Was that really only my third day? Lordy.
This time of the year turns out to be a particularly weird time for a foreign resident like myself to visit Mulago - the house officers (Ugandan equivalent of resident physicians) are all out of the hospital for two weeks, taking their yearly exams that excuse them from all clinical responsibilities. Furthermore, the interns (first-year residents) are on strike, as they haven't been paid for several months. (Fair.) This means that the whole of the ObGyn floor, including Labor and Delivery, the inpatient wards, and the Gyn emergency triage area are all being run with a super-skeleton crew of senior faculty members. I'd heard many times in other UCSF residents' descriptions of Mulago that these faculty members often peace out early or simply don't show up on their assigned days, leaving the house officers to run the show; it turns out that their patterns don't change even when the house officers aren't present.
This means that my introduction to Mulago's "workflow" (imagine my quotey fingers there) must be even more chaotic than usual. It also means that all of the Gyn emergency triage area might be manned by, say, myself and a "pre-intern" named Steven. Which it was, this very afternoon. During the morning, we at least had the somewhat questionable guidance of a faculty member; even if I didn't agree with all of her management decisions, at least she's officially in charge. But once 2 PM rolled around, she simply left the floor; no other replacement faculty ever came.
I didn't feel like I could in good conscience see patients without oversight, but leaving the less-experienced pre-intern to manage the triage queue alone also seemed wrong. I eventually settled for seeing those patients that had already made their way onto exam beds but asking the others to wait until a new faculty member (supposedly) arrived in a few hours. Wrong? Right? Dunno.
It's difficult to express how overwhelming this triage area truly is. Everywhere you turn, there's a sea of sick women staring back at you, hoping you're coming to see and help them. There are dozens of admitted patients filling the beds (occasionally sharing), sleeping on mattresses on the floor, or piled into the hallway. There is no central list or census of who these patients are, or why they're admitted to the hospital; we pick our way around the floor mattresses every morning to try to review all of their individual paper charts, and there's often some terrible discovery of a patient languishing in the corner with, say, a worsening pelvic infection that hasn't been checked in on in three days.
There is also a queue of patients waiting to be seen that trails out the ward entrance door and never seems to shorten. Some of the queue have mild yeast infections; some are dying of malaria; some of them are actively bleeding internally from ruptured ectopic pregnancies. (The central hospital admitting staff do not attempt to separate gradations of "female problems".) So you try to sift through this queue while helping the admitted patients get blood transfusions or emergency surgeries or quinine medicine, all the while feeling like you're going increasingly underwater.
In the US, one of the most satisfying job feelings in running a busy medical service is figuring out what patients need at the beginning of the day and then getting it accomplished, tucking them in before you head home at night, watching them get well again over a few days. As far as I can tell, there is absolutely none of that in the Mulago Gyn triage area. It's all of the work and chaos and none of the satisfying endings. You put out fires all day and not much else. The work never really ends, in the sense of meeting all the patients' needs for the night. Mulago Gyn work simply ends when all the physicians get so exhausted they walk away. And then the patients just wait.
I wonder how the house officers can do it. Guess I'll find out in week #3.
On the upside, Steven the Pre-Intern is awesome. I'm promoting him to Pro-Intern.
This time of the year turns out to be a particularly weird time for a foreign resident like myself to visit Mulago - the house officers (Ugandan equivalent of resident physicians) are all out of the hospital for two weeks, taking their yearly exams that excuse them from all clinical responsibilities. Furthermore, the interns (first-year residents) are on strike, as they haven't been paid for several months. (Fair.) This means that the whole of the ObGyn floor, including Labor and Delivery, the inpatient wards, and the Gyn emergency triage area are all being run with a super-skeleton crew of senior faculty members. I'd heard many times in other UCSF residents' descriptions of Mulago that these faculty members often peace out early or simply don't show up on their assigned days, leaving the house officers to run the show; it turns out that their patterns don't change even when the house officers aren't present.
This means that my introduction to Mulago's "workflow" (imagine my quotey fingers there) must be even more chaotic than usual. It also means that all of the Gyn emergency triage area might be manned by, say, myself and a "pre-intern" named Steven. Which it was, this very afternoon. During the morning, we at least had the somewhat questionable guidance of a faculty member; even if I didn't agree with all of her management decisions, at least she's officially in charge. But once 2 PM rolled around, she simply left the floor; no other replacement faculty ever came.
I didn't feel like I could in good conscience see patients without oversight, but leaving the less-experienced pre-intern to manage the triage queue alone also seemed wrong. I eventually settled for seeing those patients that had already made their way onto exam beds but asking the others to wait until a new faculty member (supposedly) arrived in a few hours. Wrong? Right? Dunno.
It's difficult to express how overwhelming this triage area truly is. Everywhere you turn, there's a sea of sick women staring back at you, hoping you're coming to see and help them. There are dozens of admitted patients filling the beds (occasionally sharing), sleeping on mattresses on the floor, or piled into the hallway. There is no central list or census of who these patients are, or why they're admitted to the hospital; we pick our way around the floor mattresses every morning to try to review all of their individual paper charts, and there's often some terrible discovery of a patient languishing in the corner with, say, a worsening pelvic infection that hasn't been checked in on in three days.
There is also a queue of patients waiting to be seen that trails out the ward entrance door and never seems to shorten. Some of the queue have mild yeast infections; some are dying of malaria; some of them are actively bleeding internally from ruptured ectopic pregnancies. (The central hospital admitting staff do not attempt to separate gradations of "female problems".) So you try to sift through this queue while helping the admitted patients get blood transfusions or emergency surgeries or quinine medicine, all the while feeling like you're going increasingly underwater.
In the US, one of the most satisfying job feelings in running a busy medical service is figuring out what patients need at the beginning of the day and then getting it accomplished, tucking them in before you head home at night, watching them get well again over a few days. As far as I can tell, there is absolutely none of that in the Mulago Gyn triage area. It's all of the work and chaos and none of the satisfying endings. You put out fires all day and not much else. The work never really ends, in the sense of meeting all the patients' needs for the night. Mulago Gyn work simply ends when all the physicians get so exhausted they walk away. And then the patients just wait.
I wonder how the house officers can do it. Guess I'll find out in week #3.
On the upside, Steven the Pre-Intern is awesome. I'm promoting him to Pro-Intern.
1 comment:
Wow. I can't even imagine how you must feel. I appreciate your description of the satisfaction you'd typically get from this kind of work, under different circumstances. You can't really appreciate "flow" unless it gives you feedback, and in this case, it can't. But I imagine the meaningfulness compensates somehow..? As someone who just gave birth (with several midwives and a doula on hand, not to mention my relatives), I know how scary it can be to labor for hours, and my heart goes out to you and to the women you treat. Godspeed.
Post a Comment