The other side of the white coat

I'm used to being the doctor. Now that my practice of medicine has come to a temporary halt, I have found myself thrown full force into the patient's side of things. Let me tell you what you probably already know:

• Dealing with insurance is confusing and painful. 
• It can be hard to get an appointment with an obstetrician if you wait until your third trimester (even if you had a good reason). 
• Picking a surgeon and preparing your dad for heart surgery is, well, a bit frightening. Even if you know what you are getting in to.

After spending way too much money trying to keep our prior insurance  [expensive because I'm pregnant], we finally figured out that if you aren't making any money Medicaid might be a good option. But, it can only be used in the state where you are a resident. Therefore, I am now a temporarily unemployed, pregnant, general surgeon on Medicaid in Washington state.  Didn't see that coming. 

Shortly after we got back from Africa, I tried to get in for my first official obstetric appointment. I was still covered by our insurance, but since I was considered "high risk" being 26 weeks pregnant without the routine pre-natal care, the OB office wouldn't schedule me. It took several phone calls from my doctor friend M who knew a tenacious doctor who was married to an OB to get me in. Whew.  It makes some sense...with malpractice and everything. After getting the appointment, everything else was fabulous.  I felt relieved after getting labs and being seen by the super-nice, smart obstetrician who was willing to see me despite my past. :)  The baby looked great on ultrasound and it was nice to confirm that we are indeed having a little girl!

A couple of weeks ago my dad called me while we were in Minnesota and told me that his heart doctor said he needs his aortic valve replaced and his doctor was going to schedule the operation in a couple of weeks. This came as a bit of a shock to me since I hadn't even known my dad had heart problems. He couldn't completely describe to me what he had, but I knew it was serious if he was having symptoms and needed his valve replaced.

"Blausen 0040 AorticStenosis" by BruceBlaus - Own work. Licensed under CC BY 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Blausen_0040_AorticStenosis.png#/media/File:Blausen_0040_AorticStenosis.png

Then, he asked me if I knew anything about the surgeon he was supposed to meet with. I didn't. Now, open heart surgery is a BIG deal. I wanted to be sure he needed it before he got the operation...and that he had the right surgeon and hospital. Turns out, its really hard to figure out who is a good surgeon without inside information. (As an aside, almost every surgeon I have worked with is excellent...but I didn't want to chance it). So, I made him an appointment with a surgeon that I know and trust...even if it was a little farther from home.

Luke and I made it to Washington in time for the appointment. It was very strange being on the other side of the "you need a major operation" conversation. But, the visit was great and my dad is scheduled for a valve replacement next week...as long as we can keep him alive until then!

Severe, symptomatic aortic stenosis...can't stop me.

How was Africa?

What do we say when we're asked, "How was Africa?" After over two years overseas, we have about 6,000 pictures and about that many stories.  I have no idea how to answer. Its like we have been to another world. How does one explain what the least developed country in the world is like to people who live in one of the most developed? Its still hard for me to comprehend that Niger and America exist on the same planet.  So, we show a few pictures and tell a few stories all the while still struggling to process the experience ourselves.

Inevitably, we then come to the next question- "What are you going to do now?" We are still working on the answer to that, too. Mostly we are praying a lot, seeking guidance, and trying to relax a bit and enjoy our time back despite all of the uncertainty.  One thing we do know...we are looking forward to meeting our baby girl in less than three months!

 

arctic freeze

We are now mobile!! After a somewhat painful searching and bargaining process, we have found and purchased a used car. We took advantage of that and drove to the snowy mountains of North Carolina.  We didn't anticipate the "arctic freeze" with -19F weather with wind chill. Brrr....

Snow...so beautiful

Its is freezing cold here!  Fires are wonderful.

Bundled up to the max

We are also successfully crossing other fun stuff off our list (as you may have noticed, most of them having to do with food). :)

Chips!!

a nephew after my own heart...he loves potato chips! (yes, perhaps I am a bit of a bad influence on my niece's and nephew's food choices...but isn't that what aunties are for?)

