Day ... 5ish

This weekend was overall pretty quiet.  I already told you about our patient we enrolled and all the files that kept me busy.  Sunday I woke up and went for a jog … or a jog/walk.  I originally thought the elevation was the same as Charlottesville, but it’s actually a little higher than Denver!  So I don’t feel quite so bad about huffing and puffing on the road.  When I got home I flipped on our little hot water tank for a shower, but nothing happened.  The power was out, which is not unusual.  However, it wound up staying out for about 6 hours.  I did some research work until my computer battery ran low, and then I spied Harry Potter and the Sorcerer’s Stone on our coffee table.  I have never read Harry Potter, nor have I watched the movies.  I’ve never really thought I was missing out on anything, but whenever people would hear that they would be aghast.  So I thought – it’s cloudy, the power is out, why not?  A few short hours later, I was three chapters away from finishing the book!  It is so good and I have no idea how I’ve missed out on it this long!  I actually googled bookstores in Mbarara to see if I might be able to find the rest of the series before I leave.  Turns out that probably won’t be the case.

After the book fest, I headed down the street to Café Ark, which was a frequent hangout of mine and Anem’s last year.  They have decent food, good coffee, and free wi-fi – which is always a winning combination.  I was a little sad to see they replaced their incandescent bulbs with ones that glowed blue, red and green.  I also noted each item on the menu was a few thousand shillings more than it was last year (it’s a sign youre in Uganda when you think a $5 dinner is too expensive).  But, I needed to do some research work and had been craving some protein all week, so I went for it.  I had fish and chips and started writing the manuscript for research project #2.  After that Emily got home so we visited a while and then went to bed.

And by saying “went to bed”, I actually mean I laid awake in bed until 2am.  I guess that was jet lag?  I’m really not sure – I just wasn’t tired at all.  So I listened to the birds, the trucks hitting the speed bump, listened to my downstairs neighbor snore through the floor, did some board study questions, and finally fell asleep.  7am came awfully early and I made my Starbucks Via instant coffee a little stronger than I usually do (yes, I brought coffee with me from home).  Breakfast was crispy toast with avocado, and passion fruit on the side.  I read through a couple quick pages of Harry Potter while waiting for my shower to warm up, then after getting ready headed to the hospital. 

Let me tell you what going to the hospital is like:

I exit my flat on the third floor and go down the ceramic tile stairs.  There is one step that is a bit taller than all the rest, and I almost trip every morning, and then I laugh at myself.  At the first floor, there are always at least 100 bees stuck to the side of the building.  I have no idea what they’re doing, but by afternoon they are always gone.  I pass the clotheslines with everyone’s laundry, then turn right by the tree with the Maribou storks perched on top and head by the other houses in the compound toward the rock/dirt path that leads across the street to the hospital.  Just before reaching the gate to busy Mbarara road, I usually greet the attendant who’s sitting outside in his blue uniform.  Sometimes he’s holding a mug of tea, sometimes a notebook, sometimes a rifle.  It depends on the day.  Once at the gate I can see the busy street (though I can hear it from sitting right here in my flat as I type this).  I walk down a few steep stairs (watching for fire ants as they cross there frequently) and then have to make the choice of crossing the road on foot or taking the pedestrian bridge up above the street.  I generally choose the bridge, as crossing the road is a bit like playing frogger.  The bridge is bright yellow and covered in Bell (beer) advertisements.  Given the altitude, I am usually short of breath by the time I walk the three flights to the top, but am subsequently rewarded by a beautiful view of the city while hearing all the honking and cars crashing over speed bumps below.  I cross down the other side and pass by the boda (motorcycle) drivers and the guy selling cell phone minutes and proceed a few feet more toward the hospital gate.   There are at least two guards there, both wearing those blue uniforms and with rifles (which they usually keep inside their guard house).  I smile and they give a friendly nod.  Then there’s a left turn onto the hospital grounds.  There are usually at least 6 storks walking around the entrance courtyard.  They are always eating trash carried over from behind the hospital, and the associated smell is a nice welcome to your work-day.  I tried to go up to a stork yesterday to get a closer look (they are so ugly, bless their hearts) but then it started flapping its wings at me and I got nervous).  A few paces past the storks on the left toward the road is an abandoned sink with grass growing through it.  I’m not sure how long it’s been there but don’t remember it from last year.  Then there’s a water ditch to hop while dodging folks throwing out hospital laundry water without looking first, pass under an avocado tree, down a ramp and you’re at the hospital buildings!

