Monday, October 26, 2009
As a med school “super senior” who has done a fair share of away rotations, I have certainly seen a good amount of red tape, especially in my attempts to prove to away institutions that I am, in fact, vaccinated against mumps, OSHA-trained to safely dispose of needles, and insured against malpractice. But the bureaucracy I experienced this morning was, as my roommate put it, “a caricature of itself.” To briefly sum up the entertaining events of the morning: I started (rather, was supposed to start) a rotation today in toxicology at an unnamed hospital in the Midwest (I am applying for residency out here…can’t be too careful, ya know). After being unable to determine the exact date or time or location for anything this morning, despite multiple emails and calls to several people, I finally found a time and place to aim for. After waiting for ages in a boiling hot room of an ancient building with 40 other short white coats, we filled out some paperwork, then watched a video on proper needle-disposal and hand-washing practices (Really? Turn on the hot water? Ya don’t say), then attempted to get paperwork to get our ID’s (one of the only things I was told about the rotation I was starting was that I was not to show up without an ID). So I enter a very inefficient woman’s office (I already don’t like her…I recognize her name as one of the people who has never returned my phone calls), and am told to find my paperwork from a giant file cabinet, loaded with manila folders theoretically alphabetized by last name (welcome to 1954). She is flummoxed when I can’t find my paperwork. ‘What’s your last name? Are you sure you sent in your paperwork?’ Yes. Three weeks ago. ‘Are you sure it’s not in there?’ Yes. ‘What’s your last name?’ Rinse, repeat. She phones the administrator of my rotation, who…says she’s never heard of me. Despite the fact we’ve exchanged emails in the last week. Finally she admits she received my application. And although the papers themselves cannot be located, I have brought along an extra copy of all my immunization records. I am prepared! Yet I cannot get an ID because there is no list of all the negative TB tests I’ve had. I had a negative one in August (yay! No post-Africa TB for me) and records of one a year for the past 5 years (though with no listed results for the other ones). I explain that if my last one was negative, they’re all negative, because you can’t be positive and then negative. She says, “I know you’re trying to use logic, but I’m telling you I need this piece of paper.” Ah yes, silly me for using logic when I just need to produce a piece of paper. And here I thought the point of this was to show you I don’t have TB. Which I can do with this one paper I’m clutching in my clenched fist. But nevertheless, I understand it’s your job is to push paper, and you need this form. So the form gets faxed from my school’s student health department (good lord they are nice and helpful there), but all the while this is taking place, I am told to vacate my chair several times. Even when I’m not sitting in it (like when I’m in the hall pleading with the student health nurse to find my files, my bag and coat are still on it). But for some reason, this woman wants to have students lined up in a specific way: 1 at her desk, and 3 sitting in the chairs (which are not in a row) in her office. Nevermind that no students are actually lining up like this, they’re just entering her small office when the previous student leaves. And yet…she’s fixated on the fact that she needs her chair so students can sit in it while they’re lined up, even though no one is attempting to sit there. Eventually, just for entertainment purposes, I keep sneaking back in there and sitting in it while I’m waiting for my fax, just to see if she notices. Finally she accepts my vaccination sheet, and sends me off to get my ID. It’s OK that it’s 10:30 am and I was told to report to toxicology conference at 9am. Whatever. So I find my way to the ID badge office, and after telling the man working there I’m a student and handing over my paperwork, I am told, “A student? We’ve reached our quota for the day.” I look around. Quota? But there’s no one in here. There are three employees back there doing nothing. You’re telling me you can’t make me an ID? No, apparently there’s a “student quota” for ID’s which is usually met by 8:30am on a Monday. But, since an initial ‘no’ is rarely the final word, I am nice and persistent and smile and finally get my shiny new ID. (And I’m not even scowling in the photo). So, only two hours late, I start to make my way to toxicology conference. It’s in the Poison Control Center. I figure since no one answered my emails, I’ll just google the exact address and ask at the front desk. Seems simple, no? So I google it, it’s a block away, I go there and can’t find any doors where google maps tells me they’ll be (I know, I know, I should have learned by now not to trust google maps). So I call the administrator of the rotation to ask how to get there. “Oh, conference is at the poison control center downtown on Monday!” Of course, there are several poison control centers scattered around the city. Could NO ONE have mentioned this to me? Ok, deep breath. “And conference will be over soon anyway, so it’s not worth it to go over there.” Ok, that’s fine. I tell her I want to reach the program director to find out where and when I can meet her so I know what I should be doing for the rest of the day (since I can’t talk to her at conference like originally planned). I am told she’s in conference (duh) and won’t answer her phone, so I should send an email to this woman, who’ll forward it on (is anyone still following me here?? I’m confused just re-reading it, and I lived through it a few hours ago). I suggest I can just send the director an email directly, but the administrator would rather I send it to her, and she’ll forward it. Fine. So I hang up and send a one-line email about how to contact Dr. So-and-so. I wait. Five minutes later I get a response from the administrator (I am cutting and pasting this), “Did we speak or is this a recent e-mail. I thought we discussed that the conference was over at the poison control center downtown?” Um, what? I’m sending you an email because YOU TOLD ME TO SEND YOU AN EMAIL. And YES we just spoke it was 5 minutes ago!!! Ok, deep breath, calm response, saying I would like to reach the director I was supposed to be meeting at conference to see where I should go for the rest of the day. Five minutes later, another email, “They r done for the day. Conference is from 9:30 til 11:30. PLEASE CALL ME.” At this point I was beginning to think I was in some parallel universe TP'd in red tape, from which I was unable to escape.
