Run Across Africa

Their names are Erin and Reuben and they are going to Run Across Africa. From the Atlantic Ocean in Namibia, through Zambia and Tanzania to Dar es Salaam and the Indian Ocean. That's a distance of 4200km so they'll average a marathon a day for 100 days. Its possible that they are in fact crazy, but they are undoubtedly passionate and dedicated. Dozens of sponsors are contributing and the money raised will go to education programs in the countries they are running through.

It makes me want to jump on a plane and go, I suppose that's rather predictable of me... jumping on a plane to Africa. But instead I get to contribute in another, positively vicarious way. I'm on the medical support team. How cool is that?!? The 'team' includes two docs from Victoria, myself, and my friend Teresa, a fellow resident at St. Paul's. We'll take turns being 'on call' for the runners and their support team as they jog across the continent. There's something rather exciting about being on call in Africa despite being planted quite firmly in Vancouver. Our 'remote' medical service will include text messages and emailed questions about diarrhea, dehydration, sprained ankles, malaria, bug bites and hopefully nothing catastrophic. It feels good to be involved in something bigger than my current world of residency, St. Paul's, and yuppie Vancouver life.

Check out the web-site.

That cracking and hissing is the sound of your fading youth

"Can we try something a bit more technical?" Fatal last words before we dropped over the edge of the mountain on those swanky full suspension mountain bikes and I launched myself over the handle bars within the first minute. It was spectacular, painfully exquisite even. Both my dramatic wipe outs and the view across Lake Atitlan as we wound our way down the mountain towards the sparkling water surrounded by volcanoes. If you're hiking and slip, you might cut yourself on the rocks but its a bit of a different story when there's a large piece of metal entwined between your legs. I was pillaged by that bicycle, worth every minute though! Gears cracking followed by the hiss of air from the back tire... either that or my knees were cracking and hissing. At the end of the day, I realized I had reached a new stage in life, where you take ibuprofen before doing ridiculous things like mountain biking down a volcano instead of after when the pain has already set in. Truth is, I'm getting old!

The biking was the culminations of an incredible week at a women's health conference in Guatemala. The content included topics like women's health and human rights as well as discussions of current challenges in sexual rights in Guatemala. It was absolutely fascinating to dialogue with Guatemalan obstetricians about their take on unsafe abortions and how to decrease maternal deaths from post-partum hemorrhage. A statistic I did not know was that abortion rates remain the same whether it is legal or illegal in the country. As usual, medical problems are often more about social and ethical issues than science.

It was delicious to all my senses to be back in Latin America. Life somehow seems more brilliant in colour, the pools are deeper, the smells more marked, life appears fuller and more vibrant to me. Spanish rolling off my tongue, gorging myself on fresh fruit and avocados the size of my head (okay, not quite). I soaked in all the colourful textiles, the familiar foods, the sounds of life and joy and pain, my soul danced again.

On a hike up Pacaya, a rather active volcano, I realized I had not forgiven my parents for something that happened in grade 8. My geology class went on a field trip to the crater of Huahua Pichincha, the volcano that towers over the city of Quito. They wouldn't let me go down the crater, ridiculous I though! So I sat on the crater's edge with the other two losers who also had been cheated out of this life changing learning experience. Oh the misery! So as I stood but a meter from the bright orange river of lava, my skin tingling and my soles melting I finally let it go. Mom, dad... you're off the hook, I got my fix!

Coning

This is something I wrote over a year ago as a medical student in Calgary and I was reminded of it being in the pediatric emergency here. I haven't edited anything, reading it now the emotions and descriptions seem so crisp and fresh and I wonder how my perspective has changed.

The Children’s Hospital emergency department. As a medical student you rotate through for a week and you either love it . . . or you really don’t. I had just finished seeing two really cute kids from Newfoundland here on holiday, one of them had fairly severe asthma and the other had, uh, a cough. I was sitting at the desk listening to one of the emergency docs ranting about people using the health system when they didn’t need to when an ambulance pulled up. The staff was pretty lackadaisical, apparently there hadn’t been a patch to let them know the ambulance was arriving which normally happens so they can be prepared. They were unsure what to expect, but didn’t seem too worried.