The hospital grounds are somewhat quiet in the mornings and rev up by mid-day.  All the patients’ attendants have the bedsheets hung up on trees to dry from washing the previous day.  Sometimes there’s a baby getting a bath outside, and I generally pass a few attendants who are very interested in seeing this pale muzungu go by.  Past the first building I take a left turn past the “free circumcision” sign, up the small hill to the ISS (HIV) clinic, and up the stairs to lecture!

Well that was tiring typing all that.  I’ll share the rest of the day next time, maybe!

Day 3

Yesterday was Friday.  After morning lecture and post-take rounds, there were regular rounds.  Wards are broken up into male and female, and each ward is just a big open room with beds on each side of the room.  One side is called road (closest to the road) and the other river (closest to the river).  I was on river side, and the most exciting part of rounds was a physical exam finding I had never experienced.  While writing in the chart, Amir asked me to listen to a patient’s heart sounds as he wasn’t sure what he heard.  I put my stethoscope on her chest and I heard, “squeak squeak squeak”.  I kind of half smiled to Amir and then after enjoying the three different sounds kind of like bare feet walking in the sand, I told Amir it was a pericardial friction rub.  Cool!  That means there is something in the sack around the heart, and when the heart beats it rubs against that substance and makes a squeaking sound.  New physical exam findings make me feel a little weird, because I first get really excited about it and then sad because it generally means something bad for the patient to me to hear/see/feel something new.  This patient has HIV and lumps on her belly, for which a biopsy was concerning for lymphoma.  So it may be cancer cells causing that squeaking in her heart.

After rounds we had a quick lunch, and then I walked back up to the wards to do an optional make-shift chest X-ray talk with the medical students.  I got there right on time, and to my surprise the room was packed – despite everyone usually being late on “Uganda time”.  Fortunately I have saved some interesting chest X-rays throughout residency and put them in a PowerPoint file.  I had all the students gather round my laptop while I went through the methods of interpreting normal chest x-rays, then had them interpret abnormal ones for me.  They did so well!  AND no one fell asleep after an hour in a stuffy room!  That was probably the best compliment of all.

After that lecture it was time to head home with a giant box of files to pour over for my research project.  I have two projects going on currently, so let’s just call this project #1.  Last year when I was here, Amir and I co-wrote up this project with the help of my research mentor, Chris.  Here’s the basic premise: lots of people come to this hospital very sick with sepsis (infection).  The % of people who die within 30-days of their hospitalization for sepsis is about 60%, based off my research project #2.  There are very limited resources as you can imagine, and sometimes it’s hard to tell if you’ve treated someone well enough as you can’t necessarily re-check labs or even take vital signs very frequently.  So we have a hand-held machine that checks something called lactic acid.  This is made when your tissues don’t get enough blood flow/oxygen, which happens in sepsis.  We are trying to see if patients who decrease their lactic acid concentration in 6 hours go on to have lower mortality rates.  If so, the theory would be that once someone’s lactate decreases then you know it’s safe to send them from the emergency room (closer monitoring) to the regular ward (basically no monitoring).

Today I woke up, and after mopping up the flood in my apartment from last night’s rain, I started going through the 120 files of patients that have already been enrolled in the study.   At this point I am checking the already entered data for accuracy.  As I go through it’s almost like a book or movie, that I see how old the patient is, where they’re from, etc.  Then what their complaints are, what their vitals and labs are, and then I start to get nervous because as I flip the next page I find out whether they died or not.  The amount that die is shocking.  Just as I was starting to get a little depressed, Amir called me that there was a patient who was willing to be enrolled in our study at the hospital.  So I ran across the street and worked with Amir to enroll her and then ship her over to the emergency ward.  I’ll be back in 6 hours to see what that follow-up lactic acid is.  It’s kind of a neat process!

After that I decided to go for a little jog.  It was tough!  It’s really humid with the rainy season and there are a lot of hills around.  I’d also like to blame altitude but I’m not sure Mbarara is really much higher than C’ville.  After cooling off and showering I’m back to my files now, and then planning on making some swiss chard I bought from a guy named John on a motorcycle!!  Pretty excited about that.

Day 2

This morning I woke up at 645 and while waiting for the shower water heater to warm up made some coffee and avocado toast. Last year I hated “showering” because you had to basically just sit in the tub and splash water over yourself with a hand-held sprayer.  Not very effective for rinsing shampoo from the hair!  So when I got to our apartment, I was thrilled to see Emily had rigged up a “shower head” with that sprayer, a broomstick, and some twine.  It worked beautifully this morning and it was good to feel clean!  I went to lecture, followed by rounds, followed by more rounds.  No surprises here, but I saw two things immediately that I’ve never seen back home: HSV vasculitis with ischemic strokes (inflammation of blood vessels in the brain from herpes resulting in strokes), and a poor woman with frankly hemorrhagic ascites (she has cancer in her belly making fluid and bleeding which accumulates in the belly to make her look pregnant. 

