What I Do Each Day

I realize that I’ve been blogging for a couple weeks now, and I haven’t really explained what I do every day. So a little on that.

When I get to the hospital in the morning, I go straight to the Female Medical Ward. This is a gigantic room (Monte peeps, think of the Moses ER) with beds separated by curtains. It holds about thirty beds. No sheets on the bed unless the patient brings one. There are anywhere between eight and thirty patients in the room on a given day.

First I check the nurses’ register and see if new patients came in overnight. About half the time, the register says no one came in. And about half the time the register is correct. The other half we just stumble across a new person sleeping in our ward, like Goldilocks.

I usually do the new admissions first, devoting an hour or more to each (translations take time). By the end of each patient I usually have about 500 things in my mind that I think this disease could be. So I go back to the nurses station (out of sight of the patients) and quickly consult my cheat sheets and handbooks. I decide what medicines to give and tests to order, and I write it down and tell the nurse. Then I put my confident game face back on, and walk back out to do it all again.

After the new patients are done, I go around and see all the “old” patients, i.e. the ones who are already here. I carry my stethoscope, my penlight, the stack of charts, a blood pressure cuff, and a plastic cup with a thermometer in it.

You may find it odd that I can carry these things all by myself. One little weakling balancing 30 charts? Yes, it is strange, and so I will address this point because I know it is tormenting you.

A chart (or “chart” if I’m in a cynical mood) means a plastic slipcover between which 3.5 loose sheets of paper are slid (or slided perhaps. slidden?) The sheets are not stapled, not three-hole punched, not attached in any way. One piece of paper is the Clinical Officer’s note, which got them into the hospital. A second piece is the note I write when I see them. And the third is the piece of paper that the nurses use to document when she gives meds. The half sheet (winner of the Most Likely to Get Lost award) is where they write blood test results.

Not everyone gets blood tests, or X-rays, or any of the other stuff that is practically required for admission to a U.S. hospital. I've gotten good at asking myself "would the results of this test change the decisions I make for this patient?" If not, I don't order it. I don't get a CBC just because someone's been bleeding a little. If the conjuctiva aren’t pale they're not anemic enough for me to care.

If I want someone to get an X-ray, my first question to the patient is “Do you have a family member who can push you in the wheelchair?” Except when we don’t have a wheelchair. In that case my first question is “Do you think you’re strong enough to walk two hundred yards?”

For lunch, sometimes I spend fifty cents on a big bowl of matoke (mashed plaintains) with beans at the local bean shack, eating with other Ugandans on wooden benches and dirt floors. If I have leftovers, I'll retreat to my little apartment, a five minute walk away.

In some ways it's similar to the Montefiore. Rounds are in the morning, and in the afternoon I do procedures and follow-up test results, have conversations with the patient and families. Same general structure as an inpatient month at a U.S. hospital.

When someone is ready to go home, I scribble “D/C today” on whatever page is up front, that way the nurse is guaranteed to see it.