Joy and Sorrow

In the clinic today, the clinical officer (like a PA) asked me to review the “file” of a 50 yr old woman with HIV and infertility, who had traveled several hours for the visit. She works as a primary school teacher and stated she and her husband are lonely. They have 2 adult children, age 25 and 26, but their daughter lives in Tanzania. My patient found out about her “ISS” (immune suppressive syndrome – they don’t say HIV or AIDS much here due to stigma) in December. Her husband also has ISS, but has been sick with TB since August. He has a CD4 count of 12. She also had a history of a blocked fallopian tube seen on hysterosalpingogram 2 yrs ago. I think there is pretty much no way she is ever going to conceive again, which she actually seemed to take pretty well. I performed a quick VIA of her cervix and hope to see her in gyn clinic next week for a biopsy.

My last patient of the day was Sarah, a 34 yr old lady with 6 weeks of vaginal bleeding, intermittent abdominal pain, a positive pregnancy test, and an ultrasound that showed an normal, empty uterus with right ovarian cystic mass. She has one teenager and very much wanted another child. I am on call tonight and was worried that we would need to take her to the theater for removal of an ectopic pregnancy, especially after she told me she had an ectopic in 2005. However, on exam she had no abdominal tenderness and appeared to be actively miscarrying. I had never actually seen POCs until today. She was very relieved to find she could keep her only remaining fallopian tube, which prompted her to say “I love you!” to me. It was very sweet.

There are 7 beds in 2 rows in the labor part of maternity ward where they keep the most active patients. I have not yet been able to figure out why they are numbered M 01, M01 extra, M02, M03, M04, M05, and M corner. I also like that instead of ordering patients to be NPO (to not eat), they order them to be “starved” (although that might just be my British attending). The Kenyans also call scut work “donkey work.”

The interns here are total troopers. They are on call every 4th night for the entire year and work 1 weekend a month…which means potentially a 60 hr call shift from Saturday through clinic on Monday afternoon. No work hour restrictions here. I have never heard anyone complain about anything. If they choose to do a residency after their internship year, they have to pay to do it.

We'll see how the rest of the call night #2 goes. I'll be waiting for my page to go off, and also anxious about what I might be missing something if I don't get paged.