The new third year medical students have started wards and were just as fresh/scared as UVAs third year students.  I went over a few things with them on rounds and then got recruited to teach a chest X-ray conference tomorrow.  After rounds (about 8 hours since I had eaten breakfast …) I headed to the hospital canteen with my research buddy, Amir, to plan our project over ground nut stew and rice. 

Unfortunately (fortunately?) there were no patients with sepsis at the hospital today to enroll in our study, so I took the afternoon to do some much needed tasks.  This included walking downtown about a mile to get a new SIM card for my iPhone to make it a Ugandan phone.  UVA is piloting a GPS-like app that tracks me wherever I go in Uganda in case of terrorism, etc.  It’s a little odd knowing you’re being watched, but it makes my mom feel better – so that’s good I guess!  And, of course, no trip to “town” would be complete without going to the farmers market.   Even though it’s not passion fruit season, I was able to score a few anyway, and left with more than I really came for (which is usually what happens at the C’ville market too).  I walked home amidst friendly calls of “hey muzungu!” and came home to make some spaghetti sauce from my market produce.  We are currently cooking on a gas tank with a flame, so I burnt the onions in the sauce, but it was still pretty decent!

Now after catching up on some work email and life tasks, I think it’s about time for bed!

Day 1

I’ve made it to Uganda!  It was quite the long trip, but it was overall good.  I was a little nervous about making the journey alone, so it was a pleasant surprise to find one of the UVA radiology attendings waiting at the terminal in Dulles when I got there.  We were on the same flight to Frankfurt, but afterward she was heading to Singapore.  And speaking of flights!  This was my first time to fly Lufthansa, and boy was I pleased!  First of all, the plain had stairs in it.  Apparently all 747s do, but that was the first time I flew in one and it was pretty wild!  I somehow got lucky enough to have a whole row to myself, my in-flight meal actually had flavor, and they had Nickel Creek albums on the in-flight entertainment system.  Can’t beat that.  I even took a pretty good nap, thanks to melatonin pills and a complimentary glass of wine with dinner.

The Frankfurt airport is pretty huge, but I made it through with a couple hours to spare before my connecting flight.  The second flight was to Addis Ababa, Ethiopia, by way of a stop in Jeddah, Saudi Arabia.  It took me a while to figure it out, but Jeddah is next door to Mecca, which explained why there were a lot of men in white sheets on the plane – they were making pilgrimage.  In stark contrast, next to me while waiting on the flight to board was a group of young 20-somethings traveling on holiday and drinking liquor straight out of a bottle … in the airport?!  Wild.  This flight was a little more crowded, and I wound up sitting next to this great couple (he was German, she was Ethiopian, and they had a super cool 4 year old with them) who actually used to live in Uganda and export flowers to the United States.  Chances are if you bought a poinsettia over the past few years, it may have come from their farm.  It was nice chatting with them and sharing Uganda stories.  The stop over in Saudia Arabia was interesting.  The flight attendings gave a warning that there were “strict rules” in the country, and they weren’t responsible for what would happen if you took alcohol or any magazine with any hint of nudity off the plane.  I tried to get a peek out the window, but all I could see was sand.  Once we took off again to Addis the plane had emptied out and I had a whole row to stretch out in and immediately fall asleep.

Each airport I went through got progressively more disorganized.  Once landed in Ethiopia, I couldn’t find my connecting flight on any of the monitors in the airport.  Somewhat panicked because I knew I didn’t have much time, I just sort of followed everyone else who looked like they might be making a connection.  Meanwhile the inside of the airport looked like a busy street with clothing vendors, and people cooking food right out on the walkway.  I wish I could have had the time to stay and sample some stuff!  I had to get re-screened through security and made it down to the “gate”, which was really just a giant open room with a lot of doors leading out to different planes.  I found an employee who said I was in the right place.  Unfortunately the news was on and that’s when I saw the story of the Lufthansa plane that crashed in the Alps.  So sad.  Then I realized my family might be panicked and tried to pick up wi-fi to contact them without luck.  Then my flight was called and half the people in the giant room moved in a big glob toward the door.  In a rather inefficient way I made it out onto the tarmac and to my plane.  Of course, after seeing those news clips, it was one of the most turbulent plane rides I’ve ever had.  But, the food was good!  I was able to freshen up in the tiny airplane bathroom before we landed.

