I make my way back to clinic this afternoon. I'd seen a patient earlier in the day when I had a free moment to pop into clinic. I sent him off to get some urgent labs done, wondering if he was having lactic acidosis, an adverse reaction to one of the HIV medications. It would be something that would have to be dealt with this afternoon if the level was high. So I sent him to the lab, and said I'd be back at 2pm.
It's 3pm, and I'm walking the drizzling rain. It's about a block between the ID offices where we'd wrapped up a lecture, and the HIV clinic. Though on Monday and Tuesdays, it's not the HIV clinic, it is the hematology/oncology clinic. When I get about 100 meters from the clinic, my phone goes off, it is a text message from the clinic. There are no pagers here, the hospital sends out a text/sms with a call back number, and I recognize the number. I quicken my pace, as I'm sure they're annoyed that I am not back yet.
I walk into the room, and wouldn't you know it, there sitting in a chair is Lucky.
Without even asking a question I tell him, "I'm admitting you to the hospital." Retrospectively I realize that this wasn't the ideal way to great a patient, who must feel like shit being as ill as he is. I remember one of the Pedi ER docs back home basically saying that if somebody shows up for a third time in too short of a span, at that point you basically need to admit. I would have been happy to admit Lucky on the first visit, and tried to persuade him to get admitted yesterday... We'll see what happens.
I admitted 4 of the 10 patients who came to clinic the past 2 days. Remember that these are days that we're not in clinic, except that we'll pop over to see people who are too ill to wait until Wednesday. I groan slightly, as my consult list swells..
I'm coming to the completion of 2 months in the HIV clinic. Aside from my 2 months on Ward 18 when I first arrived at Bara, this is only the second time during residency when I've done the same thing for more than a month. We have a one-month rotation block back home. I'm not sure if one month is really ideal. But here, the blocks are generally 4 months, which I don't think is ideal either. But 2 months has been enjoyable. I have learned a lot in these two months. Things that I never knew about before such as MAC (basically a brother of TB)-which I'm comfortable starting treatment even when I can't conclusively prove it's there (which may be rather taboo back in the US), and cryptococcal meningitis, as well as how to go about starting HIV treatment, following the treatment, and making changes. There is so much more to learn. There are frustrations, and all is not perfect. But I don't feel ready to leave. I'm having a hard time thinking about my rotations in the coming months, though I have a tentative schedule for the remainder of my time here, and I reviewed it with the Prof of Peds, who thinks it is a wise plan, part of me really thinks about staying where I am.
Recently, after a grueling Wednesday clinic session (286 patients), Dr K and I were chatting about the project I am working on, and then we just chatted for a while about what I may do down the road, post-residency. It is tough to know where I am headed, but as I was walking away from clinic today, I thought that if they were able to offer me a job in the department (after residency-as finishing my last year of residency is the only absolute/definite plan I have in life at this time), I would be hard-pressed to not take it. I could easily see myself working in this capacity (with finding a way to do some pedi work) at Bara for a few years. As I have mentioned to some, I will not be ready to leave in 4 months....
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