely remember many of those interactions; it's as if they were wiped clean from my mind as soon as they were formed to make space for more equally intense versions of the same experience with other emergency patients. Or perhaps I'm just bad at remembering my own patients beyond a certain space of time. Thankfully, the patients never forget: Kisii is a small town, so its not unusual for me to bump into a lady on the street, for her to hail me as "daktari", and then remind me that it was I who helped her with a difficult delivery. It's things like that which make working in the medical profession a blessing, much more profound than anything money could ever offer.

I don't exactly know whats slated to come in the near future, nor where exactly I'll be headed be it another part of Kenya or Post-grad school - but I'm hopeful God will push me in the right direction (because I plain stink at transitioning).

Have a great week. God Bless.

Sunday, March 29, 2015

Memories: A "Buddy" Pass

Well, a picture really is worth a thousand words. The picture above is actually the conclusion to this whole fiasco after it had come full circle. So let's take a trip down memory lane.

This story starts in November 2003, during my days at Messiah College in Central PA. My elder brother, Nguza, who at that point lived at Daytona Beach, Fl., invited me over to spend the Christmas vacation at his place. He had come across a few Delta Airlines 'Buddy passes', and he sent me one of them so that I could use it to get a deal on a ticket. I'm not exactly sure about the specifics of the deal...but I do remember till today that I only ended up paying $88.00 for a Harrisburg (Pennsylvania) - Orlando (Florida) roundtrip.

Best way I could describe the Buddy Pass is to say that you were basically flying on the cheap, but you were flying 'Standby' the whole time; this meant I had to wait at the counter, get listed as a 'potential' for a specific flight, and hope that the flight either hadn't been overbooked or that everyone didn't make their flight. Oh, there was that one extra added stipulation that I had to be formally no jeans and comfort on that trip.

The trip to Florida was for the most part uneventful. My boss, Elick Yeadon, got me to the airport safe and sound (though I remember him having to rush me back home when we pulled over to PNC Bank about 1 mile out from Messiah to get some money; serendipitously, it was then that I realized that I' d forgotten my passport). Apart from that, and maybe being passed over 2 times for a potential flight, I got to Orlando in one piece, and had a great vacation in Daytona.

When it was time to get back home, again I had to depart from the airport at Orlando. However, this time it proved to be quite the hustle to find a set of flights that would get me back to Harrisburg; it was peak season for travel, which basically meant I was stuck. Finally, someone manning the counters told me that instead of hustling to use 2 flights to get to Harrisburg, I had the infinitely easier option of taking 1 flight to New Jersey and after that taking 2 buses to get to Downtown Harrisburg.

I don't tend to hear many positive things about New Jersey, but on that day I felt New Jersey was just the Godsend that I'd been looking for. As soon as I set my sights on that NJ trajectory, everything just seemed to flow perfectly; I got the standby flight immediately, and I was headed back home. Soon as I landed in Jersey, I got the information for my buses. Turned out the first bus would get me to Allentown, PA at about 11pm, and I would have to take my bus to Harrisburg later in the morning. I surmised that I could just spend the night at the bus station.

Allentown, PA was like no other town I'd come across until then (at least nowhere in the continental US). It was only 11pm when the bus rolled into town, but everything was shut down! All businesses, even the bars: the town was dead and lifeless! Oh, as for that bus station where I'd planned to stay the night...well, it was literally just a small one-person ticketing stall set up next to a bus stop where the bus could pull over. I was basically stranded!

But then again, 'when it rains, it pours'. To add insult to injury, it had snowed earlier that night and the temperatures were frigid. So I found myself trudging through the snow with my luggage in tow, formally dressed, but not appropriately layered and stuck in a strange new town at the worst possible time. I remember walking those streets and coming across some homeless guy who looked like he was balled up in a sack and sleeping in the street. The guy was snoring so loudly, so you knew he had to be comfortable. At that point, I even considered sleeping underneath someone's porch if it was all I was gonna get.

At my wits end, I just walked up to a payphone and figured I'd call 9-1-1. I remember thinking I'd better give the police officer (dispatcher) the correct impression about my situation; didn't want him to think I was pranking him and find myself unceremoniously locked up in jail. He understood my predicament, and gave me directions to a nearby 'Halfway' house. (maybe he was new to Allentown and didn't know of any other options...or he knew how dead the place was and gave me the best option).

I got to the halfway house after a short walk, and I rang the bell. The Supervisor showed up and let me in; unfortunately, he couldn't let me sleep in one of the rooms because I had shown up too late. The best thing he could do was to let me sleep in the lobby, and attend to me later in the morning. It was a chilly place, and not the most comfortable of places to sleep, but it was better than my other options. In the morning, I got to eat breakfast with some of the residents, and by 8.30 am I was already down at the ticketing office finalizing my bus ticket. Long story short, I got home safe.

Fast forward to the end of J-Term 2004, at which point we were done with our classes, and some mission trips had been set up by the school. My good friend, Collins Mwangi, and I ended up going on one of the trips together. I don't remember if we had a choice concerning the area we were posted to, but suffice it to say we ended up in Allentown

I don't remember majority of what transpired on that Mission trip, but I do remember helping to stock food products for the Soup kitchen store; I also remember that we were hosted by the kindly Mr. Garcia and his family, who took us out for a basketball game at LeHigh University (...still have the entrance ticket stub till today). And, last but not least, we ended up at the Halfway house...Yes! The same Halfway house where I'd holed up that one eventful night.

To capture the event for posterity, on January 31st 2004, I had Collins take a picture of me seated in the very same lobby chair where I slept that night - the very same picture at the start of this post. So there you have it: finally come full circle. Memories indeed!

God Bless!

Sunday, February 22, 2015

Just a snapshot

I've neglected to write anything for quite sometime, and that was mainly because of all the stress that I went through during my stint in the Obstetrics/Gynaecology Department, but I've finally moved on to a slightly less hectic department: Internal Med.

Suffice it to say, the experience did nothing to sway me away from considering a specialty in Surgery. (I've only just managed to get over the episode of PTSD induced by the whole experience.

While I have been neglecting the blog, I managed to finally open a Tumblr account - - and started to do something I should have done 2 years ago: putting the 'Compendium' pictures of the 1st Affiliated Hospital online (similar to the one shown on this post). During my last year at Medical school, a group of us invested hours and hours of our time putting together this massive project that would highlight the new 3,300 bed hospital and, in turn, bring much need attention to our medical school.

Personally, that project is all at once one of my greatest accomplishments and greatest failures. At this point, it's easier to ruminate on the failure, because, honestly, these pictures are coming out 2 years too late; I can't even begin to think of all the other compiled work that is sitting on multiple computers, idle, serving no useful purpose. Whatever the long story behind the whole process, I'm glad that I still have Tumblr to show some semblance of what we hoped to achieve.

My most heartfelt thanks go to all members of Compendium who helped with all the major lifting, particularly Hafiz, our trusty photographer, whose great skill shines through in this particular Tumblr.

Now that I have this bit of work off my chest, I can find another hobby to occupy my mind.

God Bless.