March 4, 2015 – The silence ends! I
don’t really know why I haven’t written lately; perhaps because I had 4 evening
or night shifts in a row, which upsets one’s sleep schedule and makes one less
productive. Perhaps because I just worked 7 days in a row (which, I hadn’t
really realized till now, is pretty uncommon in our usual work lives, isn’t
it?) and am just tired. Perhaps because – despite some dramas and concerns re:
treatment that I won’t go into here – the work has become more routine – not in
the sense of boring (it is VERY engaging), but in the sense of familiar and
thus less in need of being described, from my point of view. In any case, I
have felt less like coming home and sitting down at the computer to dash off my
thoughts.
Right now, I am on the tail end of a
blessed two days off (the first was the day after a midnight-to-8am shift,
though, so it doesn’t REALLY count!), during which I came down to Freetown to
spend some time with one of my favorite cohort-mates, who was assigned to a
different facility and whom I thus haven’t seen in almost four weeks. Such a nice visit; so nice just to get a change of scene; wonderful how refreshed I feel! I think it is two things:
First – the work is, I believe, more
stressful than I actually realize when I’m doing it. I’ve touched on all the
reasons why this is so at one time or another in this blog – the ever-worrying
knowledge that our care is not all it could be, due to resource and time
constraints; the consciousness of the imperfections of being a clinician; the
concern to “hit our marks” (give enough fluid to those who need it; give
scheduled medications to everyone on our list while also treating any fevers or
other symptoms we happen to come across; clean any patient up who is lying in
their own diarrhea; etc.) every time we go in; the tension between fluid, on
the one hand, and difficulty breathing, on the other (the disease seems to get
to a place with most very sick people where their lungs are “wet” but their
blood vessels are “dry,” as I explained in an earlier post, leaving us
uncertain what to do). Etc. Also – and I tend to discount this, but I think it
is real and ever-present – the background worry about actually catching the
disease. I do NOT think about this, let alone obsess about it, very often, but
I think it is always there. Did everyone read Craig Spencer’s article in the
New England Journal (or the description of it in the Times)? Here it is:
Reading it is a reminder that having
the disease is no picnic, even if you do get better (and that is by no means
guaranteed, despite the success with expat patients up till now). Also – I
don’t know if you’ve heard about this or not – there is a lot of evidence
suggesting that, even when you have recovered, there is the possibility of a
“post-Ebola” syndrome – inflamed eyes, weakness, tiredness, aches, confusion –
that may affect some or many people, for literally no-one-knows how long. You
don’t want to go there, if you can possibly avoid it! So, when you look at that
sleeve smeared with diarrhea after you’ve moved an incapacitated patient to
a clean mattress, or that glove running with blood after you’ve bandaged the
site of a former IV that the patient, thrashing around, has pulled out, you do
kind of wonder – am I sure that none of this is penetrating the protection? I
have no reason to think it is – but you do ask the question.
Second – and this I hadn’t really
registered till I came to Freetown – it is, in fact, stressful living in my temporary, provisional digs. There is the long hike to the toilets; the (very
good but) institutional food eaten on their schedule, not yours; the always
vaguely icky, humid shower tent. Most importantly, I NEVER sleep well at the
camp, probably because, for some reason I do not understand, the Danish insist
that all public lighting – in the corridors of the tents and outside – stay on
ALL THE TIME! Also, the cots are maybe 2.5 feet wide, the mattresses are thin,
and I have arthritis in both hips, making finding a comfortable position
difficult at the best of times. In any case, I wake up again and again all
night long, and almost never feel rested. This despite my two recent improvements:
Playing the arthritis card to get a SECOND thin mattress from the camp staff
(the same sweet, vaguely humorless young Dane who checked us in told me that
they didn’t have many of the mattresses, but, “in your case, it is a medical
reason. We need to have you fresh to care for your patients!”). And – TMI
coming up – peeing in a bottle instead of hiking out of the tent every time I
have to urinate in the middle of the night (something which inevitably left me
completely awake by the time I got back to bed). Mornings I can be seen
sporting my backpack to the toilet block in order to furtively pour the night’s
production down the can.
So – stressed at work, stressed at
“home.” I am NOT complaining (more reporting), and I feel, all the time, so
glad to have the chance to do this really important work. But, you know – I
have been counting the days till my departure since I first got here,
and I’m counting them still. Six more shifts. I will happily come back again in
a few months, if the need continues (wouldn’t it be nice if it didn’t?). But
I’m happy that this stint will be over in a week.
Tomorrow (if I can make it back to Maforki, ha, ha – there
seems to be some uncertainty re: the transportation), I get to present my
game-changing idea for preventing IVs from coming out so easily. I jest, but,
on the other hand, if it works, it would in fact be a great relief to us all.
It’s based on something I saw them do in Switzerland, and I could kick myself
because I should have thought of it weeks ago. I’ll let you know how it turns
out….
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