Come And Go With Me

Job descriptions are important.  It’s nice to get an idea of what you are getting into before you sign on the dotted line.  A last chance to escape, you might say.

In residency, job descriptions were very useful.  We had a whole book to outline exactly which resident would see which patient, what tests we should order depending on what symptoms were found and which attending should be called.

Life is more vague now.   Chaos and unpredictability are the two things I can rely on.

 I know that I am in Kenya to serve as an OB/Gyn physician.  I know we have our main operating day on Thursdays.  But what of all the issues?  The problems?  The loneliness?  I don’t remember any of that in the job description. 

Reflecting on this, I recently wondered if my experience could be given clarity by reading the Bible.  It’s our guidebook to life – so why not think it could help me in better outlining my job description as a medical missionary?   The twelve disciples were called from their homes and families by Jesus, so I was hoping that maybe they received some sort of outline.   I found my answer in Matthew 9:36 and Matthew 10 where Jesus sends out the apostles. 

Here’s my summary:

-Jesus says that the harvest is plenty, but laborers are few

-Jesus tells the disciples to pray and ask for more laborers

-Jesus gives the twelve Power to heal disease and cast out unclean spirits

-He commands them to preach the gospel to all

-He instructs them on how to behave

-He commands them to heal and cast out spirits

-He warns against meddling with evil and selfishness

- He warns of persecution and hatred that will be endured

Wow.  That’s quite a job commentary.  There were a few things that especially hit home with me.

First, Jesus acknowledged the upcoming struggle – Look there is a lot of work to be done, and few workers to do it.

 Now my next sentence what have been: “So get busy!”  But His was, “So pray to the Lord that He will send out more workers!”  Paraphrase mine.  There are a lot of times that I am so overwhelmed by the sheer volume of my work, that I forget this first instruction: To Pray for Aid and Guidance.

Jesus follows this command by giving His disciples the Power to heal and cast out unclean spirits.  BAM! Such an important lesson here:  to first seek God’s help through prayer, so that you will receive the power to carry out His will.

Now I am not suggesting that you will pray, then go around magically healing everyone by tapping their shoulder, but I am saying that perhaps there is a natural progression from dependence on God to the Power to see prayers answered and miracles occurring.

The remainder of the summary is vital to me because of what it DOES NOT say.  It talks about how we should behave, how people may view us and how the gospel should be our priority, but what is NOT mentioned is:

-   How WE need to change peoples’ heart or ways or actions

-   How WE are responsible for others’ actions

-   How WE are alone – in fact the opposite!  (The hairs on our heads are numbered…)

This was a great lesson for me.  At a time when I was wallowing in a pit of frustration over circumstances that I could not change, I realized that I wasn’t being ask to change those things.

Instead, my job description is this:

1.  Pray for help.

2.  Be open to receiving and viewing the power that God is working in Tenwek.

3.  Do not try to change other people’s hearts and minds; instead, refer to #1.

Even after all of this…is it still frustrating at times? Yes.  Still lonely at times?  Yes.  I think that it will just be that way…..for a while, maybe always. 

“And whatever things you ask in prayer, believing, you will receive.”  Matt 21:23

Did I Get Them All?!

For those of you who have been reading along in the blog...or for those of you who know anything about my "luck" at work at all....it will not come as a great surprise to know that my calls here have not been easy.  There have been several poor outcomes, difficult patient situations and some very long nights.

Today, I received a bit of encuragement in the form of what I hope will be a good outcome - actually four of them - when I got to deliver a mom who was spontaneously pregnant with quadruplets.

Baby A - The Impatient and Out Numbered Boy

She has been on the ward for about 3 days, after her bag of water broke prematurely at 29 weeks.  She received steroids to help with the babies' lungs.  Today, she went into labor.  Baby A actually slipped out, delivering before I could get to the hospital.  Baby B was a footling breech, so a C section was in order for the remaining babies.  We were able to get the mom to the operating room, get spinal anesthesia in place and voila! 3 sisters joined their impatient brother in the world. 

The four babies are amazingly concordant in weight - all about 1000 gms or 2 lbs each.  They are doing well for now; tucked into the warmers of our nursery with some oxygen by nasal cannula.  The babies have a long way to go - they must gain weight, learn to feed and not develop any of the dangerous lung/gut diseases that sometimes afflict premature babies.  I would like to think that I will see the day when these four are discharged home.....but for now it is enough that they were brought safely into the world. 

