Manali Missives, February - March, 2015
Stretched to the Limit, Adequate by God’s Grace
Yesterday I (Lena) looked out from our bedroom window and noted that a fruit tree in the school ground next door was covered in white blossoms. The weather had been a bit more pleasant over the last couple of days, but today there are heavy black clouds, blustering winds and rain. The snow line is still fairly close so maybe winter is yet not over.
Usually in the winter months the patient numbers drop and we can all take it a bit more easy. In my area of work the weather is not such an influencing factor because babies are born all throughout the year and when they get sick the parents usually try to get to the hospital even if they have to walk several kms in snow.
The last week has been very busy, in the baby health clinic on Friday we had more than 70 children come for check ups and immunisations.
I am on call 24/7 for obstetrics, gynaecology and pediatrics and my colleague Dr Chris Shin is on call for medical patients. At present we have no fully qualified surgeon as Dr Philip Alexander has joined his wife and son in the United states for a bit of a well earned holiday.
A comment on face book the other day made me realize that maybe a lot of people don't know the full extent of what it means to work in a small mission hospital. I have such great admiration for Dr Philip and Anna Alexander (and many other doctors working in remote places) who have been here for 10 years and who are constantly learning new things.
There is a huge difference in my life here compared to my life in Australia, not only when it comes to working hours but also the availability of specialists to refer to. We are the specialists here and many people come from far away places because they have heard about the hospital here and the good care patients receive. The young doctors who come here for part of their training learn to deal with all kinds of diseases and injuries and when they need help they call us. I know that I am not the only one who after a busy day goes home to look up and study symptoms and treatments of some unknown disease that we have come across during the day. We rely heavily on the Internet, Medscape and medical textbooks but most of all on God and his Holy Spirit. So many times in my daily work have I stopped and put my hand on a patient and prayed for wisdom, knowledge and guidance in treating and helping this patient.
We have 2 medical students visiting us from Cardiff in Wales at present and the other day one of them told me there was such an interesting case in the emergency room. He was referring to a case of organophosphate poisoning which is very uncommon in the western world, but here in Manali where this poison is so readily available, not uncommon at all. This made me realize how these last 1 1/2 years have changed my perspective on the practice of medicine.
For example, coughs and colds are common enough but not always due to a simple viral infection.
Tuberculosis is very common and a great mimicker of many other diseases. How do you diagnose it and how long do you treat the patients, what kinds of drugs does one use? 2 days ago we discharged a woman who is about 36 weeks pregnant, she has had a cough on and off for 3 months. Her chest Xray showed a right side pleural effusion. Normally we would examine the sputum for tuberculosis bacilli but her cough is non productive (ie no sputum is produced). An attempt was made for a diagnostic pleural tap but no fluid was aspirated. We have 2 lives to think about. Do I start this woman on medications that are classified as being dangerous to the baby now without the woman having been diagnosed with TB? Do I wait until the baby is born and then treat both of them with drugs without the diagnosis of TB having been confirmed? Do I not treat even though clinically this lady has TB?
Consider the baby that I continued to resuscitate for an hour even though it had no pulse or heartbeat for 15-20 minutes (10 minutes is usually the cutoff for resuscitation) and did not breathe on her own for an hour? This little girl developed seizures after the birth probably due to the hypoxia. By the grace of God that baby seems to be developing normally and the last time I saw her was smiling and cooing without any signs of stiffness or spasticity. (Signs of cerebral palsy)
It is frightening to be a doctor sometimes and I am reminded almost daily of my dependence on others, other doctors, staff nurses but most of all on God. How does one answer the question-"how long before the baby is born?"or "will my baby be alright?" My answer is often-"only God knows". Indians understand this answer but often reply-"but you are like God to me/us". Of course I know and they know that I am not God, but it still scares me to know how much trust they put in me. Many doctors suffer from the "Messianic complex" - we feel we have to save everybody. It is very hard to accept the death of a patient, there is often a lingering doubt -"did I do everything I could, did I make a mistake, could I have done something different?"
I look at role models, the people who led me on this path. Dr Ida Scudder, Dr Paul Brand, Dr Clement Moss to mention some and I feel truly blessed and humbled to be sharing my profession with such great women and men of God. They inspired me and evoked a passion within me to pursue the vocation of a doctor, to help and serve all human kind.
Lena Reichardt
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