Saturday, May 7, 2011


A ward (Pediatrics) and B ward (Medical)

Day # 2 at Kudjip hospital challenged me more and more - mainly because I spent that night on call after seeing patients at the hospital during the day.

The call requirements at Kudjip remind me a little of call at home. One responds to calls from labor & delivery, the hospital wards and the emergency room. The similarities end there, though. A typical call at home generally results in admitting a patient to the hospital after they were stabilized in the emergency department, or at least given a very cursory glance by a physician somewhere along the way. At Kudjip, call means you are taking your patients lives in your hands somewhat independently. I am very thankful for the doctors here who are helping me along - though I feel bad having to rely so heavily on the team during a night that I'm supposed to be "holding down the fort."

My first call was to the emergency room for a young man who was drinking and fell off a 2 story building. He landed on his right side, fractured his humerus, clavicle and a couple of ribs, and was pretty much unresponsive with a blood pressure of 70. I planned on admitting him after stabilizing his vital signs and splinting his arm. As I notified the staff physician, one of the nurses started doing compressions on an infant in the bed across the room from me ... and things got serious. The next 2 hours passed in something of a blur and I felt way out of my league. I was so grateful for Dr. Becky's help. After a few more harrowing moments in the emergency room, we wrapped up and I headed home.

I lay down on the couch and fell asleep, but received a call back to the ER for another trauma victim. While orienting myself (and realizing I had only slept a disappointing 30 minutes) I got a call from the OB ward about a newborn that was having seizures. My head started to hurt - what am I doing here?

I went to labor ward first, discovering a very well looking baby that had 2 convulsions during the night but was otherwise doing well. In this country, Paraldehyde mainstays the treatment for newborn seizures, but I'm far more comfortable with diazepam - so gave that instead. I left OB ward reassured that the baby was not in immediate distress. As my trauma patient was returning to the ER from Xray, the enormous bandage covering his forearm soaked with blood and the strong scent of alcohol made me a little nauseated. He was in a car accident, smashing his arm against some part of the car when it rolled on its side. As I unwrapped him, it was obvious there was serious danger to his hand. His fingers were paralyzed and I couldn't appreciate a pulse in his wrist. When I got to the skin the reason was obvious. Both bones in his arm were broken, one quite visible. After recruiting some additional surgical help, we "reduced, stitched, and splinted" his limb (a pretty common procedure around here I'm discovering). Again, I had been largely overwhelmed and heavily dependent on Dr. Jim and Dr. Raymond in treating this young man. If they weren't there, I worry he may have lost his hand.

Both of these experiences left me a little discouraged. At home, I feel I function fairly well as a young physician. I have a lot to learn, but have made serious progress in the past 2 years as a resident, gaining confidence in treating heart attacks, strokes, delivering babies, performing the occasional resuscitation in the hospital. So far, in this place, I feel overwhelmed.

The hospital is my comfort zone. It is the most familiar part of doctoring here. My patients smile when they see me and I've seen a few make strong recoveries and leave for home. I have seen a couple die, though. But not, I believe, because of some inadequacy on my part. After just 3 days, my rounds are more efficient and I'm learning what tests and treatments are in my arsenal. Things are falling into place.

Call was another story. It was intimidating as an intern to face my first night on call. I remember a similar feeling when going for my first drive in the car having a new license at 16. Something you've wanted for so long that contains a strange mixture of excitement and terror wrapped into one. This call was more like that. I am so dependent on the nursing staff, the emergency physicians, specialists, monitors, lab results, xrays and CT scans of American medicine that facing a broken, suffering patient without them feels impossible. Yet the doctors at Kudjip do that consistently - and do it well. Several lives were saved last night. They weren't saved by expensive laboratory equipment, million-dollar machines and consultations. Somebody's child, somebody's arm, somebody's life was saved because a physician some time ago put their ambitions aside and struck out to the mountains of Papua New Guinea in an effort to relieve the suffering of the people here. God gave them that call, and they responded. Now, they've created a place where His saving efforts toward us are reflected by the doctors and nurses who work here. Each of them has a fascinating story to tell, and I'm sure each endured their own difficulties and challenges before they felt confident in this place.

I pray that in my time here I will be able to absorb a little of that medicine, and a lot of that heart.

And I wonder what their first night of call was like.

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