Take-out Pizza! Check. This will likely happen many more times. :)

Zaxby's!!!  (helped keep us sane during car shopping)

Everything is Awesome

Jet lag has been pretty brutal...but so far, most things about America are as awesome as we remembered. At the very least, we are enjoying a "honeymoon phase" of re-entry. We have checked  eleven things off the list of "Things We Are Looking Forward to in America."  About 30 more to go, then we can get down to the business of figuring out what to do with the rest of our lives. :)

Page One of "The FUN List"

Bacon Hamburger in the D.C. airport

Gingerbread houses!

A good use of the leftover Halloween candy

Pickles! HAM!  Cream Cheese!!! AMAZING

Its so big :)

so much meat!

Blue Cheese! Pears! Lettuce!

Christmas puzzles

VIDEO Skype...the power didn't go out even once

Hats, gloves, and a blue sky

$0.58 cents for a donut. WHAT?!

is this another planet?

After a semi-eventful trans-African journey (including an unexpected night in a very nice Ethiopian hotel), we have arrived in Burundi. And, well, we aren't in the desert anymore.

they messed up our flights...but at least this is a pretty sweet hotel 

free dinner...with fish

Burundi...definitely not the desert! It was green like this for the whole 2.5 hour drive 

and then we found this in our refrigerator!!! biggest avocado we've ever seen  (turns out there are huge avocado trees here...with avocados just laying around on the ground). All you can eat avocados, WHAT?!?!

and it wasn't even rotten inside

Guacamole and homemade tortillas (nope, didn't add meat or anything else)

Took a short hike to the top of the hill...its so GREEN!

In many ways, our experience here has been the opposite of the last two years. It rains every day. We are cold and wear our jackets and socks all the time, even inside, and sleep with four blankets on our bed. Our refrigerator is so full of fresh produce we don't know what to do with it all. Tab hasn't had that much work to do at the hospital- I guess the word got out that there was no surgeon here...so this might change soon.

Luke is still trying to fix everything broken.

Some other things are exactly the same, bad power, lack of resources, language struggles, and the ever present cultural misunderstandings. 

We are still looking forward to flying home soon. In two days we will have been gone for two years. It doesn't seem that long. Oh well, all things must come to an end.

crowd sourcing

How old?

When is your birthday? Most Americans grow up celebrating their birthday every year. Its kind of a big deal, especially as a kid. I bet you remember at least some of your more "important" birthdays like the day you reached double digits, the day you became a teenager, or the day you  turned 16 and could finally get your driver's license. What about 18 when you were finally an "adult," 20 and no longer a teenager. The big 21. After that, birthdays aren't quite as cool. You turn 30, life is nearly over! Nothing special happens except you are no longer in your twenties and feel old. That's me.  How did that happen so fast? And 40...it won't be long.

You can imagine that it was a bit shocking to me when I started asking people's ages here and the most common response was silence or "I don't know." What?!!! How can you not know how old you are? 

And, we had some really funny guesses on the patient's cards. Like the guy who said he was a 120! He looked old, but he wasn't that old. :)  Usually, I just accept the age that is written on the patient's card, but sometimes it is obviously wrong. Then I start the guessing process with my translator. How many kids do you have? How old is your oldest child? Are you in school?  etc...  

The  patient card of the boy in the picture said he was twenty...but there is no way he is that old. He looked about 13. So I asked his father, he said "I think he is twenty." Then, as often happens, most of the other patients in the room chimed in to help, "He isn't twenty!"  "He's probably 12"  "No, I think he is 15"  "He's not more than 14" "Does he go to school?  No, he's not in school." "We think he is 14."  So, I crossed out the "20" and wrote "14" on his card. Back to minor status for you!

where to begin...

Um, its been almost a month since I wrote a blog. And now there is so much that I could write about that I don't know where to begin. So I haven't. To get up and running again I'm just going to start small. :)

there...

After spending three weeks away in Greece and Italy, We've now been back for a week. Lets just say it has been, once again, quite the adjustment. It is quite shocking, really, one week to be walking down a Roman street lined with Ferrari and Louis Vuitton stores and the next week to be on a street lined with mud-brick huts filled with people just hoping for enough rain this year so they can feed their families.

