Ward Days

It’s Monday night, which means I’ve been here for over a week now, and so far, so good! I’m finally over jetlag, which is awesome! It feels good to sleep through the night. The research study I’m doing hasn’t been approved by the local IRB, so I haven’t started it yet, but I’ve settled into an everyday routine. We work everyday except Wednesdays and Saturdays. I wake up around 6-6:30 (we’re 13 hours ahead), check emails, and make breakfast (with ingredients bought at the local Saleways supermarket! Got some Lays lime and masala chips yesterday!) which has generally been eggs over toast and a cup of instant Nescafe with milk (probably one of the only things I miss is coffee…and chocolate—I’m definitely withdrawing).

At 7:40, Liz, Veena, and I walk to Patan, which is about 15 min away.  Liz and Veena are awesome. They are the Stanford peds residents who are here and I wouldn’t survive the day without them, as Veena speaks Hindi, which has some overlap with Nepali, and translates. Both of them are great teachers, but since Veena and I arrived on the same day, and we’re on the same team, she’s been my primary teacher and I’ve been learning a ton. The kids are precious! I’m so going to miss pediatrics.

Two of my Favorites!

But back to my routine. On most days, we have morning report from 8-9, but general grand rounds (combined surgery, pediatrics, and medicine) is on Friday and we also have a peds lecture one morning a week. The residents all arrive at 8 along with us (crazy huh? And unless they are on call they are usually out by 3:30pm. VERY different from our hours back home). From 9-10 we pre-round, which means we see how the patient did overnight, assess the data, examine the patient, and come up with our assessment and plan for the day. What Veena and I do during this time is jot down notes about our 18 patients, just so we can keep track of them. Since we don’t speak the language, we can’t round on the patients, which is disappointing, but there is nothing much we can do about it. I’ve already seen so much pathology we don’t see back home such as enteric fever, mumps, constrictive pericarditis, and even a newborn with Coarctation of the Aorta. There is also a super sad case of failure to thrive. My heart breaks every time I look at her.

Autoclaved paper = sterile field

Rounds end by 11, but by then OPD (outpatient clinic) has started, so we head there after rounds. Some children are so sick by the time they come to OPD; these are admitted directly to the wards or NICU/PICU. When we first arrived the ICUs were closed due to a Klebsiella outbreak. OPD is usually done by 12:30 usually and we head to lunch in the hospital or to a nearby restaurant (gasp! we'd never @ home) with the residents. At 1 there is usually a lecture, but sometimes not. When there is not, there is a long lunch break. By 2, we are back on the wards for quick afternoon rounds. There is also afternoon OPD after pm rounds, so I sometimes head there after.

Neeva, me, and Liz

Shilpa and Veena

Today was a great day. Veena and I glued ourselves to Shilpa and Neeva, the resident and intern on call, and took care of a baby who was on her way to respiratory failure. We saw her in the ED looking like crap (never seen retractions or heard grunting like she had) and in the 15 min period it took us to get her upstairs, she had almost tired out. The baby needed immediate respiratory support. We would’ve put her on CPAP back home, but Shilpa explained that here they look at the family (to determine SES) and decide whether they have enough money for what sometimes is necessary treatment. Apparently this family didn’t. Thankfully, the baby responded to the cheap alternative--bubble CPAP via nasal cannula.

Note the year!

I know, I’ve written so much about medicine, but that’s the reason I’m here. I’ll write soon about living in Patan, our daytrips, and the food here (also about the coalescence of Hinduism and Buddhism which is quite interesting)! By the way, the Nepali calendar is way different so it was recently my birthday here and in 2 weeks we’re celebrating the New Year! How exciting to be here for that. Also, I went to mass on Palm Sunday and met this awesome Mexican couple from Monterrey! More details later. Namaste. PS: I ask the parents for permission before taking an photos.