I Love Medicine -a little heroism is nice. And... back in the field.

So what I said in my last post about not being able to do OB/GYN all the time -yeah, I take that back. I totally take it back. Yesterday was one of my best days in Pakistan, and one of my best days in Medicine so far. I arrived late in the Labour Room (and so unfortunately missed experiencing Rounds) for which I have my lovely stomach to thank. But anyway, more interesting complex cases, I watched 4 deliveries (2 of them were happening in the same room at the same time, which was a bit nutso, but amazing) -also I loved watching the Head Resident stitch -after watching a total of 6 episiotomies, I know I'm no expert, but she does a really beautiful Matrice stitch -so clean and precise sewing up of the internal and external perineum -it's an Art. Also, it was wonderful getting to know the other residents, and meeting some of the consultants and attending physicians -this made such a big difference in the pleasantness of the experience. Loved it. Love it. One of the residents was actually telling me that here, most of the physicians in surgery are really humble, nice and of course, knowledgable. I was blown away, because as we all know, back home, surgeons have a pretty solid reputation of arrogance. Also so many of these young women physicians are already married and stuff, and they're my age (it's like the European system here where all doctors do "pre-med" straight from A-levels).

But I learned about PIH -pregnancy induced hypertension, which is caused by the release of vasoactive factors from the placenta + the effects of placental estrogen and progesterone. They actually simultaneously treat the labour pains and the PIH with Antinox, i.e. laughing gas (nitrous oxide)... Also, some mothers in labour are howling away in agony, and then others are perfectly quiet (just moaning a bit, saying "Ow, Ow...", I mean, that's pretty good for labour, right?)... we saw some more comlicated cases -one mother who was at gestation 40 weeks with an E. coli infection and in a lot of pain, but because her blood was infected, the originally planned epidural became relatively contraindicated (risk of spreading the infection from the blood to the CSF, resulting in meningitis), however, neither the nitrous oxide nor the narcotics (Kinz, which is nalbuphane... don't know if that's the Pakistani Dilotid equivalent or what) she was already on were alleviating her pains (and she wasn't even giving birth yet)... I don't know what they ended up doing... Then there was an epileptic woman who had just had a petit mal the morning before being admitted... and this morning I thought I'd pop in just for Rounds before going back to CHS, but apparently last night's Call had been pretty bad, with a PTL (pre-term labour), gestation of 26 weeks for a mother pregnant with twins and another woman in labour who was admitted with pancreatitis...

So, yes. Of course, some days are heaven and you're a hero, and other days, all hell breaks loose (forgive the cliche, but it is apt) and the head of OB beats down on everyone under her, and there's no time for Rounds. But it's still so exciting and I'm so looking forward to being more a part of all that. For better or for worse. It's a stronger feeling than a marriage vow I think (although, not being married, I guess I wouldn't really know...).

When I went back to CHS this morning, I was warmly welcomed back after my absence (since Friday technically because I had gone to Thatta and had not even seen my supervisor that day). However, I was quickly sent off to Bin Qasim for field work (the worst slum in Karachi). It was miserably hot, that sulfur-y sewage water smell mixed with the smell of burning garbage as we drove over in the AKU van (no AC). They seriously burn garbage everywhere.

It was hard to take today -I may have reached my limit for dealing with all this now -it's a lot and there's only so much of it one can handle before you need a serious break / must leave and get trained-up so that the next time you're in this kind of situation you're actually doing something BIG about it (even if it starts with just practicing medicine here...). But I didn't crack -I'm still here. There were lots of cattle on the road today, and of course, the token mother carrying her naked infant in one arm while juggling 2 paans in the other, and frankly handling those with more care than the kid. Makes you want to be sick, really. Most of the kids are running around everywhere barefoot (perfect for getting those worms that penetrate the skin that we learned about in Immunology). We visited 3 different villages in Bin Qasim -Lalabad (3 visits, 1 of which was not home... the person there though only spoke in Pashto so the AKU driver had to translate what the Dr was trying to ask, which was kind of interesting... apparently you really get a mix of non-Urdu languages in these poor areas... which makes the whole Town seem kind of like a mecca for poor-people-from-all-over-the-country or something), Chsma Goth (nobody home at the only visit there), and Rehri Goth (the worst off village which I had already visited).

My favourite part though was going back to baby Fatma though (whose photo you have seen in a previous blog post) who though recovered from her previous infection, was currently fighting another one (that's how it goes with these kids unfortunately)... lovely to see her much better though =) Otherwise, the stink of rotting fish and burning garbage and sewage, and the fly infestation of these parts was not at all pleasant... I'd say mind-numbing and exhausting, even the drive back through Korangi (another poor area... it's really like most of Karachi is actually poor...) and back to AKU. Like I said, how much of this can a person take without returning home with PTSD. I hope my feeling like I need to stop going into the field for now is not a sign of weakness... I just really need to take stalk, and think, and talk and learn everything I can so that I can be more helpful next time.

So ready to go back home... shopping last night was pretty good though, loving this Coke Studio music I bought (Pakistani musicians / poets /artists sing together and do a kind of 'fusion' of styles... the CDs are the songs from the music TV show here, which is very popular I believe...), as well as the Shafqat Amanat Ali CD (love his voice. love it, love it).

Well, time to go watch some 'House' and forget about my day... love you.