I get handed a suture

So you can already tell from the title of this post that I went back in the operating theater but not before having the most terrifying morning of my life. Dr. Peduche wasn’t working and so I was shadowing Dr. Singawe. A Zambian doctor whom I’d never met, had no idea what he looked like, and wasn’t entirely sure what ward he was starting in. He had the Pedes and the Maternity so I had a 50% chance. When I went by both and no doctor I got a little worried. Thankfully I looked lost enough that a wandering nurse asked who I was looking for and immediately dialed him up. “He’s not here yet but he’s going to the Pedes ward first.”

“Perfect thank you so much!” 

I went and sat by the entrance. I was just getting into a conversation with Ester–the lady who cleans the guest house when he walked by. He immediately cut off our conversation and led me away. “You’ve had anatomy obviously.”

“No.”

“And physiology and pathology, you must have had those too.”

Did he not hear my first response?

“No well some I guess.” 

“Perfect. Well let’s go, this first patient has pneumonia tell me about pneumonia.” 

Great, I think I know something about pneumonia perhaps. “Umm it’s a lung infection fluid in the lungs.” 

I was definitely stumbling and thankfully I was surrounded by nursing students who were equally terrified and ready to get grilled. So we stumbled our way through a pnemonia diagnosis, treatment, complications, signs and symptoms etc. Dr. Singawe was not impressed by my lack of knowledge and I was kind of sweating the entire time, but eventually we made it. Great did that and then on to the next table where he turned to us again. “This patient has Diarrhea. I seem to have forgotten all about Diarrhea, tell me about it, Claire what do you have.” 

Oh this is great. Thankfully one of the nursing students started in and again we went through everything. This time the students didn’t know the medication and definitely got ribbed for that one. I was ready for the third one anemia although I gave the wrong definition. It was better than the guy who said, “A lack of blood in the body,” but iron deficiency wasn’t much better. The same nurse student that had done so on the other two once again mentioned renal failure as a complication and Dr. Singawe thought this was amusing. “You my brother really like renal failure.” By the time we got to the fourth patient my knowledge felt a little exhausted. 

“Alright Claire what do you know about Malaria.” 

“Nothing.”  (But as I learned where it is endemic any patient that has a fever is tested for it.) 

“Well class lets see what you know.” Thus began Dr. Singawe’s efforts to instruct me and me feeling terrified the entire time. It’s scary to be asked questions that you are not confident on your answers for. Even better the accent is strong enough that you are struggling to understand. And the Doctor thinks you are a med student that has already had A&P and pathophysiology because how could you not? 

I was saved by the maternity ward where there were two ladies waiting to have C-Sections. At that point I was almost thankful to go to the theater if only to escape the questions that I didn’t really have answers for but was expected to. I’d rather face things that might make me spontaneously pass out then keep being asked questions. 

It was different group of nurses tuesday but still super nice. I think I like the people in the theater the best. The anasthesioligist for tuesday was named Juma and it’s easy to remember him because he carved his name into his arm and now it’s scarred. He’s pretty funny and very focused on football. 

“Alright Claire are you ready to assist?”

Hold up now. Scary Doctor was now having me assist with a C-Section a procedure far bloodier and gorier than a hernia removal. Sure why not? Mary was the main assist and she did everything except mop a little blood off the abdomen. I didn’t even put my hand in the incision at all, but hey I didn’t pass out either. At the end of it-”Claire you didn’t get bloody enough.” 

Ah well next times the charm because we are doing two! 

While they were sewing her up they started mentioning bride prices which is pretty fascinating if you ask me. A guy has to pay to marry a woman to prove to her father that he can take care of her. Juma was very set on complaining about this. “Why do I have to pay for a woman?”

Mary and I along similar lines of, “But if you really love her won’t it be worth it to show her?” 

“Yes, but I have a set price that I will pay in between.”

Me “But what if you really love her and her price is more.” 

“Oh I have my price set.” 

