Thursday, February 21, 2013

More things I think are funny

So, I had to walk a long ways to get this one. It's a funeral rental vehicle - if you can't read it, it says "Funeral service, the world is not enough". Maybe ya'll don't get it. I thought it was hillarious. 

Say cheese! or goat. The man who grills on the side of the road always has the goat head resting on its feet/legs out in front of the meat. At least it is smiling.

This one's not very funny if its you laying on the table. This is my OR room when the power goes off. Just hold pressure, the bleeding will eventually stop.

People here love photos. This is one of my patient's fathers. The patient just had surgery a day ago, but already the photos are developed of her in the hospital bed, and her fibroids in a bowl. Now the really funny part to me is that if you look closely at the fibroid pic, the border is wedding theme, wedding bells and berries.What a romantic picture!

It's a little hard to visualize, and for those non medical folks, this is a laparoscopic grasper (it is used for video surgery through tiny holes in the abdomen in the states). Well, here I found it in the janitors hands, cleaning trash out of a gutter. Hey, give that back, one day we might be able to use it!

Monday, February 11, 2013

Loss and Anger

I tried to pray as I walked toward the hospital. But my angry thoughts even overtook those prayers. I knew from the call that I had just received that things had been going wrong for a long while before anyone decided to call a doctor. We all make mistakes, but this one cost some little baby it’s life. One more dead child, for a patient who had already had this circumstance once before. 

I walked in the ward, asked a few questions. I already knew what the answers were – the all too frequent excuses. Never do I hear the words, “I made a mistake”, there is always justification, someone else’s fault, some other shift’s fault. That is when the “self-control” button inside me turned off. My voice climbed in volume and the heat of it’s tone was no longer concealed. I just lost it.

As I finished my verbal assault, I turned and walked toward the patient. My heart and attitude completely changed to one of concern as I looked at her. I had to counsel her on what had happened.  I felt my eyes getting teary. How do you explain what shouldn’t have happened? Her face barely changed as I gave her the news. It made it easier, that she had no expectation of better outcome, and had no knowledge of what should have been.

I’m not sure what it would have looked like to glorify God in those moments. When my voice and heart were livid, there was something that felt very much valid about it. We actually should have provided better care. But I was very much degrading in my correction. I still felt somewhat justified, as it was a completely preventable poor outcome. But the nurse wasn’t even really aware of her mistakes. They seemed obvious. After I got done yelling, they were probably also obvious to her as well. 

But the whole world of medical care is different here. Excellence in patient care, that is what the whole system in America teaches. There are times when we all make mistakes, but trying to do our best seems to me to be one of the ways that we as Christians in medicine glorify God. However, it is very hard to provide care up to the standards taught in US training when training is so very different almost everywhere else in the world. The presumption that care should still be the best possible with consideration to the limited resources of a given environment often leaves me disappointed.  I am expecting the staff to bear weight which they have never been adequately trained to carry. Formal education indeed should have taught better skills, but it didn’t. And I should do more education to fill the depths of the gaps, but I feel pulled in too many directions to engage such an overwhelming task properly.

The patient, ignorant of medical issues, was full of much more grace and contentment than I. Sitting on the corner of her bed this morning, she looked up at me with a gentle smile. Her first words were a consolation for me - “Asha for work yesterday”, sort of meaning, “Sorry that your work was hard yesterday”.  In my own self centered thoughts, I considered that yes, it was difficult, quite frustrating indeed. But she’s the one lying alone in her bed in the midst of a ward full of mothers with their newborns nestled beside them. And her initial thoughts upon waking are about how hard my day was. I responded, "No, Ma, asha for you". 

A Hard Walk

A holiday - Youth Day! Who would have known that such existed. But I'll take a holiday any way they want to give it.