Anyway, here’s hoping to a more efficient and well-organize day two…. ☺
*I realize that bad bureaucracy happens to good people everywhere. I have just experienced 95% of my life's red tape in the past four years.
A picture, just to make this post a little longer:
Wow, that's an oldie. I promise to update more often. Well, I guess all I can promise is that I'll try to anyway...
Tuesday, July 14, 2009
Two pictures I love of my roommates. L-R: me, the impossibly adorable Larry (girls get boys' names here), Narcisse, and Elizabeth A Point Sack.
Tuesday, June 16, 2009
Monday, June 8, 2009
Tuesday, June 2, 2009
Sunday, May 24, 2009
Yes! Just like the real ones.
The swimming hole where we got attacked by the fouroux, tiny insects (so tiny you can barely tell they're not specs of dirt on your arm) that are not, to my great distress, deterred by any amount of DEET.
So…what do I actually do here? Ok, a brief rundown of the day, if you’re interested:
1. Get up, thrash out of mosquito netting
2. Wait for shower (four people who all start work at the same time share one bathroom)
3. Have cereal (fake cornflakes…that’s all we’ve been able to locate) and instant coffee out on the porch (heaven…I’m telling you)
4. Go to the medicine ward, or the Kopp, as it’s known, which is maybe a 5 minute walk from here, depending on how hot it is outside, to start rounds at 7:30. (Actually on Wednesdays and Fridays there’s a grand rounds type of meeting/presentation, where someone presents a topic or case to the staff, which starts at 7:30, so then rounds are after that.)
5. Round with the team, which consists of two doctors, 1-3 nurses, and me. There’s a little cart that we drag around that houses all the charts (really, cards the size of half a sheet of paper in plastic covers that have seen better days) and order sheets (for labs and x-rays and such) and a bottle of alcohol for hand washing and a trash bin and even a little vase of plastic pink and flowers. Next to every bed there’s a wooden board hanging on the wall with a spreadsheet that includes the patient’s vital signs (with the temperature graphed, so you can see its trend with a quick glance) and medications. It’s so simple. Patients get taken care of, medications get ordered and given, vital signs get taken and recorded, and there’s none of the triplicate record keeping that keeps rounds at home dragging on till 1pm.
6. Off to the Polyclinique, which is a giant waiting room with small exam rooms off of it. It is normally anywhere from 90-110 degrees in the waiting room, but, blissfully, the exam rooms have window air conditioners. See patients until noon or 1.
7. Have lunch from 12-1, then a break from 1-2:30
8. See patients from 2:30 to anywhere from 3:30 to 5:30, basically until they’re all seen. (Top reasons for coming seem to be: hypertension, AIDS, fever and headache and/or body aches [treated as malaria, even if the blood test for malaria is negative], and tuberculosis)
9. Go back to the Kopp, where it is now approximately 95 degrees after the day’s sunlight has run its course, and record all the lab values that came back during the day, as well as see any new patients who were admitted.
10. Either do yoga, or run, or sit in a tired and hot heap on the chair in my room directly under the fan.
11. Dinner is at 7 exactly. If you’re not done by 8 there’s a stern talking-to from the ladies who work in the dining hall (who are, I must add, all very nice).
12. Putter around until bed, either watching 30 Rock (a favorite pasttime around here), or going to the lab to use the internet, or going to the nearest town to have a beer, or removing large bugs from one’s room, or duct-taping the screens down, or hand-washing clothes, or…you get the idea…there’s always stuff to do.