“3 year old boy, seizing for about 45 minutes before he got to a Medicentre clinic, given valium while 911 was called. Briefly stopped on the way here but now showing decerebrate posturing and his right pupil is blown.” The history reeled off by the paramedic. It was like an electrical shock passed through the nurses and docs who were in the area, all heads turned, and rushed with the stretcher into the trauma room. The tension was palpable, superimposed with a forced calmness. His mom following the whole procession, hand over her mouth, crying silent tears. Seemingly forgotten in the intensity of the moment. The family had moved from Vietnam 3 years previously, she spoke in faltering English, searching for words when she was asked what had happened. Flustered and crying. The doctor, put her hand on her arm, a gesture of sympathy but it seemed cold and calculated in her attempt to get any information she could out of the mom. “Page ICU, neuro, respiratory, and social work stat. Let CT know that we’ll be there in 5 minutes.” More and more bodies appeared out of nowhere. I had been told during orientation to watch the trauma rooms and get in there whenever I could so I had followed with the rest and tried to stay out of everyone’s way. It was clockwork, everyone had a role. Recording, drawing up meds, preparing to intubate, it all happened at once. I counted 17 people, all around the stretcher which laid the small body of this 3 year old little guy, Daniel. Writhing back and forth, to the untrained eye it could even look like he was just having a bad dream. To the medical professionals in the room, it mean he was ‘coning’, there was something increasing the pressure in his head and part of his brain was herniating. As if suddenly remembering something, one of the nurses turned to mom and asked if there was anyone she could call, any friends or family? No, no family in town, but the husband was on his way, he just had to pick up the 3 month old on the way.

I saw everyone buzzing around as if in a blur of activity, the only constants were Daniel on the stretcher and his mother, frozen in the same position, sobbing, hand over mouth. Clueless as to what was happening. The reality hit me, her world was ending right in front of her eyes, her pain and fear hit me in the gut. A nurse would stop once in a while put her hand on her shoulder and explain that they were going to try to stop the seizure, put a tube down his throat to help him breath, and take him to CT to get pictures of his brain. They were doing everything they could she said. The mom just shook, is shock. After what seemed like an hour but was actually a few minutes ‘social work’ arrived, apparently their job was to be with the mom. When she entered, she was the fifth person to ask if dad was on the way. Yes, yes, he’s coming. It was almost something people asked when they didn’t know what else to say and could offer no other consoling words.

In all of this I stood, an observer, a witness . . . was it possible I was invisible and had no part in what was happening? There to learn primarily, but I can never stop the feelings and thoughts that go with academia.

He was wheeled into CT, the respiratory therapist bagging him all the way. Mom sat outside CT with the social worker, a crowd of nurses and docs went in to watch the scan as it happened. There was a bleed in his right hemisphere, and yes, he was coning, uncal herniation, the bottom of his brain was squishing out below his skull. Was there trauma? Should we suspect abuse? Where’s the dad? Did he have a mass there previously? A near chorus of wild speculations. I’m with the emergency doctor and a resident, we stop on the way out as we pass her. “There’s some bleeding in your son’s brain, we’re going to take him to the ICU. Don’t worry, we’re doing all that we can for him right now. Alright? Is your husband on his way?” Yes, he coming.

The emerge doc goes to see the next patient, knowing that Daniel is now being taken care of by the intensive care physicians and the neurosurgeons. I’m full of questions and the first year emergency resident can’t hide her eagerness to use this as a teaching case. As she goes through the CT scan with me on the closest computer explaining the pathology in detail the dad walks in pushing the 3 month old daughter in a stroller in front of him. He asks where his wife and son are, the resident, immediately somber, takes him straight to his wife who is with the ICU doc. Things are explained, now in a bit more detail, the prognosis is not good. Tears well in his eyes. They assume he understands all that is happening. He too covers is face with his hands, cries out, crumpling to his knees. Sheer pain. “My son, my son . . .” his wife joins him, they cry together, sobbing uncontrollably, shaking as they embrace. My heart broke.

I was sent back to emergency to see more patients, my mind was nowhere near the child with croup, or the roller bladder who needed some stitches. The nurses stood in a group, “what could we have done differently? We didn’t get a patch from the ambulance. He really should have been intubated already by the time he got here. Why did they wait so long? They should have called EMS from their home. Is there anything else we could have done?” Constant questioning, reassuring themselves that they couldn’t have prevented this. And my role? I learn, at this point in my career I am a witness to both the functioning of the health care system and heart ache along the way. A family’s life is forever changed, we pause for but a second, and then the system keeps on clicking, like clockwork.

We've Got a Bleeder!

Helpful Hint #216

When an 8-year old zips his foreskin into his zipper there are some important points to remember:

1. Do not panic.
2. Do not just unzip it.
   
3. Do not look the father in the eye.
4. Do not make comments involving anything remotely like: 'good thing you're not Jewish, you never know what you might have caught in there!'
   
5. Give pain control (morphine, tylenol won't cut it).
6. Get bandage scissors and cut the jeans in a large semicircle starting at the waistband and going around the crotch.
7. Cut straight across the top of the zipper so the zipper easily falls open.
8. Apply pressure.
9. Suggest sweatpants for the next few days.

If gave me a flashback of the opening scene from Something About Mary. I'm just learning so many useful and relevant new things every day.

