Reviewing the Week

                I made a difference a time or two this week. Felt like a few things went right. Even in one difficult surgery where there was a complication, my initial response was the thought to call someone to help, to stand beside me, to make me feel more secure. But then after the uncertainty of the first few moments, I found myself overcome by the understanding and skill that are what is supposed to be the outcome of all the training I have had. I knew how to fix it, knew what I should do. In the states, you would have called someone, if only so that you could cover your own liability. But not here. You just put into practice the theory you once learned and fix what’s broken. It’s satisfying.

                But there are still a thousand things that I didn’t learn, or never really got secure in. Sometimes, as a new practitioner, I will get confused as to where to go during a case. And it makes it worse, because I am working with general surgery residents who I am supposed to be teaching. I want to give a clear, replicable method, but often I don’t yet have a certain way that I am in the habit of doing things. As well, since general surgery is a five year program, some of these guys have had more training than I have. And that training is on exactly the type of complicated, weird cases that they have here, not tame, benign cases. So, all of it adds up to make me a bit insecure in my skills sometimes, especially as I am trying to explain to someone why I am doing something a certain way. It can lead to frustration on my part. But in time, I will continue to learn both how to use my skills more effectively as well as how to teach others along the way.

                Other frustrations abound as well. I work with the nursing staff, and it draws my mind to compare them to “my” nursing staff from before. I really loved working with them. They made my days brighter, even the bad ones. If you’ve gotta be at the hospital 80 or so hours a week, you want to be with them. What other nurses in the wee hours of the morning when we were all weary, would let me lay my head in their lap and play with my hair or rub my back. Most of you who read this and work in healthcare might think, “um, that doesn’t happen on my unit”. Well, you’re right, it doesn’t. That’s because my unit was the best. Even recently, with the loss of one of my nurses, I have wished I could be there. Wished I could love them from closer. But that’s not where I am.

Anytime you start working with new staff it can be difficult. There is no trust on either side. Sometimes it feels like I am being undermined or manipulated. Sometimes I think they call me in the night to ask a silly question just for kicks. They must know I often can’t fall back to sleep and are just doing it for meanness. Of course I know that isn’t true, but in the night while I am lying there during what seems like eternity wishing I could fall asleep, it seems like it could be.

This week we had a poor outcome with a maternity case. The nurse said as soon as she presented with a possible abnormality noted at the ultrasound department that we should just go back for a cesarean section. He said that would be the only way we could feel like we were helping her. But as a doctor, I don’t usually treat our feelings. I make medical decisions based on facts. I didn’t think taking a 29 week baby out without being pretty darn sure what the indication was would be right. I mean, the likelihood that it would die from prematurity if I did an emergency cesarean section was almost 100% here. I wasn’t sure. So I said no, I needed to confirm what was going on first. Well, it’s hard to see if a baby is in trouble or not with no devices for monitoring. The monitoring strip hasn’t worked since long before I got here. Neither has the ultrasound on maternity. I am not very good with that funky fetoscope from the old days, and couldn’t get a heartbeat on the baby. Thought it may just be me. So I said to go bring an ultrasound from the ultrasound room which is waaaay on the other side of the hospital. It came, and by that time the baby was dead. So then that led me to multiple other hard decisions as to how to deliver the baby. I felt that nurse looking at me, condemning my decision to wait initially for the operation. I could almost hear him saying, “that death isn’t on my hands, it’s on hers”.  But the decisions are so complex, and the resources with which to make them so much more limited. Maybe that nurse was right, I don’t know. But ultimately we can’t save everyone. The best of my decisions will sometimes still end up with a poor outcome. And whether it’s because of my decision or not, I need grace from others, and help from them too. We all do. I want to learn to love the staff around me and work with them for the good of our patients and ultimately that God may be glorified through us as we image Him while we provide care.

So, to those who read this who pray for me based on the stories I tell, please pray for relationships with those I work alongside here will be fruitful. Not just workable and manageable for getting through the day, but really good. I need discernment to know what is worth fighting for and what should just be let go. And please pray that I will continue to grow in my skill and abilities. And to put some feet onto that one, if you know of anyone who could come teach me more advanced gynecologic surgery skills, ask them if they would be willing to come for a trip. It is a great place to make a difference by coming to help. But better and more importantly, a place where skills taught can be replicated as we use them and teach them to the surgeons in training who will go from here to provide care all around West Africa.