Safari Iliyofana: A week in the life...

Anne & I have been spending what feel like long hours in the hospital. We each round with our teams all morning and return in the afternoon, working until dinner. We walk to and from the hospital together each day... which is lovely. Views from my walk below.

We have been studying Kiswahili as often as possible with our teacher, Wycliffe. Nilijifunza Kiswahili kwa mlimu yangu Wycliffe. Nilikula maharagwe jana usiku na nilinyamba sana baada ya kulala. Pima, Anne.

A Morbidity & Mortality review held by the Medicine Department revealed that approximately one in seven patients admitted during the month of January died while in the hospital. As I was thinking, "Man...", the Chairman of the meeting and my Attending (present at rounds exactly three times in nearly three weeks) commented that the number was unusually low.

He conducted the meeting much the same way rounds proceed in his presence... A heavy emphasis on the less-than-important, a keen focus on failure and blame and an utter lack of decisions made or action taken. I didn't enjoy the meeting. I sensed that role models at the Attending level were lacking.

On a related but unrelated note, as a proud Rock for Riley alum, it is my sincere pleasure to take part in the announcement of Rock for Riley V... to be headlined by The Avett Brothers. This is one of my favorite Avett Bros. tunes in recognition of an often used but questionably effective teaching method.

Shame by The Avett Brothers

I spent last Friday morning working with one of the Radiology Attendings. Consultations are either very difficult to obtain or surprisingly easy & efficient. Said the Neurosurgeon, "We'll take him to the OR tomorrow." There's no middle ground on this. I introduced two cases to Dr. Wanene (who looked bizarrely identical to my landlord in Providence... but Kenyan) and he asked if I could get the patients to Radiology now. I agreed. A few corners may have been cut in regards to consent, time-outs, patient understanding of the purpose of the big needle and perhaps sterile technique... but overall both biopsies came off without a hitch. As I waited earlier that morning to speak with Dr. Wanene, a woman with the housekeeping staff requested a picture. I obliged.

It continues to feel very strange to know a very sick, young person is dying and then to watch them die. I believe I've written about this once already. I can create many explanations for why it is not feasible to resuscitate every dying patient at MTRH. There is plenty of room for spirited disagreement here. Nonetheless, it happens. Patients die while we round on the patient in the next bed.

I returned to rounds on Friday to catch the last few words of a discussion regarding a 36-year-old HIV+ man admitted with heart & renal failure. He had deteriorated overnight, pulmonary edema in the setting of an unrecordably low blood pressure was diagnosed and a rock & a hard place were noted. My Registrar and interns broke away from rounds minutes later to attempt resuscitation. Why this patient and not so many other patients, I don't know. I joined and attempted to help us clarify our options. At one point, my Registrar appeared offended by my clinical assessment and left. Others simply drifted away. It didn't go well, but unlike many others, this man did make it to an ICU bed... in which he passed away hours later.

I grumble at times about the occasional excessive use of critical care resources at home. I focus on this negative too often, I think. From here, well-trained critical care staff operating state-of-the-art equipment to save lives looks more like the vital resource that it is. Below, the three medical students who stuck it out throughout a long and unpleasant code. We shared a nice, long lunch... talking at length about George W. Bush, Barack Obama and politics both here and at home.