Friday, 8 March 2013

All in a Days work by Anon.

Hi Guys,  i hope this post gets you both thinking and talking .The author wished to remain unamed but enjoy.

All in a Day’s Work by Anon.

The usual untimely call came again. I’m beginning to hate my ringtone. I pick up, the other voice on the other end of the line asks, “Is this Dr ......?”

Yeah that is me, a Junior Resident Medical Officer in the ministry of health. After 5 years of medical school here I am a Doctor, whoopee!  However, when that call comes in from casualty I almost wish I wasn’t. I almost wish they had rung a wrong number. The puzzle is that I spent 5 years being taught how to interact and handle a patient but I’m most happy when I’m not attending to one. Hence whenever I have finished my quota of the day’s duties I dash for the exit at lightning speed before the nurse yells out “there is a i.v cannulla for u to insert here” or “there are relatives wanting to see you.”

Anyway there is no escape this time I am Dr ...... and I am the Doctor on call. With her best attempt to be polite and professional she informs me that there are patients waiting for me to see them in casualty. She does that as if she knows that if she becomes rude I will use her as the scapegoat for the reason why I didn’t decide to come down there and see these sick people. Unfortunately for her I don’t have to be mutually polite because...because...well just because!

 So I make my way down there. It is a 200m walk from my solitary room of residence to the hospital. Each step of the way, my mind is trying to prepare me for what is ahead. I am trying to predict what is awaiting me.  In a space of a few minutes I go through the entire Textbook of Medicine and the rare things come to mind first. “Will it be Systemic Lupus, will it be Rheumatoid Arthritis, will it be a Wolf Parkinson White arrhythmia, will it be idiopathic pulmonary fibrosis? But then again this is Zimbabwe.” It is usually the cocktail of HIV patients on ARVs with some sort of opportunistic infection, most commonly TB. “TB, TB, TB everywhere!” is what a lecturer used to say. She couldn’t be more right. It is either TB meningitis or Pulmonary TB or TB adenitis or TB pericarditis or simply put, disseminated TB. The youthful thirst for vain glory wishes for the diagnosis of the rare syndromes but it is the same stuff all-day Groundhog every day.

I finally arrive at the casualty entrance and shocker stuns my eyes. There is an entire rally of people filling the whole place. On the phone the nurse made it sound as if there were only 3 patients but this looks like 3 dozen. There are people on the benches, people on the beds some on the floor, some running about with security trying desperately to restrain them. Is this Gaza or Lebanon or some other war zone? A voice inside reminds me, “they are all here for you, so you better man-up!”

It is at that moment where humanity departs and in its place remains this cold calculating scientist who is entirely objective in his thinking. This ‘Mr Hyde’ has no time to show genuine emotional compassion for his patients. ‘He’ certainly has no time to tolerate old grannies who seem to be in pain from their hair to their toe nails. ‘He’ has no time for relatives who are inquisitive for an explanation of the diagnosis. ‘He’ has no emotional ration to spare for the patient who can’t afford the medication or the vital laboratory or radiological investigation needed.

I begin clerking patient, after patient, after patient. The all-so evident shortage of resources does not make the going easier. For the diabetic there are no glucometer strips to do a quick blood glucose measurement, for the hypertensive patients there is only one sphygmanometer , for the patients is pain I can only offer them paracetamol, there are no available stat doses of antibiotics, no urine catheters, no nasogastric tubes, the Xray machine is down again,  even the thermometer!  The lack of equipment and resources just adds on to the stress. It now becomes naive and foolish to wish to diagnose the rare diseases and syndromes that require intricate investigations when I can’t even confirm a fever!

When faced with this situation there are two options; Improvise or Compromise! This just adds more weight to the tonne of pressure already on my shoulders. So throughout the call I vacillate between improvising and compromising. Unfortunately it is the latter that I end up doing more.

“Oh, Oh, Oh here comes one of those relatives again”. She has the audacity or ignorance rather to complain.  She was shouting at the only 2 nurses available but now is shouting at me. She brought her very critical father but they have been waiting for 3 hours for the doctor to see them.  She does have a point, her father is gasping for air. However she is making it seem as if I was watching a soapy on TV all this time. I was attending to the other patients. Who does she think she is? I now know this kind. It is the kind that has been to foreign countries and seen better service and then come back to Zimbabwe. They claim to know a lot and wave the threat of litigation in our faces. It is commendable that she knows her rights but she has forgotten her lefts! She left Europe but is yet to wake up to the fact that she is now at a government hospital in Zimbabwe and not the NHS!

I finally get to see her father. The man is in severe respiratory distress and restless. I attempt to enquire as to what the presenting complaints are but this woman instead of giving me the relative history, she continues on to prove a point. I get a hunch. I ask for the nurse if it is possible to do a rapid blood glucose test. She fiddles about in the drawer looking for the machine, then the other nurse reminds her there are no glucose strips to do the test. Out of blind hope she decides to just check and by a miracle of God there is one solitary, lonely remaining strip left! The nurse does the test and the glucose is too high for the machine to give a reading it just shows “HIGH.” Armed with a diagnosis I admit the father.

I manage to attend to the rest of the patients and slowly the queue tappers down until it clears. Some patients leave satisfied and some depart doubting. A lot leave with nothing, because they have to buy the drugs from a private pharmacy and organise a test I have ordered at a private laboratory in town. What I guess consoles them is the understanding that it is not this young man’s fault neither is it theirs. Whose fault it is, they don’t know but also neither do I.

 We are both victims of a crippled staggering system trying to help each other limp through this patch of the journey. Hope is what consoles. Hope is what encourages. Hope is what bandages the wound on the inside. Hope is the analgesia to the pain on the inside that my prescription can’t relieve. Hope that nothing lasts forever, hope that one day we will get our act together and make things right. The hope that has audacity to affirm that change will come in our lifetime, brought forth by our hands!

As I leave the casualty department I decide to pass by the ward to check on the very sick man I had admitted earlier with the complaining daughter. I get there and I find him peaceful no longer in respiratory distress. I wonder if it must be the insulin, the wonder drug. On closer inspection I find that he is not breathing, he no longer has a pulse, and his pupils are fixed and dilated. The ward nurse says to me “Chiremba, you are just in time to certify him”

As I finish my 12 hour shift, what I have to take home  with me are two things. The first is the question as I wonder did I kill this man or he died? Because there is a difference between the two. The other thing I have to take home is the 13 USD on call allowance that I have just earned. It's all in a day’s work!

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