My time in Botswana is slowly coming to an end. It's my last day on
the wards tomorrow and I'm already feeling nostalgic. As I spoke with a
patient's brother on the phone today, and he explained to me how much
his brother meant to him and wanted my opinion on his future management,
I realized how much I have loved the ability to meet patients and their
families during my time here, and the fascinating medicine that I have
been privy to.
BLH has definitely been a rollercoaster.
Two weeks ago, I arrived to the wards to the screams of a young 13 year
old girl, blind for the majority of her life, seemingly hysterical from
some recent trauma. The BLH physicians came by to help us put our heads
together to figure out what could be the cause of her cries. I watched
as her arms flailed about. She kicked indiscriminately into the air, at
one point flinging herself out of bed. I carried her back on to the bed
as she fought to be free of my arms. She apparently had been that way
from the previous evening. Her eyes were yellowed, her liver slightly
enlarged. Her course was complicated, as she went from hysteria to
somnolence. She passed away shortthereafter. And she's been on my mind
ever since...
As I've continued to be intimately
involved in patient care at BLH, so many patient encounters involve the
question of how far we push to save someone. Thinking about someone who
is end-stage AIDS for example, how many resources do we spend on one
person, especially in a resource-poor setting? What are the ethics to
our approach? And then there are the cases where people pass away before
a lab result comes back or before a lumbar puncture can be done. It
seems that no guiding principles exist, only one's personal conviction
and value system when it comes to life and death and the role of
medicine in mediating between the two, if that is indeed possible.
I'm
convinced that Botswana is filled with possibility. I'm told the lab
techs are seeing less HIV positive results, that people living with HIV
are stable on ARVs, that more and more children are being born free of
HIV to HIV+ mothers. I'm told the government is intent on ridding the
country of tuberculosis. The indicators point to continued to
improvement, but it's difficult to reconcile this with my daily
experiences on the wards, seeing people gasping for their last breaths,
others so wasted they don't have the energy to hold up their own body
weight. Then there are those patients who are stable clinically, but
clearly have some underlying process going on that will eventually
unmask itself. One of my patients has rather diffuse lymphadenopathy,
pleural effusions, anasarca (diffuse swelling) on one side, renal
failure, anemia, etc. etc. The list of problems goes on, and every day
he tells me, "I don't know what is going on, or why this is happening to
me."
Tomorrow will be a good day to reflect and to consider all I've seen over 4 weeks at BLH. I'm eager to search for some conclusions to share...
No comments:
Post a Comment