Friday, September 19, 2008

A roller coaster of emotions

It seems that I ride a roller coaster of emotions here in Swaziland.
I started the week positive, upbeat and full of hope. By the middle of the week, I came crashing down.
I woke up on Wednesday with a terrible headache- almost identical to the one I had suffered a week earlier. This time, it was bad enough to keep me in bed and prevent me from doing my ward round. I felt really bad. I knew I was letting my patients down- this did not improve the wave of depression that I also thought was starting to envelope me. I spent the whole day in bed- only rising to make some toast and some of that ghastly coffee I continue to suffer.
I got up at 6pm feeling exceedingly low. I managed to have a shower and thought that this was my major achievement for the day. I decided to come to the computer and see if there were any much needed messages. I emailed my Mum and told her I was not doing well. I then emailed my friend Iain and told him that I was “struggling”- a gross under-representation of what I was truly feeling. I contacted him through “Facebook”- quite an amazing achievement given that I cannot even access “Hotmail” from this computer. I remember staring at the screen and it was quite a surreal experience. I was looking at some wacky things posted on his “wall” and I felt so removed from the world I was living in. The truth is, I sometimes feel like I’m living on another planet- things here seem a world away from my existence in Australia. The reality is that I’m only a 15 hour flight away from Australia, but here I face conditions I never imagined existed. I am on the same planet and yet seem so far away.
I was if, by divine providence, that Julia came up to use the computer. She found me just staring at the computer screen. With out any words, she embraced me and it was then, for my first time in Swaziland, that I started to cry. I don’t mean a tiny little sniffle- I mean absolute sobbing, where the pain seems to rise from the bottom of your stomach. I wailed in much the same way as those girls did when they lost their mother. My eyes swelled up and snot poured uncontrollably from my nose. I cried and I cried and I cried. I am grateful that it was only Julia who paid witness to this fragile moment in my life. I know that even though I am disclosing this moment to you now, she will never reveal to anyone else what took place that night. We didn’t exchange any words. There are no words to say in such situations and it is only those that are present who truly understand the extent of emotions that are evoked here.
I went back to my flat, took some of my precious “mersyndol” and slept for another 10 hours.
I woke the next morning and contemplated another day in bed. I felt completely defeated. I then realised that I couldn’t continue like this. I had two options- soldier on or get on a plane and come home. I realised that I probably would never forgive myself if I came home early and I got out of bed and prepared for another day at the Good Shepherd.
The day didn’t exactly get off to a good start. One of the first patients that I went to see looked awfully peaceful as I started to read the admission notes from the night before. I then went to examine her and found that she was not breathing and had no pulse. Lord knows how long she had been dead. She came in with high sugars secondary to her diabetes- I have no idea how she died.
I was continuing the round when one of my surgical colleagues came up to me to inform me about one of my patients on the ward.
This young girl had been with me for some time. She was 18 and had AIDS. She was initially admitted with diarrhoea which I successfully treated. I discharged her home, but unfortunately, she could not pay the bill as no family members came to collect her. She therefore stayed on the ward. During her time waiting for her family, she caught a nasty pneumonia called PCP, again which, I successfully treated.
Apparently, whilst I was in bed feeling very sorry for myself, she started to have a nose bleed. The nursing staff called the surgeon who apparently ordered some medication. The girl continued to haemorrhage and the nurses were getting worried. They asked my friend Chris, to call the surgeon again. Chris called and told him that he needed to come and see the patient. Apparently he was busy in clinic but eventually came to find the young girl exsanguinating. He took her to theatre, but she bled out and died.
He came up to me on my ward round and told me that this girl had platelets of 11 (platelets are the cells in the blood that help it clot and 11 is an incredibly low number). He had taken a blood test on the girl when she was in theatre.
He told me that if I had taken a blood count earlier, I would have known that the platelets were dangerously low- perhaps I could have transferred her to Mbabane for treatment and she wouldn’t have died.
In my already fragile state, this only resulted in yet another round of tears (but thankfully a little more dignified this time). I really felt as though I had contributed to this girls’ death.
After a prolonged discussion with my beautiful friend Katerina, I realised that perhaps things had been blown out of proportion. Firstly, there was never any indication to do a full blood count on this girl. In Australia and US, it is a very common test, but here in Swaziland- I really have to have a good reason to do it. This girl never displayed any bleeding problems and I had no reason to investigate for platelets. I only order tests if I think it will alter my management. Patients have to pay for every test and medication I prescribe and I have become acutely aware of the consequences of over investigating- people simply can’t afford to eat after a hospital stay.
Secondly, even if I did know her platelet count, there was never anything I could do about it. This patient did not have enough money to be discharged from Good Shepherd. In order to be transferred to Mbabane, you need family to take you and money to pay for it. Both of which this girl did not have.
Thirdly, this girl had AIDS and in reality there probably isn’t much Mbabane could have done either.
I still felt very shaken and I was so disappointed that my colleague spoke to me in this way. I am working so hard. This is really difficult. When I’m not working I’m reading textbooks and trying to learn as much as I can. I am professionally isolated here and it can be incredibly lonely.
I woke up today feeling much better. It’s a public holiday here so that people can vote in a farcical election. Nevertheless, it is an opportunity to remind me just how peaceful Swaziland is. Despite all of its problems, the elections should proceed today without any violence. This cannot be said for very many African countries. I am truly grateful that I chose to work here. I cannot imagine how difficult it would be to work in conditions like mine and have the added concern of violence, rape and torture.
I am spending the day with Katerina and Frank. They are returning to Germany tomorrow and they want to spend their last day in Swaziland with me. I am really touched by this. They are truly remarkable people and I feel so blessed to have met them. I will miss Katerina doing the ward round with me. Despite her being a student, she is incredibly bright and I appreciated bouncing ideas off her and her gentle reminders when I would forget to order prophylaxis. I know that this won’t be the final goodbye for us- we will inevitably meet again. Today we will appreciate the “other side of Africa”- we are off to a game park. Hopefully a little sunshine and fresh air will leave me feeling invigorated- ready to face another week.


graemew said...

Hang in there Mel .... If they get to critical of you kick em in the gooleys

Bryan said...

Oh Mel - It's so interesting reading your blogs. What's your postal address there? Just ignore that surgeon! reminds us how small things can make people snap when they're vulnerable and already fragile... take care and hope you've fully recovered from the headache and cold.