Thanks to the research of my partner - OtherDoc - I learned that the incidence of spontanous quads is 1: 571,787 so the existence of these babies is a rarity and miracle in itself.  Please remember these babies, and the many others in our nursery, who need your prayers.  We are very limited here in terms of what we can do for them medically, so each healthy discharge home is truly a blessing.



My grace is sufficient for you, for My power is made perfect in weakness.
2 Cor 12:9

Christmas In Kenya

I am humbled by, and grateful for, the wonderful response of support I have received from family and friends since I have been in Kenya. 

Your comments, emails and prayers have been a fortress of strength in this time of transition. I thank God for each of you - please know that your friendship and support is most treasured!

Merry Christmas and Happy New Year!

What Teddy Does.....

At least 40% of the email I get is inquiring about the health and antics of my feline companion.  I am trying to balance my blog with elements of medicine, culture, spiritual matters...and of course, Teddy. 

That being said...while I am been busy taking call and working at the hospital, here's what Teddy does......

He tries to hide.



He explores.

He spies on the neighbors.

He eats (obviously).

Mainly though - he sleeps.

Retrospect: Blood

A look at a call night in Kenya...in reverse....

Note: All times are estimates.  Names have been changed for privacy.

0130 am   The night is cool and dark as I walk home.  I don't have my flashlight, but there is just enough light to guide my way from the hospital.  As I round the last curve to my house, I pass the pasture where the cows are always grazing.  There is rustling in the grasses.  I wonder if it is a cow.  Or a wild dog.  I have scissors and an umbrella.  Not much for fighting off an adversary. 

I feel like I have been fighting all night. 

I think about the picture in my purse.....the two dead babies....and Wilma.

The words of a hymn run through my mind, "Would you do service for Jesus your King? Would you livee daily His praise to sing?"

As I pass through the gate to my house, I think that though our human timing and actions are often imperfect, God's plan is exactly perfect.  All things are happening for a reason.....as random and futile as they may seem.


Midnight:  The blood bank is clean and I am glad of that.  I lay on the cot, my arm out-stretched.   My exhaustion weighs me down. 

The tech pokes around in my arm.  I am afraid to look - I am alittle worried I might pass out after missing dinner.  How embarassing that would be.  The blood flows out of my arm and into the bag.  I begin to joke with my coworker about how in the US, I would get a cookie after giving blood. 

We talk and laugh as the two units are collected.  It feels strange to laugh.


1100pm:  I am talking to the family of the second patient, Ali.  I tell them that I am sorry about the baby.

Meanwhile, Wilma's blood pressure is continuing to drop.  It is ~ 50/30.  The drain has bright red fluid in it and she does not appear to be making urine.  She is getting IVFs and has received one unit of blood.  The second unit has finally arrived.  Her condition can only be improved by more blood, but there is no more in the blood bank.  At this point, I am worried that not even that will save her. 

"What is her blood type?" my co worker asks.
"A-positive," replies the nurse.
"I will donate to her," my co-worker offers.

I am also A-positive.


1030pm: The second baby is out in less than one minute.  The baby is taken out of the OR.  Word comes back that this baby did not survive either. 
Tears are hot in my eyes as I finish the operation.  


1000pm: OtherDoc and I place surgicel and a drain and close the incision quickly.  Wilma's BP has started to drop and I know that she needs to get out of the OR soon.  She needs massive blood transfusion..and SOON. 

Sweat runs down the sides of my face and the back of my neck. 
Meanwhile, a call has come in: there is another patient pregnant and bleeding in Labor Ward.

  
0930pm: The bleeding has not stopped: it comes from the uterus, the SQ tissues, the skin.....a thin oozing welling up constantly.  Wilma is in DIC.  I ask the anesthesia guy to call my partner, OtherDoc.


0830 pm: Not just a previa.  Previa + Abruption. The placenta - implanted over the cervix (previa), has started to rip away from the wall of the uterus (abruption), causing hemmorhage.  The blood that could not escape throught the cervix has infiltrated into the walls of the uterus.  Couvelaire uterus.  It bleeds anywhere I try to stitch.  I ask my co-worker to take a picture of the uterus with my camera.



Posterior view

0700pm: There is blood on the delivery bed and on the floor.  She is uncomfortable, writhing in pain.  She is known to have a 24 week IUFD (intrauterine fetal demise).  Now she is actively bleeding.  A quick bedside ultrasound confirms my fears: an apparent previa.  I call for IV fluids, an emergency CS and 2 units of blood.

