Yesterday was a long day 😐 The kind of day that I normally wouldn’t write about, but precisely because it had been that type of day, I found myself sitting on my bed bored, uninspired and writing. I really shouldn’t have been (writing, that is) but there you go. I think that the main reason I was so bummed was that I didn’t study yesterday. I didn’t put in the usual 2-3 hours. There was no valid excuse, not really. What I did do with the time wasn’t nearly as good, or as rewarding.
The day had started out well. Alarm clock 5.30am; snooze; out of bed at 5.45am; bathroom (the regularity of my bodily functions is starting to scare me, I’m only 31, why is everything becoming so predictable aaargh! 😓…) 5.55am (at least ten minutes later than initially planned) push-ups: sets of 32, no… 35 (this was decided halfway through the first set 😐) done with that by about 6.15am; weights: 10km dumbells aren’t much but when you get to about 28 of a set 35 reps there is some pain in the places where you want some gains. Done with all of that by about 6.50am. Kitchen, fix fruit and cereal quick, fix some lunch for work, quick. Shower, then seated at my desk/dining table at 7.15am, quick breakfast. 7.30am Housekeeper arrives, “Aren’t you late for work?” she asks, “Only by a little bit,” I say while chucking the bowl and spoon into the sink. I’m outta there within the next 5mins.
At 8.05am I parked my car in the doctor’s parking lot at Dora Nginza hospital (actually on the grass next to the lot along with a bunch of other cars as there aren’t enough parking bays for everyone employed at this institution) At 8.10am I walked into the ward. Here we go: 30 patients between myself and another doctor. Our intern had been on call the previous night so she did not join us. I saw 17 patients throughout the day, in addition to three call backs. Call backs are patients that I had seen in admissions the previous Thursday when I was on call, discharged home and asked to come back for review of their condition or blood results or to discuss with the specialist physician who runs my ward.
There are two patients in my ward who have multidrug resistant TB (MDR TB). Both are HIV positive, one also has end stage kidney disease, and the other has cryptococcal meningitis (CCM). Serious stuff. The lady with CCM is one week and a half into her course of treatment, and once she completes the two weeks of amphotericin B we will be able to transfer her to the local TB hospital, a much more appropriate place for someone with her condition. We won’t be able to transfer the other lady, she is very ill, cachexic, with decreased consciousness. Her prognosis is very poor, we’ve discussed it with her family. We’re keeping her comfortable, as pain free as possible. Blood tests every couple of days to review her kidneys and make sure her electrolytes stay in check. These two ladies are ‘isolated’ in the side ward. They are receiving the right treatment, a veritable cocktail of pills that would frighten even the bravest of souls. It’s just that they shouldn’t be here in a general medical ward.
Our other patients are more of the general medicine variety, I discharged five today. An old hypertensive diabetic lady who had suffered her second stroke. No sense in keeping her here, she needs to be at home with with her family. Regular follow up with physio- and occupational therapy. Another lady who had completed five days of intravenous antibiotics, now no longer dyspneic, not coughing, and overall looking much healthier. A clear sputum sample had excluded pulmonary TB. Off back home you go. The other three were the same simple sort of cases.
Then there’s a 41year old with frightful blood pressure readings despite our escalation of her antihypertensives. She has been in the ward since last Thursday, and also has very bad kidneys. Possibly the cause of her refractory hypertension? Maybe. One could be the cause of the other in this case, and conversely. How does one have bad kidneys at age 41 anyway?! We’re doing a full work up on her, to exclude causes of secondary hypertension, hyperthyroidism for example or some sort of rheumatological abnormality. Once we have all the results together if we haven’t found an obvious answer we will discuss her with the renal unit at Livingstone hospital (LVH).
My last bit of work for the day was a lumbar puncture (LP) on an old lady. She is somewhat confused and none of her blood results or her initial lumbar puncture show a possible cause. It could just be good old dementia (pun intended 😛 but she doesn’t quite fit the bill for that diagnosis) The consultant had me do a second LP (unusual as it’s quite an invasive procedure) to look for cytology in cerebrospinal fluid. “Cytology?!” I asked. “Malignancy maybe. What else could be causing the abnormal normal protein levels in the first sample?” He replied, almost shrugging.
Done with all of that (work and stuff) by about 3pm. Gotta get some studying in today, I thought as I walked to my car. To follow up with the good bit I did over the weekend. I had spent all Sunday morning and the early part of the afternoon at the books. I had to pop by the bank on the way home, then make a quick stop at a sports shop in town to fill in an entry form for the next road race, even as I felt the residual pain in my legs from last Saturday’s marathon. I then stopped at the Spar not far from where I stay, as I had finished the milk that morning. Meryl called. I probably shouldn’t chat to her the phone while I’m driving but hec she’s far away and I miss her. I got home much later than I would have liked and used that as an excuse not to study. Not good. Physicians don’t make themselves man! I mentally scolded myself. It didn’t work on that particular day. It’s ok I thought, it probably means that I’ll hit it extra hard the next day.
So there I was yesterday evening feeling guilty, bored and unispired. So I thought I would write about it, and I did. I did not post it up yesterday though, as I have this idea that I should only really write when I am inspired? Yes and no. I have had a bit of a think about it. To only write when I’m inspired would be to only write the good stuff, the fun bits of my experience here in Port Elizabeth. This was an example of an average day. Average uninteresting day at work. Average day in terms of inspiration, or more appropriately the lack thereof. To study I suppose, and to write…