So, I just returned from a hike. Went to a place that I had never been before. I can't really tell anyone where it was, since we were pretty much lost for 6 hours. It was a strange combination of pleasure and torture. I love to hike, to walk in the beauty of creation. It is soothing and refreshing to me. Gives me time to think and spend time with others. So, all was going well. But, it turns out that when an African points to a path and says "its very bushy bush", that actually translates to "don't go down there". We thought it meant something like "a fun adventure awaits down there", but that was somewhat of a Western translation. No one brought a machete, so we just bushwhacked with our bodies. This is how it felt inside - "ouch", "owww", "ahhh". Through tall elephant grass, along steep, shifty slopes, across streams, over bush animal traps, under trees. There was no one else out there to ask for directions, but we knew that there should be some sort of path or road at the top of the ridge. So, we climbed thousands of feet up. I say climbed, but it was more of a scramble on the loose dirt alternating with thrusting your whole body into the elephant grass to try to create space enough for your tired frame. The joy and refreshment became mingled with physical strain and the uncertainty of being lost.

Finally we found an actual path. Woo hoo, we thought! The top was just over these few, just over these next few upward, upward we went. I walked on ahead of the others at one point. I heard a noise. It was a noise of a human farming. They were beating something rhythmically. Signs of life! Then I saw her. Some would say she looked like a normal woman, but I saw in her a map and a guide. My heart fluttered with hope again. She spoke little english, but I understood that this path would take us back toward the hospital if we kept following it. The others came a few minutes later and I gave them the good news.
I couldn't really understand how far we had to follow, but this was the way back. Turned out it was a long way from there, but indeed it led us correctly, and wearily, home.

The trip led me to consider many things. The feeling of being lost, without direction or hope. And how, when you are lost, you are really glad that someone else is lost with you. But when you find a better way, what a joy it is to bring others along, no longer to nowhere, but to somewhere purposeful and fulfilling. I also thought of the verses about the narrow road, the road less traveled. Those are hard roads sometimes. They can leave us tired and weary. Sometimes they are filled with the feeling that nobody else is out there, every one else is on the big, wide road far off. It can be a lonely feeling. But then I thought about one of the verses that rings frequently in my soul, perhaps it is the best reflection for a man when he is on a difficult journey -
The steps of a man are established by the Lord, 
And He delights in his way. 
When he falls, he will not be hurled headlong, 
Because the Lord is the One who holds his hand.
Psalm 37:23,24

I mean, how much more comfort could there be? We never walk alone. That no matter how hard the road, or twisted the path, our support is none other than the Almighty God. 

Thursday, February 7, 2013


It was one of the wimpiest moments of my life. I came home, flipped on the light, rounded the corner, and saw a shadowy movement that wasn’t supposed to be there. It was on the ceiling between my bedroom and the bathroom. I turned the hallway light on, hoping that it was nothing. But then I reached for the bug spray. It was a big, ugly spider. I mean, I’m not scared of spiders really, but this one had a big hairy back and sprawling legs. I didn’t want to be walking underneath it to get to the bathroom and have it suddenly jump on me. I used up the whole can of insect killer, but still, he was wearily moving around. My imagination started going – “you know, I’m in Africa, there are all kinds of dangerous insects and such”, “it could have some kind of poisonous venom”. I decided the best thing was to get my surgical safety glasses just in case he had some kind of dangerous spraying potential. I reached for the broom and tried to charge him with the handle. But to no avail, he crawled in a little crevice. I could still see his legs wiggling around inside. I don’t usually sit around wishing for a husband, but boy, in that moment I wanted some man to come kill this creature. So, I had no choice – I called my neighbor Jim, who is a general surgeon, as a husband-like fill in to squash him to death.

I began the conversation with an explanation that there was an 8 cm spider (probably more like 5, but when he was hiding in that crevice, I remembered him like he was 8cm), really ugly, I used up all my bug spray, etc, etc. Then I just broke down and said it, “Can you just come kill him?” He was over in a skinny minute, and brought his own fly swatter with him. I kind of wished he would have brought some more sturdy type of weapon so that it would justify my calling him for intervention. But, he used that fly swatter in a mighty, destructive way.  Two swats and there was just green spider juice left on my ceiling, with no signs that there was once such a vile arachnid clinging there.