Mary-”It is true but the prices are usually fair-if my dad asks too much I will be living with them and be their responsibility forever. And a woman should be honored” 

“No, No they are too expensive. And I want to be married.” (Juma) 

“But if you really love her?” Me

“Doctor what did you pay for your wife?”

Dr. Shingawe, “Why don’t you ask me that question when the ladies have gone.” 

Well I better not let them know that last time my going price was called into question it was 1 slipper. 

Lunch was the same thing as yesterday and the doctor ate so fast that all I learned about him is that he was also Catholic and that he’d always wanted to be a doctor. He then dissapeared and I got to have lunch with Juma. Everyone always wants to know about America and so that was what we talked about. I am getting quite good about making generalizations about the country. He wanted to hear all about the eye surgery as it was one of his buddies from football. 

After lunch we got ready for the second surgery and we were just about to start when we realized we were missing something–oh yeah it was the Doctor. Doctor Singawe had managed to sneak off an had fallen alseep unintentionally in the recovery room. It is a bit difficult to do a C-section without the doctor so that halted our proceedings for a hot second. This go around halfway through the sewing up buisness which took longer because the bleeding was harder to stop on the uterus, (which Dr. Singawe’s solution was just making more stiches till it stoppped,) he handed me the suture. You heard me. He handed them to me. And said okay your turn. 

I tried I really tried sewing the abdominal sheath but when I dropped the suture into her abdomen my attempt was ended. I’m no good at sewing to begin with and then on top of that having to do it with forceps and tweezers really isn’t in my skill set. “Next time,” he said and finished the job.

“Alright Claire,” he said after we finished, “Can you help me with rounds by taking notes so we can leave on time?”

“Of course.”

“You know how to take patient history right?”

“Ummm sort of as an EMT.”

He gave me the ultimate look of how do you know nothing and we started on the maternity ward. He would talk to the patients while I would write the beginning information than he would dictate to me. The problem is he used a lot of technical terms which I couldn’t spell even if someone with the same accent that I had had told me to put them down. Some words I definitely wrote down down wrong like congenital for general several times until I really listened. He didn’t seem to mind though–well until a nurse brought a previously finished chart and asked, “You want me to give her what medication?” 

Okay so I hadn’t really heard him and had kind of scribbled something that I thought was similar to what he’d said, but to be fair a lot of the notes looked a little bit like that. I also don’t think I’ve ever written that fast in my life out of fear or adrenaline from the surgery but we got it done. As he got more comfortable with me taking notes he dictated while scrolling facebook and checking football scores so at least I was giving him a break even if I was giving the nurses heart attacks when they reviewed the charts. I don’t think I prescribed anyone anything too crazy and most of the ladies were doing alright and just recovering from C-Section. 

When we finished this a frenzied hour later my hand was cramping and I was very thankful to sit in a chair while he worked on writing something up. What I was less thrilled about is when he handed me a summary of C-Sections and a list of three other conditions to learn about. (Anemia, Malaria, and Pneumonia) “Learn these tonight, and I will see how you do tomorrow. See you at the pedes ward at 8 have a good day.” 

Oh no. I had to go back and even better I got to study. The only slight problem is there is no power from 5-11 at night which means my studying time was 6:30-8 in the morning when there was power and internet. Yay! So not only had I been run ragged all day doing things I wasn’t qualified for but I got to study first thing in the morning. Life doesn’t get much better than that. In all honesty, it’s really good for me to be pushed but at that moment I wasn’t thinking the most friendly thoughts towards the doctor. I went home dropped off my stuff had a brief talk with Rick and Patrice where they told me I shouldn’t put up with it and I said it was good for me and then went for a walk. 

It’s hard to remain riled up when the evening is so spectacular. I did a loop and found the creek which was a little disssapointing–very filled with trash, but there were lots of birds, and a pretty sunset, and good angsty music I was listening to to calm myself down. I had a random nursing student run up to me ask for my number and if we could be friends. I said yes but she hasn’t contacted me so I wonder if it was on a dare. I kind of carry the wake of Mzungo everywhere I go but I’m usually so wrapped up in unwinding that I don’t super care if people are whispering about me. Hey at least they aren’t blatantly asking me out-we count our blessings. 

