Marie's Blog from Lambaréné, Gabon<-- back
On My Own...
September 5, 2008
Looking back over my last entries, I have made much progress and overcome many challenges. As Dr. Schweitzer would say, I have confronted my “boulders,” in such challenges.
“Those who do good should not expect people to clear the stones from their path on this account. They must expect the contrary: that others will roll great boulders down upon them. Such obstacles can be overcome only by the kind of strength gained in the very struggle. Those who merely resent obstacles will waste whatever force they have.”
As for my progress in medicine here, I may not have moved any boulders, but I have certainly rocked them a little, learning so much from my work here. Above all, I know that this experience will serve me in the future by reminding me to slow down and connect with my patients. What I am learning here is that knowing your patients, understanding not just their state of health and how they feel, but also where they come from and what is happening in their life, is as important as any treatment you can give them.
Much has happened in the past six weeks. There have been times that could not have passed more slowly, and others that seemed to pass at warp speed. Having worked alongside my supervising physician for four weeks now, I have enjoyed learning and working through patient management with her. Just as a mother bird decides when her little one is ready to learn to fly, Dr. Natacha has decided it is time for me to leave the nest. I am now seeing patients on my own, but thankfully, always under her close supervision.
At first, the idea of seeing patients in this semi-independent manner seemed quite daunting and almost paralyzing, in fact. I stockpiled every medical book I could find in my office, fearing that I would have a patient with an ailment I would not be able to diagnose. I thought, “What if I don’t know what to do, or worse, not even where to look?” My confidence was vacillating between two extremes—I was anxious to begin consultations in order to contribute to the unimaginably heavy patient load, but at the same time I thought, “What am I, but a fourth-year medical student?!” I was nervous to the point I actually remember thinking, “Marie, just don’t kill anyone!” During my first week on my own, Dr. Natacha and Dr. Carine were always there to answer my questions. Gradually, with each passing day, I felt more and more at ease and confident in my ability to help my patients. It occurred to me that I had really learned something in those seemingly endless hours of studying disease after disease, and working with patients back home at the Greenville Homeless Shelter clinic where I volunteer. Now, after a couple of weeks, I have just two books on my desk and exponentially more confidence. I even admitted two patients to the inpatient service here, successfully diagnosing them, and starting their treatment rather smoothly. One was suffering from an exacerbation of chronic bronchitis and the other, sadly, tuberculosis and a subsequent HIV and toxoplasmosis infection.
I will never forget the latter admission. He came to the Polyclinique without much money or family support. When he came to my office, I was immediately taken back by his thin, meagerly withdrawn stature. He explained that he hadn’t been feeling well—that he felt short of breath, had occasional fevers, and no appetite. He went on to explain that he did not have much money and heard that Schweitzer would be his best chance at getting help. As I went through my evaluation, I knew that there was a high likelihood of him having a grave illness. After seeing his chest X-ray, it was apparent that he needed to be hospitalized. He was reluctant to be admitted to the hospital due to not having any family to help care for him there and very little money to pay for it. We were able to convince him, and thankfully the hospital worked out a way for him to pay. Having settled that, we were able to find him a bed while we awaited other test results.
That evening, I went to check on my new patient. I found him lying on his bed, a black plastic mattress without sheets or blankets. As I scanned the rest of his area, I realized he also had no food to eat. As I mentioned in an earlier post, at the hospital here, a patient’s family is responsible for the nonmedical care a patient requires, including linens, food, hygiene, and physical therapy. That being said, the hospital usually keeps a reserve for social cases like this one. Unfortunately, the hospital was out of this reserve. As for food, it was too late to ask for food to be brought. Although he denied being hungry, I could not sleep knowing he had nothing. I went home, pulled the sheets off the bed in our vacant room and hurried over to our dining hall for dinner. I knew, if anything, I could smuggle some food back to him. When I returned later that evening, the nurse was working on establishing his intravenous access. I didn’t want to call attention to myself, fearing a scolding for opening up Pandora’s Box, so I set the wrapped bundle on his bed and said bonne nuit! I imagined him opening up the bundle of linens, seeing the meal, and maybe feeling better knowing that someone cared. The next day, when I entered his room, his smile said it all.