As he left I mentioned that he should not tell anyone about this episode. After the door closed behind him, I began my deep belly laugh. It hit me that I had just called my neighbor to come kill a spider. I felt the impact of it even more, and laughed even harder as I put my surgical glasses away. I got a little caught up in the moment. My family would be ashamed of me. Perhaps I should be ashamed of myself. Yep, probably so, that was kind of shameful, I’m an embarrassment. 

Sunday, February 3, 2013

Dirty Old Men

There are a thousand reasons to become an ob/gyn. But one of the best is not having to deal with dirty old men. I was reminded of this pleasant part of my job today during one of my interactions.

 I mean, its not really that flattering to have a 70 year old (actually probably older, but it’s hard to tell age here) hit on you. Today, walking home from church, an old man who I have met before came riding his horse to greet me. He said he had come to my house previously but I had not been home. He said that he would come by today again. Another woman missionary doctor was walking with me and asked if I felt comfortable with him coming to my house, since I lived alone. I sized the man up as he rode ahead on his horse and responded that I was pretty sure I could take him on physically if I felt threatened. That’s generally the way I decide if I let someone in the house. It’s frail and wimpy men only in my home.

I was trying to be nice, so when I got home I semi-reluctantly heated up some of the only leftovers that I had to offer him. It’s always culturally appropriate to offer visitors something to eat. He dropped his horse off in some grass before reaching the house and dismounted. He wore a long, pink, embroidered typical robe, a “man-dress” I would call it, along with a little Muslim type hat squeezed onto the top of his head. Now, I know that it’s probably just a cultural difference, but that kind of appearance just doesn’t do anything for me, doesn’t make my heart beat faster. He sat down and ate. Then he got to business. He said that he would like to marry me. He smiled a near toothless grin, his wrinkles totally encompassing the rest of his face, seeming to believe that this was a great offer. I told him that he was too old. His response was that he was still strong. That, however, did not counteract the 40+ year age difference in my mind. He only has one other wife (a huge perk, who wouldn’t want to be a second wife?).  Then he went on to tell me about how I look fine to him. That too, initially may sound nice, but since he seemed to have the appearance of cataracts on both lenses of his eyes, it negated any compliment on my appearance. He also listed the other benefits – he would let me live at my house and I wouldn’t have to move to his compound, and he would give me children (I had to hold the laughter back on that one, I know more about the inadequacies of his reproductive system than he does). When he grasped my arm and my hand, I knew it was time to go, visit over. So, I walked him to the door and graciously told him goodbye. But inside I was rolling in laughter to think of how those chili beans I gave him to eat are going to give him the worst, most terrible gas ever! That is why they were the only leftovers in the fridge, I couldn’t handle them. That is also why I was reluctant to give them to a guest, but in hindsight, I was glad that he was the recipient of those terrible beans. That will teach him to come to my house for dinner and a marriage proposal!

As he left, I was reminded of my training in medical school at the VA hospital. I used to laugh and say that if you ever felt bad about yourself, you should go there for a few days. For a short time, it is relatively flattering. Constantly comments come such as “where were you when I was a young man?”, "you sure are looking good this morning", and “you’re the prettiest thing I’ve seen all day”.  I mean, initially you think, look at these sweet old men, they are so cute and kind. If you really took the compliments to heart, you would leave work believing yourself to be a top supermodel, pretty much a magnet for men. And then you realize that they are almost all visually impaired as they comment on your beauty, and often have a strange combination of loneliness and perversion that would find any female on the planet attractive. And so, you just smile and nod, and learn to pass off the comments while keeping far enough away that they can’t reach out to touch you.

Oh, the joys of ob/gyn. There may be raging hormonal waves with postpartum depression on top of jealous wives, etc, etc -  but thank the Lord that old men aren’t trying to seduce me, lie to me, or grab ahold of me in my clinic.