I quickly review her paperwork.  Her name is Wilma and her hemoglobin is 8.4.


Oh that You would bless me indeed,
And enlarge my territory,
And keep me from evil,
That I may not Cause pain.

1 Chronicles 4:10

The Road Home

I started work on Tuesday - just a half day - then jumped right in on Wednesday and finished out the week.
My work day starts with a physical challenge.  As I have alluded in previous posts, the combination of the altitude, the terrain and my personal distaste for exercise has caused my transition here to be a little rocky.  I thought I would share a little more about the neighborhood....just to defend all my whining....


This is the first hill that I encounter outside my house.  Here I begin to experience shortness of breath.  The sidewalk is slightly tilted to the left, so I also imagine that one leg is growing longer.

 This is the second hill.  Here I often feel like I might not make it the rest of the way.  Talking is out of the question.  This is where, on Thursday, I regreted eating chili for lunch. It will give you reflux.  And it alwas makes me feel a little bit like I have to urinate.  Strange.  There are sometimes donkies here grazing by the roadside, sometimes a cow.

This is the third and final hill.  By this time, I am hoping that I don't see anyone at the top because I am too winded to talk.  My legs usually are feeling tired - especially if it is the second or third trip of the day.  I am usually wishing I had taken the afore mentioned donkey.

Overall, I have decided to view this physical stressor by pretending I am on one of those reality TV shows - like The Biggest Loser - only I am in Kenya, and I have participate and continue my job. 

Here's some other views from my walk:

The view from "my" side of the hill

Home at last!

Home Sweet Tenwek

The community of Tenwek is built around the hospital and is rather like a college campus.  Most everyone living here works in some capacity for the hospital.  The terrain is very hilly and the elevation is a severe ~8000 feet. 

The altitude takes some getting used to - I have had headaches, fatigue, achiness and shortness of breath when walking.  It's a lot like residency.  Or heart failure.

I have to walk up a rather steep hill to get to the hospital - it only takes ~ 4 minutes, but the combination of my poor conditioning, the altitude and the terrain leaves me huffing and puffing.

My house consists of a kitchen, living/dining room, bathroom and 2 bedrooms.  There is actually a lot of closet and cupboard space.  It's a little barren yet, but I am getting settled in. 

My living room: Notice Teddy on the fireplace!  Unfortunately all my lovely curtains
were left behind in Cincy, so I am sporting the Kenyan motiff.

Another view of the living room and the door to the guest bedroom

My very small bathroom - it has both hot and cold water!  It is also
a weight loss motivator because it has only about 12 inches between the tub and
sink!   There will be no running to this toilet.....

My bedroom: The mattress is very firm, so I improvised.  I folded a blanket
and a thin mattress pad in half right in the middle, so now it is slightly less firm.

Another view of my bedroom.  The over the door shoe rack
may be the BEST thing that I brought to Kenya.  It is multipurpose.

Another bedroom view and a shot of my bedside table made of my ActionPacker
(the one that KLM didn't destroy)

The dining room "area".  Note the Charlie Brown Christmas Tree.
No ornaments because *sigh* Delta made me leave them behind. :-(

Shopping In My Sleep

After five abandoned bags, four days of travelling, three uncaring airlines, two long layovers and one missed flight, I finally made it to Nairobi.  (HA!  Best 12 days of Christmas EVER!)

Only one more task lay between me and my goal of getting to Tenwek  - my home for the next two years: the big shopping trip.  Because Tenwek is ~ 200 miles from Nairobi, a large degree of planning goes into food shopping.  Food staples – flour, sugar, rice- can be bought in nearby Bomet.  Some fresh produce is available at Tenwek, as well: potatoes, carrots, pineapple, bananas.  However, the majority of food stuffs – meats, cheese, dairy and other “necessities,” are purchased in Nairobi.  The trip is only made every 6-8 weeks, so quantities purchased are large, the bill is high and it can be quite a change for someone who is accustomed to running to the grocery twice a week.

Add in the fact that I had had no sleep, had only stepped off the plane a few hours earlier and wasn’t completely sure what was in the bags I repacked at the airport - and you have a mumbling, drooling recipe for disaster.  Thank goodness I had two Tenwek veterans there to help with the shopping or I may have come home with 56 packages of Ramen noodles (which I was happy to see they have here; they are about $.50 each!)

