[Disclaimer: this is more of a personal post, but I'm throwing it into the blogsphere. I don't hide my uneasiness of my upcoming move back to America, but perhaps in recent posts I haven't fully explained why Jo'burg has-so completely-caught me off guard. This may not be the most eloquent post-but I'm going with it.]
As I was driving home Sunday evening, I couldn't help but obsess that I am under the 3 month mark. It had been a non-stop 3 days. An almost maniacal pace to making sure to enjoy my weekend. Work. Friends. Fun. Not wasting the present moment, aside from the drive down the M1 toward home, wondering how I make sure to squeeze every drop out of my last months here.
JT (clinic doc I work with) "What's Holy Cow?" she asks me as we both walk down the hall. I'm caught slightly off guard.
Me: "A cow in India?" I assume there must be a joke here. Then I realize I'm being culturally insensitive. "Actually, any Hindu cow."
JT: Smiling. "No really, I've never heard this expression before."
Me: "Huh?"
JT: "You just said 'Holy Cow' a minute ago in the hallway."
Me: "Did I? Oh. Well, it's a more polite way of saying 'Holy Shit' if you really want to know."
I'd just come out of my examination room, and ran into SM. He's the guy I admitted back in February, who came into the clinic having been sent out of the hospital in January with a whammy diagnosis of AIDS and PCP pneumonia. He had to wait a month to be seen in our clinic. And when I saw him that day for his initial visit I admitted him back to the hospital, thinking that his PCP wasn't getting better, that he likely had some TB as well. What the hell, I figured, he looked so bad that I decided we'd just treat him for everything but asthma.. When I left for vacation, I'd just seen him in the clinic, and he was breathing better, but still looked like crap. And so there he was in the hallway, he'd put on weight, he was able to talk without having to stop and catch his breath. I don't know if the "Holy Cow" was when I saw him, or when he asked for a letter saying he was ready to go back to work. That was Thursday.
Then on Friday morning, as usual, there were folks milling about outside the entrance the the clinic. The packed waiting room was to be expected. There were already charts pulled, people were ready to be seen by the doctors. It was going to be a hectic day. But hectic is the norm for this clinic anyway. Friday was hectic to a new level, given that we were short four doctors. But really, that didn't induce stress or concern because all that we could do was just plug away and know that at some point we'd get through seeing all 185 patients. I managed to see just over 30 patients during the day. Most were fairly routine. A few were complicated: failing treatment regimens, sick visits, questionable TB diagnoses. In addition to HIV, I meddled in routine management of high blood pressure, diabetes, and epilepsy. But I enjoyed the day. And as I packed up my stuff, I thought back to some of the patients I had seen, and that's when it dawned on me, that I hadn't discussed any of the patients with an attending. Which isn't unusual, per se, but almost invariably I look for guidance on managing an issue, or turn to my attending for help when I'm stuck. But, things had just clicked during the day. There were times when I didn't know for certain exactly what my attending would do in such an instance, but I was confident that I was making good decisions.
We, miraculously, finished clinic at 4 pm. And I walked out with AK, and Dr. T (the other clinic consultant), reflecting on the day in general, but also on how busy the clinic continues to be, with no end in sight, and likely escalation of services. (There are some 500,000 people who still need to get on HIV treatment in SA!). And then there was talk of other clinic business, a conversation which maybe wouldn't involve junior staff in many places. The whole event of Friday's clinic made me feel like I'm an employed doc there. This is why I'm dragging my feet on setting up a new rotation for May and June. I could easily stay in the clinic for two more months. Though, after chatting with AK and Dr T, I went to the wards to try and find a patient that I had admitted, and ran into the Chairman/Professor of Medicine. I hadn't seen Prof in a while, so we chatted about the clinic, and also about my schedule for the rest of the year. We also had a great chat about Kili, and Machu Picchu, and travels in general. And I almost died when he suggested I take a few days off to go travel to the Okavango Delta, in Botswana. [Jean-I hear you].
I was home for about an hour on Friday, chatting to my new house-mate (a Kenyan anesthesiologist) and then was out the door to go visit AC. AC was holed up in his house, having had some kind of "face surgery" on Wednesday. I'd been lying to friends all week, saying that AC really had Botox and that it had gone bad and he was too embarrassed to see the world. So I headed up to his neck of the woods, and we had a great evening eating take away, catching up, and watching episodes of Little Britain and other mindless crap on the TV. But it was nice to just have a night in.
And then Saturday... I went to the gym in the morning, which I NEVER do. But I knew it was going to be a gastronomic day, so decided to do a little damage control before the damage was had.. And then CB and TB and I (CB, TB, BB-whoa) went for High Tea at the Saxon hotel. Talk about chic. Talk about lavish. Talk about fun. Sitting outside, on a beautiful fall day, sipping champagne, eating scones, cucumber sandwiches, and other heavenly desserts while planning next weekends upcoming backpacking trip in Swaziland was pure bliss. The bill was 630 Rand. That's roughly 63 dollars. For all three of us. Twenty bucks per person for high tea at one of the classiest hotels in Jo'burg. This is why...
