Rainy days

I have to say that I was so tired last night while I was writing that I was actually falling asleep while I was typing. I had to go back to read what I wrote because I didn't remember. Needless to say, the sleep deprivation here is taking a toll on me. It didn't help that I took a benadryl right before starting to write--that stuff is way more potent and sleep inducing than ambien! Unfortunately, due to the benadryl, I had a benadryl-hangover this morning and really all day. I was just completely out of it basically all day. But, somehow I did manage to get out of bed and get the day going.

I have to make a comment about last night's dinner. We went to a restaurant not too far from our hotel where Melles' wife's sister works (got it?). They placed the order for what we would be having the night before and all of the food was specially made for us. Unfortunately, the menu was not something that I could go out and just order here on my own because it was a special order, but it was so unbelievably good. I haven't mentioned this, but Hannah and I have been to several different restaurants around town and apart from the Chinese place, the menu is the same every where: Italian (spagetti, pizza, lasagna--but NOTHING like we have it in US, less tasty), burgers, fish of various kinds and national food. I have had more burgers here in the last 2 weeks than I have cumulatively in the last year simply because initially there just wasn't anything that sound appealing, especially in the heat. The Italian is OK and actually tonight we had pizza at the hotel and by far it was the best we have had thusfar. They put hardly any pizza sauce on the pizza. The fish is generally very good and comes with "vegetables" including potatoes, carrots, and squash. The national food is the typical Ethiopian dish found in American restaurants with injera and some sort of meat soup-goop in the center that is eaten with the hands. This is by far my favorite. Thats what I've got about the food here for now.

We went to work as per usual this morning and went to report once again at 8am. Today, we heard a death report on a patient that Hannah transferred to the ICU just 2 days ago. The case was very complicated with many details that I am leaving out, but ultimately before the patient was transferred to the ICU, she became unconscious for no clear reason despite an LP that was essentially unremarkable and broad spectrum antibiotics to cover meningitis and other infections. She passed away this morning, which given her multiple other serious problems was not unexpected, but she was only in her 20s. What I took away from report this morning though was that there wasn't really a review by the interns as to why she actually died and what the events were that lead up to her death. Any time a patient dies in the US, we always try to do a full review and make sure we really know what happened unless it is very obvious. That isn't something that is really emphasized as much here.

After report, rounds followed on the side of our ward with more significant problems. Our attending rounded on the entire side with us today, and it was actually nice to have him there for rounds today. I realized something about the medical system here today. First, I have to say that when I arrived here, the medical system actually seemed much more sophisticated than I was expecting. They have quite a lot of labs that can be ordered, x-rays, a CT scan, ultrasound, etc. But, the problem with a lot of this is that much of it takes a long time to come back (days), so it is quite difficult to manage patients who are acutely ill. I feel like a lot of decisions are made based on very little information, especially to what we would have making these same decisions here in the US. I would also like to comment on physician work hours related to this. Here, the typical day starts at 8am and goes to noon when there is really a 2.5 hour lunch break. Then there are admissions from 2:30 to 4:00 and then everyone goes home. The physician who is on call can leave shortly and then must return to be on call overnight, which they are every 3rd night. The limited time in which patient care is done here I think really speaks to the need for physicians to work long hours to be able to provide the best patient care possible. Additionally, I have found it extremely difficult to know everything that is going on with my 22 patients each day with a work day that only includes 5.5 hours of actual work. By the time we see the patients, review the vitals, get the lab results back, look at imaging, and admit new patients everyday, that doesn't leave a lot of extra room for reviewing charts or doing procedures. I understand with this system why only half of the patients are seen every day--there is just too much to do each day.

On that note, I did another thoracentesis today on a patient with a unilateral pleural effusion. These are a little more cumbersome in terms of removing the fluid as compared to doing them in the states because I was having to remove the fluid with a 20cc syringe. This patient today had about three-quarters of her right hemithorax full of fluid, so I needed to take quite a lot of fluid off. Because there are no vaccutainers here and the fluid doesn't drain really very well on its own, I had to aspirate the fluid over and over again with this syringe. But, we did end up getting a little of 800cc out, so hopefully she will at least feel a little bit better. The two patients that I have done these on likely have tuberculosis and I have learned that straw colored fluid is the expected appearance in this setting. I had to walk the fluid to the national health laboratory today myself, which involved a 2 block trek outside of the hospital. We'll see if the fluid is at all revealing.

It was quite cool today for a change and it finally did start raining at about 3pm and has been off and on raining since then. This is not the rainy season (July is), but it has been quite rainy, cool and cloudy for the last couple of days. Its sort of nice though if for no other reason than my room is now nice and cool. I'm also hoping this will keep the bugs away so that I wont have to apply my OFF! before going to bed tonight. Henish actually gave me something called Jungle Juice last night that is 98% DEET. Yes, that means it probably causes cancer. I sprayed it on the comforter of my bed as well as the curtains in my room hoping maybe this will keep the bugs away.

We have decided to stay in Asmara this Saturday to show Henish around and, quite honestly, to take it easy. We may also take a train to a nearby city this Easter Sunday since we wont have much else going on that day. We may try and go to some of the church festivities on Saturday night that goes on most of the night, but that may only be if we can get a hold of the appropriate dress. Tomorrow will be an eat-fest with lunch happening at the associate dean Andu's house, and then dinner with a coffee ceremony at Melles' house. I should get my fill of national food with that. :)