In the end, I had 3 shopping carts loaded down with $750 worth of goods!  I purchased household items: laundry basket, trash can, soap, cleaners, Kleenex, etc.. and food: canned veggies and fruit, cereal, oatmeal, bread, cat food, sugar, peanut butter, milk, soup, etc.  Then it was off to another household goods store for towels and rugs.  Cha-ching!  On the following day, cold foods: yogurt , cheese ,more produce: apples, oranges, lettuce,  and meat: chicken and beef, were purchased. 

My well-stocked kitchen cabinet!

I have never owned so much food in my life.  And it is very daunting, not knowing when you will go food shopping again. 

The milk here is one of two ways: you can either buy it locally straight from the cow – unpasteurized with the cream still on top OR you can buy it in boxes in the store.  The boxes do not need to be refrigerated until opened.  The box milk is okay with cereal, but it tastes funny to just drink.  Cereal here is expensive and it is difficult to get US brands.  I will likely be eating either yogurt or oatmeal for breakfast.

Some pictures of my new kitchen:

Will follow with more pictures of my new home! 

Oh, Teddy!

Despite our very rough start, Teddy and I made it to Kenya safely!

Of course, our journey continued to be laden with surprises.  As you may remember, I was supposed to catch up to Teddy in Amsterdam, where we would fly together to Nairobi.  Unfortunately, in addition to making me leave half my luggage behind, KLM also put my cat on the wrong flight to Nairobi.  Teddy arrived ~10 hours before I did and had to spend the night in customs.  More like kitty jail.

When I arrived in Nairobi, Igathered what baggage that wasn’t lost by KLM (3 of the 5 pieces), and then I went to find Teddy.  He was LOCKED in an iron cell, in his kitty Cadillac, which was also locked.  No food or water.  He looked so forlorn.  It was straight out of one of those dog shelter commercials – you know the one with the sad Sarah McLachlan song?  He was very dehydrated, but perked up pretty quickly.  Within 12 hours, he seemed to be back to his old self.

On Friday evening, we travelled to our new home in Tenwek, Kenya.  Teddy was very excited to explore his new home.  A little too excited.  I was busy unpacking, etc.. when I noticed that I had not seen Teddy in a little bit.  I began to look through the house.  No Teddy.  All the windows and doors were closed.  I was tired, jet lagged and completely baffled.  How do you lose a 20 lb cat in a secured house?

Suddenly, I heard a commotion in the living room.  And there was Teddy in the fireplace – covered in soot!  He had managed to sneak past the wire grate and climb up into the chimney.  Good grief.  His whiskers had dirt stuck to them and his white paws were black.  I grabbed him with a towel, but not before he made little black paw prints across the tile floor.

One dirty paw - After the cleaning!

If this wasn’t exciting enough….yesterday I lost him again.  I of course checked the chimney first thing.  No Teddy.  Doors and windows closed.  Frustrated, I continued unpacking.  After a few hours, I heard my roommate exclaim,” I found Teddy!”  He was asleep in a kitchen drawer.  He had crawled into an open cabinet and into the drawer.  When she tried to open the door, she heard a hiss and saw black fur.  So, I just emptied out the drawer and left the cabinet open.  Maybe it will keep him away from the fireplace.



Teddy in his drawer - Top View




Teddy in his drawer - Cabinet view




Nap on the Couch



Meanwhile, I am getting unpacked, getting organized and trying to recover from the jetlag.  I will send pictures of the house and surroundings soon…assuming Teddy behaves.

 My new address:   Carrie Huber

c/o Tenwek Hospital

PO Box 39

Bomet, Kenya, East Africa

How KLM Stole Christmas

It all started with the cable guy. 

I cancelled my cable TV service weeks ago but I still had my internet service.  I wanted to keep the service until the last minute so I scheduled the Time Warner guy to pick up the modem between 8-10 am on November 29 (my day of departure).

I didn't have to be at the airport until 1 pm.

He never showed.

When I arrived at the CVG Airport, my day continued sharply down hill. As I piled my bags by the Delta terminal counter a sour faced agent took my passport.

"Where's your Kenyan visa?" asked Sour Face.

You have to have a visa to visit Kenya.  Visas can be obtained by sending off your passport to the Kenyan embassy in the US and then having the documents mailed back to you OR you can buy one at the airport upon landing in Kenya.  The visa is only valid for a few months - long term visitors also have to apply for a long term visa. 

