Jetlag recovery program - 2/21/2011

Jetlag recovery program - 2/21/2011

The first stage of jetlag is denial.  I thought I would have an easy run of things as I stayed up a bit late (~11pm local time), slept well, and started to stir around 0430 - not much different than my normal sleep pattern at home.   I dutifully laid there for another hour but was unable to doze back off.  A shower and a cup of strong coffee were good for, at least temporarily, another 3 hours of sleep or so.  So energized, I snuck out of bed (Wendy and the girls were still comatose) and walked up to the hospital for rounds with Paul - about 7:00am.  I'll separate out the medical details below so that those of you who don't care can spare yourselves the shop-talk.  

The workload was uncharacteristically light.  I got to meet the four residents:  Towodros (the chief), Daniel (3rd year), Segni and Dejene (the interns).  They did most the presenting of the patients while Paul mostly asked questions to draw out the necessary information and lead the residents to the proper conclusions.  He is a very calm but direct teacher - well suited for his role here.  Makes me miss at least that aspect of residency training.  Rounds are different, of course, than in the states.  It is thin, but not entirely devoid of paperwork.  Also, malaria figures into the differential diagnosis of pretty much everything… fever, anemia, malnutrition, tachycardia - where a patient is from winds up being important as those from areas with endemic malaria may have this additional malady to contend with.  Hemoglobin values are suspect, so an exam of one's palpebral conjunctiva is  a critical gaugue of whether or not a patient has ample red cells to tolerate an operation.  We also pray regularly on rounds, especially if someone is having a difficult source or appears to be struggling emotionally.  It is neat to see the residents do this with genuine caring and without a hint of awkwardness.   

After a few cases, we returned to the house for lunch - Injerra and Wat (that's Amharic for culinary heaven, if you didn't know).  After that we headed back up to the hospital.  That's when I hit the wall.  There was a period of relative inactivity (something that was quite rare the last time I was here).  The residents handle much of the pre and postop work.  Our role in the clinic, much like on rounds, is more supervisory.  This relaxed pace, though nice in some ways, served to unmask how truly tired I was.  I went back to the house for a fifteen minute nap and wound up taking 10 of them in unbroken succession.  Hopefully it will translate into a resurgent work ethic in the coming days as the workload is expected to increase.  

Rounds were much shorter (and more organized) than I remember them being the last time I was here.  The surgical load was to be light for a Monday - just a few scheduled cases.  We started in the ICU (no one was bagging themselves this time through) and saw a trauma admission from the night before - a man hit by and then run over by a car - he had stable pelvic fractures, a proximal tib-fib fracture (he had already been put in traction), hematuria, and generalized abdominal pain.  We performed a bedside ultrasound and it seemed that the foley catheter balloon wasn't necessarily in the bladder, though the catheter itself clearly was.  There was no free fluid in the belly, but we were rightfully suspicious for a traumatic bladder rupture.  Short on other diagnostic means (no CT scanner, only barium available for cystography), we decided on laparotomy - suspicions would be confirmed and Daniel, the 3rd year resident, completed a nice two layer repair.  In the afternoon, it was mostly dressing changes on skin graft patients.

The girls were a bit crabby today, but on the whole did quite well.  They took a walk around town with Wendy and Becca Gray - Tessa said that was her favorite part of the day.  As expected, Tessa dove right into the Ethiopian food while Emma picked at it.  Dinner was a bit more western and Emma managed to make up for her lean lunch.  The girls are in bed now (again, not necessarily sleeping, but at least pretending that it is possible).  I'll be heading to mine soon enough.   We expect tomorrow to be a but busier for today - hopefully we'll all be through the jetlag by then.