Salaam

My first shift in the pediatric emergency department. I suppose I did look the part, dressed casually in gray cords and running shoes, the standard green scrubs top and my trusty stethoscope around my neck sporting a rubber duckie key chain as the ultimate crying-kid distractor. Clipboard in hand I was wading through the crowded waiting room trying to find some vomiting child I was supposed to see. The place was swarming and loud, parents and kids covering every nook and cranny, all looking at me somewhat expectantly as if I was some kind of lifeline.

Then, a gentle hand on my arm and the Arabic greeting, "Salaam aleikum". The dull roar faded a bit and I turned to face a woman, completely veiled in the black niqab with only her smiling eyes showing, looking at me with confident familiarity. Instinctively I replied back, "aleikum salaam" with a grin and desperately searched my memory for those eyes. With a rush it came back as I caught sight of her husband sitting across the room in his prayer cap and full jet black beard. Six months ago those same eyes had held my gaze with terror and her trembling hand had grasped my arm as she lay in the operating room having a needle stuck into the jugular vein in her neck in preparation for her high risk cesarean section. Her heart was double the normal size, and was failing as it tried to cope with all the changes of pregnancy. We didn't speak the same language, but everyday, I sat and spoke with her and her husband, a deeply compassionate, sensitive, and caring man. The baby had been delivered prematurely and was born at 5 lbs, now she was a thumping 6 month old... granted she did have a bit of a cough, but had her mothers big dark eyes that peered at me solemnly and intently.

Its amazing how powerful one look can be. In a moment, salaam, peace, is exactly what I felt. The next moment, the roar rose again, the vomiting child had heard their name and I ushered this new family into a room to be seen. Strange. Some patients impact me so powerfully that I can remember the exact emotions that coursed through me, the thoughts I had as I anticipated seeing them each day, and the way they stuck in my heart. But it never crosses my mind that they will remember me, that I was someone in green scrubs who looked different to them. It gave me shivers down my spine and warmth in my belly.

Other lovely feelings I'm having are related to ridiculously cute kids (granted, some slightly neurotic parents... why can't they just vaccinate their kids?!?) as well as my work week now being around 30 hours instead of 80. Last night I got to put a bright pink cast on a giggling two year old's leg, saw my first ever case of mumps (uh... yeah, there is in fact a vaccine for that FYI), and got to make funny faces at all but one of my patients (the exception was a 15 year old with a hole in his finger, I just didn't think he'd be that into it).

After explaining to my sister how I only have 12 shifts in four weeks and that I get to play with cute kids all day, she asked quite a profound question. "Well, why wouldn't everybody want to be a children's emergency doctor?" Good question. It stopped me in my tracts. The answer didn't take me too long. Well, clearly, its because you don't get to delivery babies and be at birthday parties everyday, that's why.

Good People

He purposefully walked towards the podium, then stood before us, his figure tall and imposing. Starting on the left of the room his gaze washed over us, gentle and intentional. Silence descended like a warm blanket over us, somehow safe and exposed simultaneously by his eyes. Then he spoke, a voice in one breath peaceful and powerful: You all look like good people.

I was at a talk organized by a group called Streams of Justice and we had just heard a presentation on the gruesome history of residential schools in Canada run by the church and the recent recompensing that the government was making. Aboriginal children removed from their communities and families to be socialized and reformed. Their language and culture was to be educated out of them and the even greater tragedy was the rampant abuse and neglect that occurred while attending residential schools. The monetary settlements themselves sounded gruesome to me. They give different forms of abuse a different value, so many dollars for being beaten, a different amount for anal penetration, and the list continues.

We put numbers and dollar amounts on people's pain . . . on people's lives.

Evil happens because good people sit back and do absolutely nothing. His gentle words cut straight to my heart.

He shared with passion how his sisters and brothers had been affected and are now further wounded by the settlements that are being proposed. One hundred years of children affected. I hurt, I hurt because who we are is beautiful human beings, as beautiful and precious as anyone else. What we need to understand is how to heal. We need to heal.

The first step in the oppression of other people is that we objectify them and they are no longer people. 'Indians', not human beings, the 'Indian problem.'

So, good people, are we to continue to do nothing? To walk by the human beings who sit on the street who cannot heal themselves. Are we to continue to do that as good people?

As I left, I told myself in no uncertain terms: I don't ever want to be one of those good people who does nothing.

Acidosis

soul crushing
guilt
a sick sick mom
gorked baby?

how can my omission cause such catastrophe?
why did it happen?
a sleepless 32 hours
I had to talk to another family
whose brother's lung was full of blood
whose liver had failed
heading to the ICU

maybe excuses
maybe justification

stumbling from hospital in a daze
I didn't check on her
I went and slept
and woke
and dreamed
of people drowning in their lungs while I watched helpless

tragedy happens
and I have often stood and witnessed
counseled
listened
discussed
even helped
but not caused

I don't want my actions to matter this much
don't want my life to make a difference
my being has deadened