...and here

Its impossible to describe the emotions, thoughts, and feelings that come with the jump between worlds. It feels like we have returned from another planet, far, far away. But, we are slowly adjusting back to life in the desert. More vacation stories to come. :)

conversations in the OR

One of my favorite things about my day is the sometimes random conversations that happen in the operating rooms.  When you put a female American surgeon in the middle of  an operating room full of Hausa men, interesting conversations are inevitable. As my Hausa has progressed, the conversations have become less frustrating and more enjoyable because with my Hausenglish and their Frenchausaenglish we can usually figure out what is being said.

The following conversation transpired while I was tediously cleaning spinach, pus, and inflammatory tissue out of the abdomen of  a patient who waited 5 days after his stomach ulcer perforated before coming to the hospital.

Me: "Why do Hausa people wait so long with severe pain before coming into the hospital??? It would be so much easier to fix if they came right away. And fewer people would die."

A (Anesthesia): "Hausa people consider it a weakness to complain about pain. So they don't, even if it is really painful."

Me: "But we have pain for a reason. It tells us when something is wrong. Pain from a perforated ulcer is SEVERE, I don't understand how you could ignore it.  People view pain differently in America. Americans think they should almost never have to feel pain."

A (as if revealing some very interesting news):  "I read the other day that in Europe they give women pain medicine and even anesthesia for childbirth!! Do you know about that?!"

Me: "Yep, epidurals are a wonderful thing."

A: "But, that's crazy, women are supposed to have pain during childbirth. It is part of the curse of childbirth. You shouldn't take the pain away. And who gives the anesthesia? The obstetrician?"

Me: "The anesthesiologist does."

A: "Oh."

The conversation went on about whether Eve caused Adam to sin because he loved her and if women should have pain during childbirth. The conversation quickly became way too complicated for my Hausa.  I wanted to tell him how many of my patients had epidurals during and after their operations when I was a resident...and that more than half of women who give birth in hospitals in America have an epidural.  Even if I knew how to say that in Hausa, I'm not sure he would have believed me!

The Uncool

A few years ago I worked for UPS. There were thousands of people that worked in the facility. I could walk from one end of the building to the other and only exchange nods with people. I was just one of the crowd. I was a regular person. People knew I was a supervisor but no one except my employees knew my name. That was AMERICA. This is AFRICA.

Some days working here makes you seem like a rock star. Everywhere you go, people know your name, they greet you, they want to talk to you. They know your name even though you've never even spoken to them before. They know you were in town yesterday. They heard you bought mangoes. They wonder if you still want to buy a bicycle, their cousin sells bicycles. They might even know what you had for dinner last night. They invite you to have lunch with them or to stay in their house etc... It is kind of nice to be in such a friendly place. But after a while it can be ego inflating too.

There's a great scene in the movie Almost Famous about The Uncool. William has just spent the last month touring with a rock and roll band and having a mostly great time. The scene involves the teenage William making a late night phone call to his mentor. The story he is set to publish is going to make one group of people upset with him either his employer for wasting their time and money on him or his new friends in the band.  He is faced with a reality that he didn't want to return to. The truth comes from his mentor in an honest and brutal statement. It goes like this:

Lester Bangs: Aw, man. You made friends with them. See, friendship is the booze they feed you. They want you to get drunk on feeling like you belong.

William Miller: Well, it was fun.

Lester Bangs: They make you feel cool. And hey. I met you. You are not cool.

William Miller: I know. Even when I thought I was, I knew I wasn't.

Lester Bangs: That's because we're uncool. 

I think it is interesting that after several months of being a mini-celebrity you change. You can go places expecting people to be nice and to know who you are. But then, there is the other side of fame and fortune. When you are just going for a walk to get away from people and think, often you encounter someone that knows who you are, and wants to know if you need someone to wash your bicycle, or buy you mayonnaise, or wants to ask you a million questions. It is hard to have a good attitude either way. I find I struggle to have a good attitude in both situations.

It will be interesting to be back in America where I am just an ordinary person again. Will I miss the days of being a VIP? Will I have a good attitude about it?