13. Go to bed, rinse, repeat…
Tuesday, May 12, 2009
1. There is an entire country off the coast of Gabon. It’s called São Tomé and Príncipe, and it’s the second-smalled country in Africa (after the Seychelles). It’s an archipelago of 12 or so islands, the two largest being São Tomé and Príncipe. According to my guidebook (the only one ever published on Gabon, as far as I can tell), the islands were formed from volcanoes, and were unsettled when the Portuguese came in 1470. All the islands comprise 386 square miles and have about 165,000 people, and they speak Portuguese.
2. There are a lot of Chinese people in Gabon. According to an article from the nytimes, Gabon is running out of oil, and to compensate for its lost income it’s allowing Chinese logging companies into protected forest. Not good. But anyway, the hospital has anywhere from 3-6 Chinese men out of 26 beds, all with malaria, none speaking any French. There’s a lot of charades going on on rounding.
3. There are many things I like so far about Africa, but hand-washing, line-drying, and then ironing all my clothes (botflies get killed by the heat) isn’t one of them. I think I’m going to take my chances and put most of my clothes in the hospital’s industrial-sized washers (with notoriously hot water).
AH! A bug just fell down my shirt. Ok, zen with the bugs, zen with the bugs, zen with the bugs…
Sunday, May 10, 2009
Wednesday, May 6, 2009
Thus begins our rotations here in Lambaréné. I am doing adult medicine, and the other American medical student (also a white girl named Elizabeth, to maximize confusion) is doing pediatrics. This week so far I’ve been in the inpatient wards in the morning (rounding on 26 patients in as many minutes) and the clinic in the late morning and afternoon (today: 2:30 to 4:30, hardly the schedule we're used to keeping at home, though it is oppressively hot, effectively limiting how many hours one can actually work during the day). On my current to-do list: 1. Learn French, 2. Learn medicine, 3. Learn to understand Gabonese French, 4. Learn names of medicines in French (Esidrex?? Never heard of it. Oh, wait, it’s hydrochlorothiazide? Riiiight, I have heard of that). The doctor I was working with actually left to go get something yesterday and said, “Ok, you can see this next patient while I’m gone,” and I was like, ummmmmm thanksbutnothanks. It takes me 10 minutes just to read the notes from their previous visit, because they’re all in illegible French with abbreviations I can’t figure out. Oy. Adventure! (Ça va aller...at least I hope.) :)
I’m already a little bummed out (for lack of a more eloquent phrase) by the sick people. Not that sick people in the US don’t bum me out, because they do, but I’ve already seen a few people this week who are sick. Like, I look at them and wonder how it is they’re even still alive. I saw literally the most cachectic girl I have ever seen in my life yesterday. She was 22 and weighed maybe 65 pounds. Good lord. AIDS is a scary thing. She'd been sick for a year but hadn't come to the hospital until now. I just think of millions of dollars being spent in the US chasing incidentalomas (translation for non-medical people: incidentalomas are little shadows and blips that are discovered incidentally on CT's and MRI's done for other things, and usually turn out to be absolutely nothing) and it makes me crazy.
Ok, off to bed. Under my recently re-strung mosquito netting. Now hopefully it won't fall on my face in the middle of the night, causing me to brush it off my face in a panic cause my half-asleep brain is concerned it's an ant colony, or a hungry mosquito family, or a bat. Or a spider the size of a yorkshire terrier that we calmly (ahem) removed from my roommate's room the other day. (Picture to follow)
This is a very interesting place, for reasons I didn’t expect. Dinner every night is a veritable melting pot of nations. Some of the faces around the table: A couple from the Ukraine (internist and surgeon), a nurse from Switzerland (the German-speaking part), a man from Switzerland (the French-speaking part), a nurse from Spain (who retired from a career as a lawyer and then became a nurse), two Gabonese students, and a doctor from France (who is on sabbatical from a 20-year career as an internist in the French Antilles and drove here from France). On the way back from dinner the other night in town, we were piled into the back of a big van, and we picked up a German student on the way, and suddenly everyone in the back (except the Americans) started speaking German. (As Other Elizabeth said, “This conversation has taken a turn for the German.”) And I kind of enjoy conversing with someone when neither of your first languages is the one you’re speaking in. There’s no self-consciousness about grammar or pronunciation when the person you’re talking to probably won’t notice anyway.
Sunday, May 3, 2009
Saturday, May 2, 2009
Friday, March 20, 2009
It's like she was saying, "Congratulations on the Match! Soon you will look like this. Make sure your scrub pants are tied real tight." (In case you're wondering, L-R: personal [hospital] pager, stroke pager [stroke intern off today], code pager, pre-pre call [i.e. back-up admission] pager, PDA.) Oy. I'm glad I'm putting of graduation and internship for another year. :)