April Fools'!

No water, no taxi or bejaj this morning, Sonal and Elliott both got shat on by birds at lunch, internet is in and out at the Hotel, and terrible disease is everywhere. I forgot how overwhelming this was going to be.

This morning Sonal and I went (unshowered and coated with market dust from yesterady, as our water has been out since yesterday afternoon) to morning report where 3 of 25 soft-spoken and heavily accented interns (2 of whom are female) gave short reports on overnight admissions (stroke, heart attackand fielded a couple questions about management and differential diagnoses (the list of possible diagnoses responsible for signs and symptoms). We were introduced by Dr. Shitay (our host) and another attending physician as "staff doctors from America" here to help and teach. We then spent our mornings alongside one resident each in an outpatient medical clinic seeing patients who had been referred from the general triage desk from which others had been sent to the emergency department. I sat with Zekerias who interviewed the patients, conferred with me a bit, and wrote orders (chest x-rays, labs) which would result this afternoon and be managed by the afternoon resident. We saw a 26yo woman who looked like an ill 60 with the most remarkable splenomegaly I've ever seen and stage IV AIDS on new HAART unable to tolerate her GI side effects, a 60yo sparkly-eyed barefoot man with leathery skin, cute shorts, and recurrent (or perhaps incompletely treated) tuberculosis, advanced and crippling leishmaniasis (from nearby desert area where sand flies hang out), a 21yo man with remarkable energy but 10 months of a 50-pound weight loss, night sweats, cough, and fever today.

Although I feel remarkably better right now than I did when tears snuck out at lunch break, day one is officially overwhelming and raising doubts that spread far beyond the walls of the Gondar hospital. At the risk of spewing unfiltered internal drama onto an unprotected format, I'm... going to.

At the tail end of my medical training, a journey that started 10 years ago when I decided to take a summer chemistry class at Cornell while I was working as a paramedic and bagel sandwich preparer, I wonder today (specifically April 1st, 2012, not "these days") what utility this all has. American patients often need hugs and better parenting more than my medicine and Ethiopian patients show up at the hospital already wasted from AIDS and past the point where medical intervention is useful. Maybe the rest of my family has it figured out and my efforts would be better spent, would feel more meaningful helping high school and college kids blossom, express themselves, find meaning in language and memoir, hone skills of analysis useful in love and academia. Lordy, days like this make me want to grab Elliott's hand and climb into the mountains.

On the up side, we both woke up feeling physically better and stronger than we did all weekend. Our bodies are adjusting to the food, the travel stress, the smoky air, and the altitude. Elliott made strong, tasty coffee with our new pot and sieve and milk powder and we ate biscuits and sipped coffee in the sunny, breezy (and garbage-fire-smelling) courtyard before leaving for work. Soon after, as there was no water and the guest house laundry machine is broken, he walked all the way past the hospital to the piazza with our essential laundries and found the laundromat closed and barely escaped a piazza boy sneak attack which led him to a dirt-floored house offering to do laundry for 3 times what we should expect. A bit deflated, he packed up our dirty clothes, and trekked back to the Hotel to meet us for lunch where I was kind enough to dissolve into quiet tears with the trigger of his loving presence. You're welcome, darling!

He set out for home on foot where he found the water capable of a trickle, filled our buckets (useful for flushing when the water is out) and washed coffee dishes. Sonal and I attended cardiology clinic where we saw 19yo's with heart failure and atrial fibrillation treated with baby aspirin as warfarin therapy can't be safely monitored. Jeez.

OK, before the internet goes out again we're gonna do some quick research on adrenal insufficiency in TB and AIDS for a presentation on Thursday to our physician colleagues. Yup, that's certainly my personal specialty in Seattle! I'm so glad I'm here with a friend.

I feel OK sharing all these doubts and party-pooper attitudes with you, Dear Reader, mostly because I know this will get better and more encouraging. Thanks for letting me vent.

An update on the outdoor voices:

• The vocal goat lives in the yard just outside our window and rises early with the local roosters.
• The human voices are two and represent the monotheistic split of the region. There is 5 times daily call to Islamic prayer from the mosque down the street to the right and the aforementioned Christian fellow projected from the CD sales booth.

Here are your photos foreshadowed yesterday. And here's the hospital playground; note the awesome plywood teeter-totter. Smooches near and far!