A heart too hardened...?

With the local satellite down since last Thursday I've been without internet for almost a week!

As written last Friday:

Dear friend,

Another Friday has come and gone for what has been quite an eventful week. Monday was the worst day of my time so far in regards to the work. With the consultant, Dr J, back on the wards we did a full round of all the inpatients under my care (i.e. women’s ward). We went through each of our patients with a fine-tooth comb, especially a few tricky medical patients we have had for a while, which was satisfying but made for a very long morning.

Having heard that Dr J was back from South Africa after three weeks away there were a hoard of patients milling around outside the ward office hoping to get a chance to see him and get his review – a few previously arrange, but mostly “self-referrals.” As Dr J is still recovering from his illness he is trying to limit himself to half-days, so this flood of unexpected, unplanned, unfiltered patients was frustrating to say the least.

I don’t know how he does it, really. The day turned out to be so chaotic. Patients (literally) pushing their way to you, giving you no space, with a complete lack of a system or any kind of order. And it wasn’t even me specifically that they were clamoring for. 

The work here is never-ending, the resources scare and prevention nonexistent.

As I was walking home at the end of the day I was so frustrated. That frustration combined with exhaustion led to anger… and anger to blame. “Why can’t you just sort yourselves out?!” I thought in silence. Immediately I felt horrible and ashamed. When did my heart become so hardened? After one bad day I had lost sight of why I was here. Who am I to point fingers? Who am I to boast in my own situation? Can I take any credit for the fact that I was born into a land of the plentiful while the people here were not? No. I cannot boast in anything but Christ.

Since then I’ve been considering whether my heart has become too hardened. Have I lost empathy? Compassion? Are empathy and compassion feelings and emotions? Are they thoughts? Are they actions stemming from all of the above? Or all of the above?!

I’m a bit dumbfounded because daily I have seen all kinds of poverty yet I haven’t felt… sad. At all. I have thought to myself, “This is sad,” but I haven’t felt anything. I am working hard with what I have and to the best of my abilities; I have come here to contribute, recognizing the injustice of it all. Yet I don’t feel outrage about the injustice.

It is a quiet act, changing the world -- one rectal exam at a time.

Yet through it all I continue to feel very little, if anything at all. Maybe it’s because I have yet to make a connection with any of the patients or staff. Back home I thrive off of building rapport and relationships with patients and colleagues, but here not only are the people a bit stand off-ish, but there is the huge barrier in communication (building rapport via an interpreter is near impossible).

Love is an action, embodied by sacrifice, so I’m here, but has my heart become hardened beyond the point of what is normal for this job?

Day 12, Case 4

(A glimmer of hope for my potentially hardened heart)

We currently have a woman in her early thirties who was admitted with a couple months history of worsening upper back pain. A pleasant woman with a sweet smile, she had no other warning signs or symptoms. X-rays has since shown a dangerous collapse of T4 and T5 vertebrae (= two back bones relatively high up in the spine), most likely due to untreated tuberculosis. Now on bed rest she has been started on TB treatment and we are waiting for a specialist consult on her X-rays from an orthopaedic surgeon overseas. The bottom line is, however, there is virtually no chance she will be able to get that kind of surgery here.

Constantly at her side is her baby daughter, Albertine. She is about a year and half old and quiet easily the most adorable baby I have ever seen. Very aware of the (very important) life lesson of “stranger danger,” it has taken these past two weeks for her to warm up to me. Then on Wednesday for the first time ever she locked eyes with me then slowly began to grin. As I excitedly waved back, her smile exploded and she laughed. My heart melted in an instant and I fell in love.

Today on my ward round the mum complained of numbness of her legs. On examination she has lost normal sensation all the way down from her mid-trunk – a very bad sign. With Albertine staring up at me with her big brown eyes all I could think as I was examining her mum was, “Beautiful girl, please don’t become an orphan.”

I am daily astounded with how sick people are here. In ways you just don’t see back home. I am astounded by how physically small the people are here – women older than me who look like they belong in the children’s ward. Reading the scale, when you see “60” it is not 60 kgs but pounds. Skeletal eighteen year olds with severe HIV who must have acquired the infection in their early teens. Placing your stethoscope on the chest of a patient who is so malnourished -- ribs so prominent -- that drum of your stethoscope is unable to lie flat as it should...

This afternoon I scrubbed up to assist Dr J with a hand amputation of a patient whose right hand has slowly rotted away after severe burns earlier this year to the point that it was now mummified. (I’ll refrained from posting pictures as it is actually quite frightening, but I have some if you’d like to see.) As we were starting the procedure, I said to Dr J, “It’s so tragic,” to which he simply replied, “Here, tragedy is life.”

Here, tragedy is life.