At the Entebbe airport everyone again moved as a glob toward the entrance door, and we were all greeted by people spraying hand sanitizer all over the place.  You couldn’t get in without being sanitized, and then it was time to make it over to customs.  I had to fill out a form to state that I (a) didn’t have a fever,  (b) wasn’t bleeding from any orifice inappropriately, (3) hadn’t been to West Africa, etc etc.  Then when I made it through that line there was a thermometer waiting to check my temperature.  Thankfully, I passed, and then made my way over to the visa counter.  I always get a bit nervous when I check bags, and say a silent prayer for every miraculous time when they come out on that conveyer belt relatively unscathed.  I headed to the door and met my motel pick-up guy named Steve, and we were off into the city!

I woke up today after a surprisingly refreshing 4 hours of sleep in the Sunset Entebbe Hotel, and took what I figured would be my last real stand-up shower of the trip.  They had a real fancy shower head installed, but unfortunately not much water pressure, so the shower took way longer than anticipated.  But it felt so good to freshen up!  After re-packing a few things I went out on the patio for breakfast.  The Ugandan hospitality was just as I remembered.  As I was marmalade-ing my toast and pouring some coffee that hadn’t yet been tainted with milk (thank you, Lord!) one of the workers came up and asked me if I wanted an omelet!  Well of course I did!  Interestingly he brought it out and it was white instead of yellow, and I also noticed a hard boiled egg with a white yolk.  I’m not sure what that means, but all the same it tasted fine!  I had my breakfast while looking over some palm trees listening to the birds sing.  Not a bad start to the month!

My “driver” came soon thereafter to take me to Mbarara.  The roads were still full of potholes, but this time since the rainy season started yesterday, also full of mud!  That made for an interesting trip.  Halfway through we stopped to meet a physician named Martin at a roadside stand (directions were: tell your driver to meet me just past Lukaya at the junction in the road to Masaka).  My research mentor and I hope to collaborate with him on a project while I am here, so I was getting the details on if I think that is possible or not.  I will probably head over to Masaka for a few days next week to try and work things out.

On the second half of the journey jet lag started to set in a bit.  It was nice to see some familiar things along the way that jogged my memory from last time, but after a while it lulled me into an accidental nap!  I didn’t sleep too long, and the rest of the time my driver and I had lots of stimulating conversation on everything from why a lot of Ugandan children don’t go to school, to his theory on how HIV spreads so quickly.

Once we arrived I was welcomed into my “flat”, which I’ll be sharing with Emily, a UVA graduate heading to med school in  year or so.  She’s living here for 2 years and working on some research.  We’ll be roommates the whole time, and then another of my co-residents, Christina, will be joining us sometime next week.  We’re on the top floor of an apartment building which looks out over part of the city … as well as over a speed bump.  You may have heard me complain about this speed bump last year when I was here.  But this time I came prepared … with earplugs!

After getting unpacked I walked to the Golf Course Supermarket to pick up some avocados (YESSSSSSSSS) and some other things for breakfast and dinner for the week.  And in an hour or so I’ll be heading to the hospital for evening rounds!  

Enjoying Spring before the trip!

Stuart rode the train down this weekend so we could spend some time together prior to me leaving.  I had a short work day on Saturday, and the weather was perfect, so we decided to drive out to a couple of vineyards we had never visited before.  The first was Prince Michel and ... well ... we won't be back to that one.  I almost spit out every glass of wine we tasted!  Then we went onward to DuCard.  We wanted to visit there for memory sake as we drove by it every time we took the drive from Charlottesville to Pittsburgh.  The views there were really nice, and the wine was much better!  The company was pretty good too.

Sandals!  Finally!

I guess the vineyard workers were out early that day.

After our trip we cooked some dinner and I started packing.  I also started freaking out a little bit.  If you know me, you know I tend to be a bit ... ahem ... anal and obsessive about some things - particularly packing for a long trip.  Last time I went I had a couple weeks to really think about what I needed and what I didn't.  This time since I was on the wards I only had one or two days.  Stuart had to talk me down and take me on a walk or two during the packing process, but I think I've got everything covered!  Hopefully I don't get stopped for drug smuggling as I have a pill bottle for just about everything that could happen while I'm there!  Unfortunately Winson has learned what suitcases mean, so he was also panicking a little bit while the packing was going on,  My friend Hayes is nice enough to keep him for the month.  I'll miss the little guy!

Stuart is at work today and I'm organizing my bags and thoughts the last few hours before I leave!  It'll be a long haul from DC --> Frankfurt --> Addis Ababa --> Entebbe --> Mbarara, but I'm excited!  If you dont mind, say a prayer for my safety!

