So . . . upon arrival I was reminded of the challenges I’ll
be facing during my time here.
Something I was ‘aware’ of prior to coming, but something you can’t
prepare for. It’s funny, as it
really doesn’t matter how much you know your getting into . . . you really
don’t realize it until you are living it.
The simple things . . . like internet, cell service, srub techs, patient
transport, communication with people who speak your own language fluently . . .
are really the things that get you.
I performed my first cesarean section as an attending this
past Saturday . . . I had a non-surgeon Haitian physician assisting me (one who
at least spoke a little English), and I was my own scrub tech. It’s amazing how such a simple
procedure can feel so exhausting.
As if that weren’t enough, I spent the entire day worrying . . . what if
I got into the uterine arteries and didn’t know it . . . what if she ends up
having a post partum hemorrhage . . . what if I need to take her back to the OR
. . . what if I’m causing more
harm than good?? . . .
Besides the cesarean section, I had other tasks that kept me
busy over the weekend . . . helping Sandra clean out the storage room (which .
. . nick if you are reading this, made your place seem clean and organized) .
. . and most importantly putting
together my introductory presentation for the cervical cancer screening
project.
Come Monday . . . I was ready to get started. We didn’t have everything we needed
yet, but I at least wanted to start thoroughly getting the staff educated as to
my plans, as nothing I do will really make a difference unless they continue
doing what I teach them. Sandra
interpreted as I discussed the very basics of my intentions to some of the
female staff . . . all four were on board.
I had also found out that morning that the nurse who was to
be my interpreter and the first to learn how to perform VIA had to go to the
states emergently as her daughter had appendicitis. She’d be gone for the week. With Sandra leaving on Wednesday, I would have no one here
to assist me . . . something that could possibly push things back a week. But, Sandra said she would make sure
things were taken care of. I will
say right now, even though she wont be here with me the entire time . . . this
project would not be successful without her.
Then . . . to
clinic I went. Just as I had the
two previous days, I was deemed responsible for seeing every GYN patient and
every pregnant patient. With the
charts stacking up prior to be even getting there . . . I made the decision to
go ahead and start screening people.
We may not have had everything ready . . . but so what? I came here with the sole intention of
ridding the Haitians of cervical cancer, and I’d be damned if I ended up
spending the whole time feeling like an intern in triage for the next several
months. The first patient happened
to be the cousin of the lady I had sectioned on Saturday. We offered her the screening, and she
accepted. Finally . . . we were
getting things started. Five
people screened in the first day . . . one positive who wants to have a
hysterectomy for Fibroids . . . success.
I found that the post op hgb for my cesarean was 10.3 (from 11), and she
was good to go home.
Then, my last patient of the day . . . a very simple
pregnant woman who said her last period was sometime in December . . . also
said she had been leaking urine since she was pregnant. Unfortunately, it was not her urine she
was leaking. She was ruptured at
most likely 27 weeks (by a growth scan by an OB physician who comes to OSAPO
once a week . . . [someone who spent some time working with my second year
Docent, Dr. Wickstrom in Kansas City . . . Dr. Wickstrom also worked with one
of the partners at my new practice in Alaska . . . very small world]). No NICU here or anywhere close by. We discussed that she needed to be
transported to another hospital better equipped for a 27 weeker. And transport means we write the orders
and the patient needs to find her own way to get there. As I said before . . . the patient was
very simple minded, and could not repeat our orders. She had come alone.
Luckily another woman at the clinic knew her mother and said that she
could help make sure the message was relayed and she got the proper care. We gave her the day one antibiotics, a
first dose of BMZ. She then
left. I would have kept her until
we could provide transport for her, but no one seemed to want to help.
At this point .
. . I was so frustrated with the system . . . what I really wanted to do was go
on a nice long run with my dad to talk it out. Unfortunately, not possible. It’s amazing how one simple day can contain such a mix of
emotions. A very eventful day, I
must say.
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