I downloaded a logic game that I’m now addicted to so that’s how I spent my evening before finally setting up the mosquito net because I’m tired of waking up every morning with my hands covered in bites and going to sleep because yay I get to get up in the morning and study–my favorite time to study. 

I must be a nervous sleeper or something because I was so worried about getting up to study that I didn’t sleep at all in preparation which made me even more excited to study first thing in the morning after not sleeping. I got so distracted by malaria that I lost track of time and Ishmael and Emmanuel got to watch me enact my fail proof coffee drinking method of inhale it as fast as you can without (a) burning your mouth too badly or (b) choking. It really sucks being addicted to coffee sometimes. (Stay away from drugs kids.) I think I retained about 25% of the information I was trying to learn but now at least I know how to identify and treat Malaria for when I run into it in the states. 

I did make it to the hospital not to late and found Dr. Singawe huddled in a storage room on the phone and looking miserable (like physically unwell) Oh it’s going to be a wonderful day I can already tell is what my brain thought as the nurse cheerfully directed me to him. It was a bit like he’s your problem now. I did the smart thing and waited outside the storage closet until it was safe to go in (the doctor looked a little better.) 

“Someone already did this ward for us.” He stopped and coughed. So he is sick. 

“Okay,”

“But there is a sick baby to see.” And guess what that baby had… Malaria, but not just Malaria, Anemia, and not just those two but also Pneumonia as well. It was the trifecta of diseases that I learned about. Now truly unfortunate and I’ve been thinking about this child alot I’m not positive the poor kid lived. So thoughts and prayers for them. It makes me realize how lucky we are to have the facilities and resources that we do. 

Dr. Peduche came in and pulled Dr. Singawe aside I think to lecture him about something because when he came back in he looked even less happy. 

“Hi Claire, how are you?”

“Good,”

“Keep folowing him take care.” And then she left. Apparently she was sick with a tooth ache. The unfortunte part is if they drop like flies that leaves me doing C-Sections and we all know how I am with sutures. 

We went to the fast lane after that which is where paying patients come to get checked out really fast or sometimes even paperwork signed. Lots of moms bringing in sick kids and the doctor just checking to make sure it isn’t malaria. It felt oddly like the U.S. the kids were even attached to their mothers phones. I suppose bringing in slightly ill kids makes more sense in Zambia where the kid might have Malaria. 

He then started teaching. He taught me on Malaria which made me feel like my morning studying was pointless. Then we went over DKA which he didn’t ask me any questions on just lectured me. Does he not understand that Diabetes is very American and ketoacidosis is very chemistry which is something I have a working knowledge of? But no he didn’t ask but when we moved onto Nephrotic syndrome Dr. Singawe was agast that I didn’t know my kidney anatomy front to back. Why did he wait to ask me questions on that? 

“You mean you don’t know everything about the glomulus.” 

“No, no I don’t.” 

One day he is going to realize that I don’t know like anything and that is the day I will be getting my M.D. 

We called it a day after kidney’s and he suggested I go to surgery to follow Dr. Shamunza because he wasn’t going and I think he was done with my presence. 

I scrubbed up and walked in to them finishing a finger fix all I saw was the casting. Dr. Shamunza having not met me yet turned to me and went, “Who are you?”

“Claire.”

“Why are you in the opperating room?” Which I suppose is a valid question even though the anasthesiologist Becky and I were chatting it up. 

“I’m a student.”

“Okay, welcome.” 

Juma-do you remember him the anasthesioligist with his name scarred into his arm?-was just kind of wandering around. Apparently it was his buddy on the table. “We won the football game that’s what’s important!” Was Jumas’s response to his injury. “You should have seen it we were on the field and the ball came out of nowhere right into his thumb and bam.”  I don’t even think he was working that day because he left as soon as his buddy was done. I suppose if you work in the opperating room you can just watch your buddies get cut open I guess it allows you to have a very intimate connection. 

