MON-WED: Ninafanya kazi hospitalini, I am working in the hospital. And by working, I mean really working. We're short-staffed here in the "summer" (really the winter, we're slightly south of the equator, and it's chilly at this elevation). From 8 am Monday morning to 2 pm Weds afternoon, it's pretty non-stop. I'm somehow responsible for a resident, 3 interns, and two clinical officers; a 15-20 baby intensive care nursery; a 20-ish bed inpatient pediatric service including consults on complicated neurosurgical patients; any pediatric patients in the ICU (one currently, usually 1 or 2); backing up the CO's and interns as they evaluate all outpatient visits to the Maternal and Child Health Clinic (another 20-30 per day) or the Casualty; resuscitations in the delivery room or the OB theatres; and evaluating all new admissions. By the time I've rounded on all the admitted patients I can barely remember where I started, so I just pray that God gives us clarity and wisdom and makes the biggest problems clear. The good news is that RVA is now out until the end of August, so that clinic and the daily follow-ups are at least suspended for now. We move as a group from bed to bed, checking for low oxygen levels, listening to babies, holding xrays up to the window lights, flipping through notebooks of paper to examine medicine charts and be sure the patient is receiving what we expected. The progress is slow, for the patients and for us, because this is a tertiary referral hospital. No one comes here with a simple, treatable disease that gets better in a day or two. They come with chronic intractable problems, neuro-developmental delays, pallor and weakness, poor nutrition and gasping breaths, congenital deformities and desperate social issues. It takes patience and pondering to untangle the story; it takes days and often weeks to treat the meningitis or clotting disorder. On Monday I was also on call, so the seven admissions (plus the three I decided should instead by treated as outpatients) all required more thought and checking and labs. There is a review meeting to discuss the management of a baby that died, a tragic story of a mom on her 4th pregnancy with NO LIVING children, all dying in the perinatal period, and this time she loses her baby again to a cord prolapse, unthinkable suffering. Oh, and did I mention that as the lone pediatric consultant on Tuesdays I have to come up with an hour-long teaching conference each week now too?
Scott is also covering an extra week of the male medicine ward because of short staffing as well. Thankfully his service is not quite as crazy (most morbidity and mortality in Africa occurs around childbirth and the first five years of life), which means that he had more home time to deal with our mysterious infestation of fleas or bedbugs or some such pest. Julia and Caleb were the main victims, I was up at 2 am to go to the hospital and also comforting Julia who was scratching numerous bites. We're grateful for a washing machine and doom (bug spray) but it took a lot of work for Scott just to process all the sheets and blankets and clothes . . . oh, and we've had kids staying with us again, three boys for various periods of time, the last one leaves tomorrow. So when I do come home, it is generally straight to the kitchen to cook something for everyone, which is actually a therapeutic way to recover from the day, palpable and palatable and pracitcal. Monday to Wednesday are just plain intense.
THURS-FRI: But then, miracle of miracles, we reach Weds afternoon, and Mardi appears. We discuss the service one by one, a passing of the burden. And I walk out, free, at first bewildered. Ninashinda nyumba, I conquer the home (I like the active Swahili rendition of being a mom at home). Four teens on summer vacation. A card game. Baking, washing, listening, straightening, more baking. A video. An afternoon run with Julia through the adjacent forest, we pause to marvel at black-and-white colobus monkeys in low branches, to listen to the chirping of the white-bearded skittish blue monkeys, to be thankful that Star has chased baboons off the road ahead and waits between them and us. Julia pushes the uphill pace and I try to keep up. I go to the library which is open a few hours per week during the holiday, and fill a bag with good books, a pure pleasure. Swahili lessons, answering emails. And I cook. In the last 36 hours: biscuits, an apple-strawberry pie, balsamic-citrus chicken, mashed potatoes, salads, homemade whole-wheat bread, yoghurt-making, cream of pumpkin and cream of broccoli soup, lemon-blueberry scones with boysenberry jam, lentils with carrot-rice, fresh fruit. brownies, fresh tomato sauce and pasta. Every single one of my kids is getting skinnier in spite of the output of the kitchen, but I do try. Sitting on Caleb's bed looking up college web sites. Walking to the dukas. Writing. Giving Scott a haircut (Jack got tired of waiting for me and Luke cut Jack's hair earlier in the week). Working from home on some of the administration for the Paediatric department, and for our WHM field.
Though the weekend blends back a little as Mardi and I take turns on Saturday, and next weekend I'll be on call the whole time, the week is starkly spit. And I think I like it. It's easier to give 110% when you know there is definition to the time. I'm less resentful of time away from my family when it is balanced with protected time together. I suppose it is part of the way we are made, for work and for sabbath, for rhythm, for contrast.