Mobile Study

When we arrive at the conference, day 1 will be an intensive course called Pediatric Advanced Life Support (for me) and Advanced Cardiac Life Support (for Scott).  This is not our first time to take it, of course, but it has been many years (should I confess I've never even SEEN an AED, the automatic defibrillators that I hear are in malls and airports and schools and everywhere these days??).  In order to offer the certification efficiently we're supposed to have studied the manual and completed a pre-test and reviewed 12 case studies.  So we're studying in the car, our only "down" time to prepare.  As we drove out of Bundi I opened the text.  And realized, I love this stuff.  Equations where cardiac output is related to stroke volume and heart rate, where the world makes sense in numbers and diagrams.  Pages of drugs where one has to choose, where there are options.  Glossy tables, color coded ideas, science, data.  Sometimes I forget how much I love medicine that is technical and effective. As I'm reading, I get a call from the health center, the blood bank is empty, I make more phone calls and beg for type B for my little friend with the UVA T-shirt who has a hemoglobin of 3.  Which is not even an emergency here, just a moderate deviation from the average marginal life.  The contrast makes me shake my head, and try to remember as in a distant dream a world where I might have just written an order in a chart:  transfuse 150 ml PRBC . . .and within a few hours it would be done.  Where Mr. UVA would have been on a heart monitor, pulse-ox chirping, oxygen available,  in a clean room surrounded by functional up-to-date equipment and attended by an army of professionally trained staff.  Instead, I'm calling from one district to another and doling out shillings for transport and hoping a set of tubing will be obtainable when the blood finally arrives, and that he'll have stayed alive two days eating beans from a common bowl and hanging out on his mattress.  All to say that a foray into the world of PALS, with its protocols and order, feels a little like going home.