"I'll be getting it in Nairobi." I replied.

Sour Face shook her head.  "No.  You are booked as a one way ticket.  You either have to have a visa now or you have to have a return flight booked."  Her co-agent, Donald, seemed to be nodding in agreement, explaining that if I get kicked out of the country, Delta doesn't want to foot the bill for a return flight.

Apparently, there is a problem with nefarious persons sneaking into Kenya without visas.  According to Donald and Sour Face.

An hour later, I had talked to my contact at SP and reluctantly, so had Sour Face.  And a refundable return ticket had been booked.  Game on!

Then Donald seems to notice the bags.  "How many bags do you have?"

"Ten."

More head shaking.  "How many bags do you think you can have?"

Internal monologue:  Well, Donald - obviously I think I can have ten bags or I wouldn't have brought them.

"According to delta.com, I can check ten."

You ever see a hawk swoop out of the sky and kill a rabbit?  That was Sour Face.  "But you are switching to KLM in Amsterdam and November/December is peak season.....etc....

....therefore....THEY ONLY ALLOW FIVE BAGS PER PERSON."

I know in the Bible it describes Lucifer as being a beautiful creature, but I think he may also have a sour face.

I could feel the tears starting to burn in my eyes.  Five bags!  I had ten!  Donated suture, medical supplies, household goods, clothes, medicines, medical books......one whole bag of gifts (Christmas presents) for a mission family in Kenya.....all carefully packed and repacked multiple times to ensure proper weightage.

Failure could not be an option.

"Can the bags be overweight?"  I was grasping at straws now.

"It will cost more."

Of course it will.

So, my mom, my cousin and I set about doing an extreme unpack/repack in the middle of the Delta terminal in CVG.  All bags were unlocked and opened.  Underwear, books, forceps, suture and other items were tossed about and thrown onto the carpet.

Note to self: All clothing will need to be re-washed.

In a moment of panic, I realized I had no idea what was being repacked.  I tried to supervise, but in my adrenaline laced fury, I just remember saying, "Help me!" alot.

That may have been the screaming in my head.

At one point, Donald was tagging a bag while I was packing it, because all the while the clock is ticking and I should be at the gate for my flight!  Finally, five bags were packed and I left my poor family to clean up the exploded luggage leftovers while I ran to security.

I missed the flight.

Deep breath.  My cat is in Amsterdam.  I just had to chuck 40% of my luggage.  There is a mission family who will not get their Christmas presents.  There is a hospital that will not get an allotment of donated suture.  I don't know where my five bags are or what exactly is packed in them.  I hope I have shoes.

I am being held against my will in Cincinnati.  I want to LEAVE.  I tried to leave.  I paid a ransom (luggage fee).

Failure is not an option.  I still have to get Teddy in Amsterdam!

Three hours later....

After many tears, cell phone minutes and discussions with the Delta agent, the SP agent, the pet agent and my therapist (just kidding on the last one), I had a new flight plan and I had located my bags.

I will be arriving in Nairobi a day later than planned (Dec 1).  Teddy will stay an extra night at the pet hotel in Amsterdam.  I will spend today trying to think about what vital things did not get packed and possibly buying a bigger carry on bag.

Persecuted? Is this a ploy to discourage me?  Knock me down and keep me there?
Protected?  Why does God seem to sometimes not hear prayers?  Was there a purpose to me not being on that flight? 
Poor travel planning? Why did I insist on keeping my internet service through the weekend?!

As someone told me yesterday - I may never know the answers to my questions until Eternity.

Luckily, eternity has no visa requirements, luggage limitations or slamming cabin doors.

Oh.... and Delta's answer to my trail of tears?  A $6 food voucher.  Not valid on alcohol.

I bought chocolate. 

This story does not have a happy ending....nor does it end.  I am merely hoping for a better day today.  There are things that have to be accomplished no matter what obstacles befall you.  I HAVE to go to Kenya.  I HAVE to find my cat.  Everything else......well.......I'll just do the best I can.


For the record, I don't actually "hate" Delta, but I do like this picture from a fellow
disgruntled traveller.  It made me smile.



Finally on His Way.....

