Okay, okay!

Construction of the new hospital. Would you let your teenage children climb that wooden scaffolding?!

Today is a different beast altogether. "Today is a different beast." Not, "all together," you fools!

Elliott's kettle from the pan man made our coffee ceremony even better and Sonal and I caught a bejaj right up the street from the guest house after scoring some breakfast dabbo (bread). One of the interns gave an EXHAUSTIVE morning talk on mitral stenosis and regurgitation that was both informative and old-school text-book based, unlike the case-based presentations we're used to. We got coffee at the outside eating area at the hospital cafeteria (table service, hill-side breeze, yellow chirping birds, and the chance to ask them where they get their laundry done) then attended walk rounds in one of the male medical wards with 7 interns and a remarkable attending. This was my turn-around activity and I could feel it happen, feel my eyes widen and my curiosity engage. In the course of 14 patients we saw 3 with leishmaniasis (2 of those with concomitant TB), a 12yo with booming heart failure from rheumatic heart disease and intractable vomiting from digoxin toxicity (presumed as we can't get a blood level), a 15yo boy who stepped on some metal 2 weeks ago and came in during rounds with the lock-jaw, muscle stiffness, and full-body spasms of tetanus (that's a first for me), fulminant liver failure due to the double hit of disseminated tuberculosis and hepatitis B with a massively swollen belly full of ascites, stiff man syndrome vs. ankylosing spondylitis, unknown cause for disabling proximal muscle weakness. And holy physical exam findings, Batman! Our attending was so informed and such a formal and wonderful teacher that I felt completely liberated from any delusion that I am supposed to act like a true attending here. I see roles for myself and I also take my mother's reaction to yesterday's blog posting to heart: I am here not to be a savior but to do my job with kindness. I just had some yummy fasting shiro and we're off up the dusty path past construction to attend Type I Diabetes clinic with Dr. Shitaye. Their resources for monitoring diabetic control are so different than ours AND the epidemiology of this disease here is so different that I'm really curious to see what this clinic is like. Dr. Shitaye is a no-nonsense, practical woman who seems to kick ass and takes names while demanding high standards from her students. It'll be nice to see her in action in the clinic she started.

p.s. I had a very exciting dream about escaping from Nazi Germany with Elliott and I'd like to thank Dr. Elizabeth Hutchinson who provided invaluable advice on getting through customs undetected. We all made it.