Neonatal resus, or how not to kill a baby

I haven't written here in quite a while. The 3rd year of med school was really hard, and after my last time in Chad, I was not in a good place emotionally, which made it all even more difficult. At the end of the year, we have an exam that is the equivalent of Step 1 in the US, which allows us to pass on to clinical rotations during 4th year. Here med school is 6 years, 3 basic sciences and 3 of rotations.

It was hard, but I passed, bought a house (no joke!) and went on vacation for 5 weeks through Central America (Mexico, Belize, Costa Rica and Panama) which did wonders for my mental health. I came back rested and feeling better than I had in a while. Ready to start rotations.

However, as luck would have it, my 1st rotation was OB/GYN. And I started to have flashbacks from Chad. From hemorrhaging mothers and ruptured uteruses, and dead babies. More than once, I had to force myself to think of something else, look out the window and distract myself, so as to not start crying. Nobody here, the residents, attendings, fellow students, know that I've been to Chad and have seen more tragic outcomes in 6 weeks than they will see in their entire careers. As an inexperienced med student with no way to process any of it, and in a setting so poor in resources, than even if I had known what to do, I wouldn't have had the materials necessary to do it.

But let's skip over my 4 months in OB/GYN and jump forward to today. I have now started a 3-week rotation in Neonatology, before moving onto Pediatrics. And today we had a class and sim-lab for neonatal resus. I held it together by forcing myself to concentrate and actually learn everything I could, practicing manual ventilation and intubation, and learning all PEEP and PIP parameters.

At the end of the class, I walked out quickly, trying to hold back the tears. I couldn't stop thinking of one baby in particular, in Chad, who was born alive but died while I auscultated his diminishing heartbeats. That moment will be etched in my memory forever. The feeling. The shock. The numbness that followed. The only ambu bag we had was pediatric, which the nurse was trying to use but I don't think our efforts at ventilating were at all successful. The OB/GYN was busy trying to save the mother's life. I had no idea what to do, and there was no one else. I *know* that there was nothing else I could have done. But right now, I feel like I killed that baby. I feel like I should've been better prepared. And I'm fairly certain that, had that baby been born in a hospital with a NICU, or at least a neonatologist and better equipment, that baby would not have died.

THE UNFAIRNESS OF THIS WORLD MAKES ME INCREDIBLY ANGRY AND SAD.
(Sorry for yelling, but I can't help it.)

The world in 2018 is a disaster, and instead of improving, everything is going to hell. Instead of having a better division of resources, we're polarizing more and more. The rich are getting richer, and the poor are struggling to stay alive. The feeling of impotence and the anger at the world, at the leaders, at the greed of the richest and the apathy of...pretty much everyone (myself included) is getting to me. We need to do better. *I* need to do better. 

The thing about Tchad

Being here is a crazy mixture of awesome and heartbreaking sadness. I was talking to Dr. Danae today, about the fact that I don't plan on coming to work in Africa full time once I graduate, because I don't think I could take it. I would eventually just want to crawl into bed and cry myself into oblivion.

Take today for example: we started with a woman who got to the hospital at 5:30am after many many hours in labor at home. Baby no longer had a heartbeat. Uterine rupture, and so badly ripped that she needed a hysterectomy. She had had 5 kids (including the baby this morning), but only 2 were still alive. After the surgery, we asked if she wanted to see the baby, and watching her hold it just broke my heart. I can't imagine going through that. 

The very next case was a 27yo with advanced breast cancer. We did a mastectomy, but only to give her more time, as it has already spread to her lymph nodes and there's really nothing more we can do. (Pictures at the end, scroll carefully if you don't want to see it).

Then an elderly man came to say his wife, who also had had a mastectomy for advanced breast cancer was having trouble breathing and was complaining of pain. Nothing we can do, except give her some pain meds. 

Then a woman with a urovaginal fistula, who had it for 10 years. Imagine leaking urine 24hrs a day for 10 years. Imagine it for just 1 day. 1 hour even! Not being able to sit down without leaving a puddle. Walking and having urine run down your legs. Your clothes, constantly soaked. The smell of urine like your shadow, always there. 

That was an incredible surgery. It took 4hrs. It was hard and physically challenging, but also very rewarding. Barring any complications, this woman will soon be able to hold urine in her bladder, and void it only when she wants to. I'm really excited for her! 

You see what I mean? It started with a couple of really sad cases, but ended on a happy note. Plus, I get to be in the OR all day, every day. The OR is definitely my happy place. I get to do stuff, like stick giant needles into people's backs (spinal anesthesia), or suture the skin at the end of a case (I'm already getting faster! Closed a hernia in 5 minutes today!!) 

So yes, I love coming to Tchad. The experiences I have here are invaluable, for my training as a doctor as well as for my growth as a person. I intend to come back every year, whenever I have a chance, but I don't see myself staying here long term. 

But then again, God might have other plans...