Biblical Proportions

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It is the second day of work in Kaberamaido, Uganda. I am working with Dr. Bill and the other EMTs. We are stationed just outside the orphanage compound, and are serving the local village women.

I am kneeling next to an older patient, along with my translator, and asking her the standard questions. Name, Age, Chief Complaint, etc. I am also gathering a brief medical history having to do with TB, Malaria, and HIV/AIDs.

The patient in question appears to be a healthy one. It has been a refreshing surprise to Triage this woman, as there doesn't seem to be anything acutely wrong with her. She doesn't have any clinical signs of TB or pneumonia, and she isn't having a malaria attack. The only thing she is complaining of is vision loss, and given her age, it might just be due to getting older as opposed to some other medical cause.

I begin interviewing her on her vision loss. How long as it been going on, is it getting worse over time, is it all the time or just sometimes? She answers accordingly. I am writing down her answers when she begins speaking to the translator. The translator turns to me and says "She wants to know what she can do to improve her vision so that she can read the Bible again."

The pen in my hand freezes, and I am crushed with humility. I turn to her, speechless. Here is this woman, a woman who has walked for miles to see us, and the only thing she requests is the ability to read the Bible again. "I will do everything I can." I say.

Dr. Bill comes over and examines her. He wears reading glasses, and lets her try them on. Our translator pulls out a Bible from his back-pocket, apparently something he carries with him wherever he goes. Our patient breaks into a smile and begins reading quietly to herself. Dr. Bill asks if she can see, and she says yes. He vows to give her his glasses at the end of the day, when he's done working.

I make a note on her record so that we remember to find her at the end of the day.

I go home that night and read the Bible, and understand every single word.

First Patient

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It is the first morning in Kaberamaido. I have barely woken up when Jacquie walks into our room with a stethoscope around her neck. The EMS nerd in my wakes up, and I remember why we are here. I grab my stethoscope and pull on some scrubs, and I am ready.

I walk outside and greet the women who have congregated. There are the leaders of our trip and some new faces, women that live in the village and have just stopped by to say hello. The rest of the team begins to wake up and come outside, and everyone seems to be chatting about the rest of the day except for an older woman. It is beginning to get hot out, and I wonder why this woman is here, as it soon becomes clear that she is not part of our team.

Dr. Bill wakes up and comes outside. I walk inside to see what's for breakfast, and remember that I left my backpack on the porch. I go to retrieve it, and see Dr. Bill examining the mystery woman. Apparently, our first patient had arrived.

Dr. Bill and Jacquie brought her inside to examine her on the couch. The rest of us waited outside. Jacquie emerged and announced that this woman most likely had TB, and that her left lung was filled with fluid. She said that this would be a good teaching case, and all the EMTs should come inside and listen to her lungs.

And so, we did.

I walk up to the patient, who is now laying on our couch, chest exposed, surrounded by 6 or so collegiate EMTs. It strikes me as how awkward teaching hospitals must be for the patients, and I realize what a great sacrifice patients at teaching hospitals make in order to train the Doctors of tomorrow. Jacquie hands me her stethoscope and I take four-point lung sounds. The difference is clear, and amazing, if only from a clinical standpoint. It is unlike anything I've ever heard in the States, or anything I could have even thought possible.

I want to spend more time listening. I want to examine every second acoustically, to internalize it, to understand it, but the others are waiting for a turn and I feel badly for the patient, so I hand the scope back to Jacquie and go wash my hands.

It strikes me as odd, how casual this encounter has been. TB is so stigmatized in the States, especially to us healthcare providers. (With good reason, I suppose.) And here we were, first thing in the morning, with a TB patient worse then any one in the States for the last few decades, sitting on our couch. "She has a few months to live, if that." I think, while I turn the faucet and wait for the water to flow.

I wash my hands thoroughly. It's all I can do.

Malaria Attacks

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It is my first official day in Kaberamaido, Uganda, and the team has headed to the orphanage to meet the children. We arrive and are welcomed by a hundred or so faces, children lined up according to sex and age, all watching us with fascination laced with uncertainty.

We are introduced to the children's caretakers, formally called "matrons," and begin introducing ourselves to the children. We stumble a little, awkwardly speaking English to children we know cannot understand us, hoping for the slightest bit of connection and receiving none.

Regardless, we persevere. We take the children outside to play with the soccer balls some members of the team brought. I sing along and play a game when Jacquie, the medical teams leader comes out and requests an EMT. Stef follows Jacquie. I wait a few minutes to give them space, and then follow.

"Liz!" Jacquie declares as I enter the room. "Glad you're here, you can help Triage." I nod and grab some gloves. My heart pounds as I feel the eyes of the patients staring at me. Adrenaline courses through my veins. I get a piece of paper and a pen, and team up with Stef. Our translator is waiting for us to tell him what to do. The room is separated into three groups, Priority, Respiratory Distress, and Abdominal Pain. We decide to tackle the group closest to us, which happens to be Abdominal Pain.

I kneel down next to a young girl, and get the basics out of the way. Name, Age, Chief Complaint; severe abdominal pain. I get a set of lung sounds. Clear bilat. I ask if she's had a fever recently, she says yes. I ask if she has a fever now, she says yes. I ask if she's been coughing, she says yes. I ask her if she has to spit anything out when she coughs, she says yes. I ask what color is it? She says clear/whiteish. I make a mental note, "no blood." That means no TB. I ask her lie down so I can examine her. I unbutton her shirt and realize there's no need to palpate. I see a mass in the upper left quadrant of her abdomen, a huge swollen mountain erupting from her small body. I place a hand gently on it and test for rigidity, which of course is present. "Lit?" I ask, which means "Hurt?" in Kumahm. She nods yes. I tell her to button her shirt and let her sit up. I don't need to examine her further.

Stef finishes writing up the report and I bring it to Doctor F., the Emergency Physician we are traveling with. He stares in disbelief at the size of this young girls spleen, and sends her to the Priority group to wait for a van to the hospital with a tentative diagnosis of Malaria.

I move on to Triage the others. The questions are all the same. The answers vary, but I stay the same. I am a machine. Every patient is an equation, a question that can be answered through logic and a systematic algorithm of questions dictated by protocols that I have studied. I can feel the art of medicine and the logic pumping through my blood, as natural as the air I breathe. I am in control. In a world where HIV/AIDs runs rampant, where children are dying from treatable diseases like Malaria and Pneumonia, where diseases like Dysentery, diseases we eradicated in the USA decades ago, still exist, I am in control. I am focused and I am in charge. I am one with the universe and all who inhabit it. I am living, breathing, Medicine.

I am living, breathing, Art.