We ate lunch Ugali which I’m getting very adept at eating and talked about the skin. (We were doing a skin graft next.

“So Claire, what are the layers of the skin?”

“The epidermis..”

“Great what are the layers of the epidermis.”

“Um.”

“How many are there?”

“Um.”

“Where are you at in Medical School?”

“I’ve just finished my basic sciences and not done all of anatomy yet.” 

“Ah okay, well let me teach you then.” He gets it I nearly fell over with relief. For the record I now know that there are four sometimes five, on the palms and heels and I can list the names with my version of spelling. When we went in to do the skin graft we found that there was a pocket under the skin by the graft which would just create another open wound over time so instead of grafting I watched Dr. Shimunza put about five million sutures in to close the hole and put the skin back together. We will do this graft next time. Once he was done feeling around under this guys skin which was a little gruesome the surgery itself was rather boring. 

Then once we’d finished he turned to me, “Okay see you tomorrow.”

Wait that was it? Where was I supposed to go now?

I texted Dr. Peduche and she said go to out patient department. But what was I supposed to do there? There were a lot of people wandering around so I did what any person as lacking of knowledge as I am would and went to the physiotherapy department to shadow Theodora. 

“Hi Claire,” her hands were covered in plaster. “Have you put on a cast before?”

I was getting a little tired of saying no so instead I said, “I’ve watched.”

“Okay, let me teach you.” I could put on casts all day long it is so fun. You get the plaster wet and then wrap it around the limb and then smooth it over with your hands. Was I covered in it for the rest of the day? Yes! Was it awesome. Yes!

This guy had a fracture in I think it was his fibula (I know the difference I just can’t remember the X-ray.) The only crutches the hospital had weren’t a set, too small, and slippery on the bottom so I watched him make his way very very slowly out of the building. 

Hanging out with Theodora is just wonderful. You’ll never guess what image she has a devotion to! The Divine Mercy image. We talked about the struggles with working as a physiotherapist with limited resources but how much she liked her job. I also learned that as a health professional in Zambia you don’t get to choose where you go you get assigned. Our only other patient for the afternoon just needed a hot pack and a massage so I helped her with charting which she explained a lot better and I don’t think I wrote in anything horrible. We went to the Pedes ward to look at a patient but her decision was it was a bad situation and it was better to let the Doctor decide even though the nurses wanted her to make a decision. Honestly, kind of a power play. (The kid had a completely fractured Tibia complete with a very swollen leg.) 

Then she left me in her office and went to go see a quick patient. I sat there for an hour. And while I sat there from the next room over I got to listen to mysterious chanting about nurses but also baboons and Potassium. I couldn’t figure out if it was a mnemonic or helping with English, but it was a little unsettling. Everything rhymed. 

When Theodora came back she announced that her friend had a treat for us. Turns out Mwena (her friend) had oranges! She bullied him into carrying her backpack because she was a lady which was really funny because then she demanded that we get more fruit. Turns out Mwena who works in the pharmacy lives just down the road from me. While he was getting us lemons I climbed his tree, at Theodoras request and grabbed more oranges. He took this all in good humor and was pretty funny. “I thought the white girl at least was a lady.” 

“Sugar cane now please.” Theodora asked. 

So we got sugar cane as well which is the bane of my existence. I’m pretty sure you could kill someone by wacking them with Sugar cane it’s very hefty. Even better it is impossible to eat without a machete. I’ve tried. Patrice and Rick sit and laugh at me as I attempt. The only thing that works is if I break it well I can peel and gnaw on it with my teeth. It’s so good though–I’m just not skilled enough to enjoy the simple things in life. 

They dropped me off and that is when I began my hour long battle with it for the evening. I lost. So I ate dinner in dejected silence while Ishmael and Asbel laughed at my inability to eat the sugar cane. I will defeat it one day…

Song of the Post: Pour some Sugar on me

Quote of the Post: “I won’t carry your backpack because you’re not a lady. Oh I want this I want that?” -Mwena, “Oh I do want some of that now!” -Theodora “That went out of season two months ago!” -Mwena.