Today, my cat left for Kenya. 
**Pause for dramatic effect**

Today, I boarded Teddy into his Cadillac of a kitty kennel and took him to the Delta freight yard in northern Kentucky.  After 90 minutes of paperwork, an early morning phone call to my most-awesome vet to get an additional form and some handywork from a very kind Delta worker who helped me reinforce the Cadillac - Teddy was loaded onto a flight to Atlanta.



The Cadillac of Kennels

  In Atlanta, Teddy was met by the very caring staff of Animal Land petmovers, who then called me to say that he had completed the first leg of his journey without any problems.  He will "hang out" in Atlanta until his flight to Amsterdam tonight.

Tomorrow I will begin my part of the journey.  I will be leaving Cincinnati and flying to Amsterdam via Boston.  In Amsterdam, I will catch up with Teddy.  Any pet flying internationally has to stay and rest 24 hours at a pet hotel - ours is in Amsterdam.  Then we will be on our way to Kenya!

A huge thanks to all of you who have been supporting me thus far...with prayer and with finances.......your love and support is very needed and much appreciated! 

Learning to Accept Ecc

⁸We are hedged in on every side [troubled and oppressed in every way], but not cramped or crushed; we suffer embarrassments and are perplexed and unable to find a way out, but not driven to despair;  ⁹We are pursued (persecuted and hard driven), but not deserted [to stand alone]; we are struck down to the ground, but never struck out and destroyed…”    2 Cor 4:8-9  (Amplified Version)

In southern Sudan, the heat would often soar to an oppressive 115 degrees.  By day 6, the heat was no longer a conversation piece.  It was too hot to waste words.  The stress of a week of heat, crowds that never thinned and diseases that eluded us began to take its toll.   On the next to last day of clinic, 100 patients were turned away because the time to be seen had run out.   I was careless; I walked to camp, seeking solitude at the close of the day, instead of waiting for the truck.  I stopped twice along the short trek, sure that I would not have the energy to finish the walk in the heat.  I collapsed on my bunk, too dizzy and tired too drink the warm, gritty water that was to sustain me. 

It was only 2 days until my departure back to Nairobi – why did things suddenly seem so bleak?  So HARD?  The mission was almost finished!  I should have been joyful!

Nearing the summit of your goal is hard – the environment gets more hostile, obstacles seem to loom larger than before, the nay-sayers voices are louder and frustration is easy.   You thought you would be sliding into home; instead you realize that in front of the plate is a Goliath that was not anticipated.  There is no better time to abandon a project than in the eleventh hour.   I think that if there is anything that cause the Devil more satisfaction than keeping people from trying it’s getting them to start and then just give up!

I have been preparing to move to Africa, to work as a missionary physician in Kenya for over a year now.  FOURTEEN MONTHS of talking, planning, reading, studying.  And now I am one week from my departure.  Sliding into home?  More like slamming into a million Goliaths!  Excited?  Mostly tired and irritated! 

I am bombarded with paperwork that was incorrect, rejected and lost.  I have a fort of bags that are too heavy – thus are packed, unpacked, repacked and ill-packed.  A house that won’t sell.  A mortgage that won’t refinance.   A permanent address in one state, a driver’s license in another state and I live in my car. 

I am confident that if Lot had had to fill out some of this paperwork, he would have never made it out of S&G. 

The road is harsh when the goal is near.  The tendrils of doubt combine with the distractions and frustrations and the Devil so strategically often places the Last Exit at this point. 

But I am not alone.  And there was a reason I started this journey 14 months ago.  My purpose and calling have not changed.  I am distracted at times, but not de-toured.  Through the irritation and tears, I have come to rely more heavily upon His grace and have found that He has not forgotten me.   Unprompted and undeserved, there are blessings that to light my path – and so, I continue on - trusting in His wisdom, having faith in His love, and learning from His word:

The end of a thing is better than its beginning; the patient in spirit better than the proud…

Ecc7:8

 Prayer requests: Safe travel for myself and Teddy...and our belongings.  Maintenance of my sanity.  Good thanksgiving fellowship with family and friends.  Good airport karma.

 

Residency Protection Program

This is dedicated to all the new private attendings who are seeking escape.....

A former co-resident and I were recently discussing some of the differences between residency and private practice (or in my case - locum work).   We found ourselves commiserating about some of the very difficult patients we had had to care for recently.  Difficult not because of perplexing health issues, but due to sometimes overwhelming social and "other" issues.

Take my patient: a woman in her mid-twenties with 45 medical allergies and a history of 15 or so previous surgeries, now complaining of pelvic pain.