A long winter's post

Today was a really nice spring day!  I was lucky enough to get off work early, and when I came home Winston and I went on a 4-mile jog.  We ran into one of my attendings, which is always good when you’re sweaty and beet-red.  But we also ran into dozens more people using the trail we were on: walking, running, biking.  There’s always a sizzle in the air during spring in C’ville – you can feel how much people have been itching to get outside for the past few months.  I’m going to miss this place!

It’s been a cold, and somewhat stressful/busy, winter.  I really shouldn’t complain about the stress too much because a lot of great things have happened too!  Here’s a quick life update for you:

1.     1.    Stuart is loving his job, and he’s been busy traveling all over the place for it!  He just got back from Houston this week in time to run a half-marathon.  Before that he was in El Salvador, though for a mission trip digging water wells rather than for work.  But his “gas skills” as I call them definitely assisted him in that work!  He’ll be off to Colorado in another couple of weeks, followed by Savannah.  I’m pretty proud of him!

2.      2.   I’m packing my big suitcase, because I’m leaving for Uganda next Monday!  I hesitate to speak too soon, since you likely know that the last trip in September was thwarted by terrorists in the nation’s capital of Kampala.  Good Lord willing, the news will stay quiet and I will be flying out of DC Monday evening.  I’ll be there for a month, working in the hospital as well as being a busy bee with two research projects.  I will also plan on eating avocados and passion fruit until I explode.

3.      3.   I GOT A JOB!  Probably the most exciting news of all!  I also didn’t want to “speak too soon” about this until everything was written in stone, but since I’ve signed a contract and gotten an email with future vacation requests, I figure it’s safe!  I will be at Georgetown University Hospital in DC and technically have two official titles.  One is “assistant professor of internal medicine”, which means I get to teach medical students and residents (!!!) and the other is “hospitalist” meaning I will only work on the hospital wards and never in the clinic.  God’s sovereignty is apparent yet again in our lives with this job.  I’ve changed my mind a few times along the way about career plans, but ultimately decided that (1) I love being in the hospital with very sick patients, and (2) I love teaching and “coaching” medical students and residents into becoming better doctors.  This will let me fulfill both of those passions, and I’ll get paid at the same time!  Can’t complain about that.  My father-in-law just alerted me to the fact that my current and future employer are in March Madness.  Too bad I’m not a basketball fan …

4.       4.  We were going to buy a house … but then we didn’t.  After my job was semi-official we started looking for houses.  “Being ready to be settled” is an understatement, and Stuart and I kept busy scouring the market for the perfect house to re-start living together in.  Unfortunately the DC real estate market is … well … kind of insane.  We quickly found out what bidding wars were, and once our “perfect house” went for 100K over asking price?  Well, we decided to rent for a while. 

5.     

5        5.   I’ve been baking a lot of pies.  Not sure why, but I got on a kick to make the perfect pie crust.  I still haven’t succeeded, but my colleagues have gained a lot of weight!

Until next time … I’ll probably be blogging from Uganda!

New Years Oyster Roast

Stuart rode the Amtrak into town for New Year's Eve.  It was a night of MSU football, but being as he was a bit upset with the Bulldogs toward the end of their season (and because I asked to go on a date), we forfeited the television and headed downtown for a nice dinner out.  We went to a Japanese/Sushi place called Ten.  It's supposedly frequented by the C'ville famous, but instead it was just us and a bunch of half-dressed gals out for the new year.  The food though, was fantastic.  We had everything from avocado tempura to wagyu beef rolls (cooked of course).  After we got home we decided to be festive and watch the NYE celebration on TV, and made it all 'til 1030pm and fell asleep.

On New Years Day our friend Will, a fine Southern boy, threw an oyster roast.  Now I love a good social event involving food, but am unsure about those slimy bivalves.  But since January is right in the midst of oyster season, and you can pick up these guys nearby, I thought I would give it a try.  Stuart has always loved oysters, and I have to say I'm surprised that I enjoyed them right along with him!  It was called a roast but they were more of steamed I guess you'd say.  Given that you cook a lot at once, you can imagine some are almost raw and some are more done.  I liked them most somewhere in between, where just a nudge would slip it out of the shell and onto your cracker.

A lot of people came to the occasion, fortunately mostly doctors and nurses, as it turned out shucking oysters is pretty difficult and you can cut yourself pretty bad!  I think Stuart and I may have to fashion us an oyster shucking/crawfish and shrimp peeling table for future shindigs!

Steve, already with an injured wrist, gives shucking a try

Oops!  Oyster 1, Josh 0

An iPhone really can be used for about anything; here it doubles as a flashlight to check the doneness of the oysters

Will dumping out the steaming shells