And then there was a bit of excitement. We were all in separate cars, driving to the outdoor gear shop at the mall, when we came up on a car wreck. A truck had overturned. Thankfully, CB is also a doc. We walked over to Moses and took care of him for the HALF AN HOUR that it took for an ambulance to arrive. Moses had pretty nasty head wounds, which were bleeding pretty profusely. He wasn't really all that bad, aside from blood everywhere, which included on my khaki pants by the time we were done. And we proceeded to shop, all the while I was hoping people wouldn't notice the blood on my pants. This being Jo'burg, who knows what people would think.
Thankfully, I had packed a change of clothes. One never knows when they'll have to render first aid and get all bloody in the process. So I headed over to S&S house to change. Actually, the plan had been to have dinner with S&S, and just before leaving home earlier I'd grabbed some extra clothes, kind of thinking that we were long overdue for a late night in which I usually just crash at their place. So I headed over to their house to just relax on the porch and have a chance to catch up with them. While we were hanging out, David called. He's this lovely guy from Argentina, married to great South Africa guy who had left that morning to start his new job in Abdu Dhabi. So of course we quickly told him he was joining us for dinner.
Dinner ended up being 6 of us, with S&S, myself, Clifton (whose boyfriend-the Belgium pediatrician-was out of town, skiing in Europe), Argentina David, as well as British David. The food was decent, the wine was superb--and flowed freely, and the conversation was fun/hysterical-and flowed freely. We must have finally left the restaurant sometime after midnight, and then headed out to go clubbing for a few hours. A few of us ended up back at the house, and we crashed for the night. Well, Siza and I decided it was necessary to continue drinking wine til just past 5am. The morning after usually consists of breakfast, and then we all depart on our way. But after breakfast, we went back to the house, lounged around, and then headed to an Art Show. Not that I have any appreciation for art, but it was fun people watching. As that wrapped up, we bumped into more friends there, so then we all went for coffee, and then ended up back at the house for a bit, and then headed out to dinner. Finally, well past dark, it was time to head home.
This is why... I'm having my cake, and eating it too. I know this cake is going to be gone. And I have a hard time thinking that the next cake is going to be this delicious.
On Thursday, I got to see SM, in person. To see that he really is better. That he feels better. That he is actually going BACK to work. It's powerful to see folks, who are close to the brink of death from HIV, make these recoveries. And sure, it sucks to see those who don't make it. I find this immensely gratifying. I contrast this to the work I do back home, which I do find gratifying as well, but to me the outcomes back in Massachusetts/USA are more certain. I feel like there is more of a guarantee that folks will get better, but that here, that guarantee is gone, and so there is a level of pleasant surprise when people get better. There is also more of a challenge practicing medicine here. Labs may not come back quickly, x-rays are slower. CT scans are days away, and MRIs are almost nonexistent. You have to make a clinical diagnosis, and plan your treatments, and weather the storm while waiting to see if you're on the right track or not. And it's gratifying to have to use more cerebral power to take care of patients, than to use technological power to figure out what is going on.
On Friday, I felt like part of the team. There wasn't a division between resident/attending or junior doctor/consultant. We were all there equally, with the attendings there for problems we couldn't handle. And I'm so familiar in the clinic now that sometimes I literally forget that I'm not employed there, and that, in fact, I'll be gone from this clinic in May. I felt like I had the leeway to practice my own style of medicine. I changed HIV medicines on a few patients. Started different blood pressure medicines. I reveled in the autonomy of Friday. This does become a mute issue after I finish training, period, but it added to the overall pleasure of my work here. I could explain further, how part of the underlying issue is that the repercussions of litigation do not exist (which is not necessarily a good thing). I didn't have to worry that-even though I think I made the best clinical decisions possible, down the road some lawyer would find an article saying that when I changed a medicine or started another one, that I had made a bad decision...
And then the weekend... I have to preface this carefully, for it would never be my intention to disrespect the great friends I have amassed back in Massachusetts, back in Dublin, Back in Colorado, and now scattered around the globe (aside from Antarctica). When I lived in Dublin, one day a very close female fiend of mine lamented on how she felt she was missing close friendships with other women. And I was slightly put-off, which showed. What did imply for our friendship? That even though we shared this close friendship, it wasn't of the same caliber as a friendship with a woman? But now I get it. For the first time since I came out (way back), most of my friends in Jo'burg are gay men, and they are great guys. Their friendship is different than the friendships I've had when I lived elsewhere. Looking back, in the past many months, we've often had dinner twice a week, and rarely have we not met up at least once a week. There is a level of trust in our group (so much so that scandals are volunteered openly). It's not like the group of men I think of when I reflect on where I have lived previously. It's unique. And there is the international mixture as well, which adds an extra element to the group as well.
And of course, there is Jo'burg and SA itself. I am mesmerized by the workings of the city. I get motivation from seeing those who work so hard, yet have so little. And of course, there is Bara itself, a hospital unlike any other hospital in the world! I don't write this as a comparison to my place back in MA, and folks know that I think the hospital back in MA provides excellent medical care, and that it provides well for us junior doctors, and that the teaching there is top class. If Bara ran as well as that hospital the people of Soweto would be immensely lucky, and healthier.
So, this is why I find it difficult to leave here. I can't describe how excited I am to arrive back and see my family, my friends, and the newest additions to both.
This is why a part of me will remain a Jo'burger for life.