The words "pelvic pain" can truly strike fear into the heart of any gynologist.  As real as this entity can be, it is often confounded by physical abuse, social and emotional factors and other health problems.  Not to mention malingering or secondary gain.  It's frustrating for patient and doctor allike and sometimes requires a trial and error approach. 

It made me think back to the days of residency and how - subconsciously - we often tried to "run the clock down" on these patients.  "Get an ultrasound and see us back in 2 weeks."  Which often meant - "I will be on vacation then," or "Maybe the next person will have some clue what the heck is going on." 

In the post-residency world - there is no hiding, no evasion maneuvers.  You are responsible for your patients for all their good and bad attributes.  You can't give them to your partners, you can't avoid them by cancelling office or being on vacation.  They will find you.  If you practice in a small town - they will probably find you in Wal Mart.  :0)

Likewise, you are their physician, whether you have the answers or not.  If you don't have the answers - and sometimes you won't! - at least know where to look it up.  And who you can call later to share the good and the bad.

So, a bit of advice to all my readers who are still in residency: beware the consequences of hiding from your patients.  Learn well how to deal with the difficult patient, the depressed patient, the abused patient and the patient with pathology.  Learn now - because these patients will soon be looking for you.....

Adventures in CraigsListing

As part of my preparations to move to Kenya, I have been slowly selling off my "stuff."  Tables, bedroom set, mirrors, knick-knacks, dishes, clothes - basically anything that I could slap a price tag on - I have tried to sell!

The subdivision I currently live in is a private cul-de-sac and prohibits yard sales.  Thus, I have had to find new and interesting ways of selling my belongings: consignment shops, flyers at work, and - best of all - Craig's List.  Craig's List is not just a way to sell things - it's a whole other way to experience the culture of one's city.

For those of you who aren't familiar with the process - Craig's List is an online "community board" for a city. People wanting to buy or sell something can post an ad with pictures of what they have/want.  Responses to the ads are made via email.  When I post something online about an item for sell - potential customers can send their "Hey, I'll buy that!" emails to me via Craig's List.  I can then respond.  Once a deal is struck, the item can be passed off one of two ways: 1. Meet at a common place or 2. Have a bunch of strangers come over to your house.

In the beginning, I was selling a lot of small items that fit easily into my car.  So, I met people in common areas, near my house.  But as the items got larger, I started having them come over to my house to pick up the items.  And then it got interesting...... here's a few of my memorable customers....

The SpendThrift:

The guy who bought my VCR: I sold it to him for $10.  He knelt on the floor, emptied out his pockets - $1 bills going everywhere.  He picked up ten $1 bills, handed them to me and then crammed the rest of his money back in his pockets.  "Got any extra food you're gonna throw out?" he asked.  I gave him a package of spaghetti and some sauce.

The Bargain Shopper:

The guy who bought my bookcase: it was one of those pre-fab, put-it-together-your-self deals.  I was asking $10.  He looked at it, looked at me, and said, "This is gonna be for my kid.  He'll probably tear it up in a year.  How about I give you $5?"    I said no.  He said, "You got change for a twenty?"   

The Hoarder:

The lady who bought my TV stand, side table and ottoman: She loaded up the furniture and immediately began looking around my house, even going from room to room.  "What else you got?  What about this picture?  That's pretty.  Or this clock?  I collect clocks.  And the flowers in your bathroom - I love those!"  She wanted my armoire.  I replied, "I'm still using it - it actually has all my stuff in it, and honestly it's not very well made.  See - the drawers don't completely close." 
"That's okay - I want it, here's my cell, call me when you want to sell it!"

All in all, CraigsList is awesome.  I've sold a lot of my junk...er....stuff for reasonable prices. 
I'll finish with a few tips:

1. State "Exact change required."
2. Write down how much items are listed for - I got short-changed $5 because I forgot how much the agreed upon price was once!
3. If you live alone and have the CraigsListers come over to your home, you should have a friend there with you, or have a friend call to check on you.
4. Back to #3 - When the friend calls to check on you, don't let it go to voicemail, because then your friend may think you are being assaulted.  (Sorry - YOU know who I am talking to!  :0) 

.......and hey, if you know anyone who wants a 4 place setting of Christmas dishes....I'll give you a good deal!

You Know You Travel Too Much When......

.....Your cat starts packing himself.