I left the Angau hospital today, and I took the emergency department home with me. It’s been a while since I have done that. When I finished residency, I was at the top of my game, armed with 9 years of training, and an armamentarium of medical knowledge. Then my life shifted…from one day to the next I was not a resident anymore…I was the staff, the attending, the consultant… the one that residents and medical students would turn to if they had any problems. For the first few months, the responsibility and the stress of the ER would filter into my daily life. But one day the feeling was gone, and as I’d leave the ER, the internal dialogue would whoosh away as I walked past the security guard, the paramedics lined up in the hallway waiting to be triaged, and the patients waiting to be seen.
But today was different. Today, I took the ER home with me again.
I was showing the emergency department to Leslie and Rob at the end of my shift, when a man holding a floppy baby walks into the room. He is dazed with panic and looks around in confusion, taking a step first in one direction and then another. No real purpose to his steps except to find someone that would help his baby in the midst of the chaos. I notice him, and direct him to the “resuscitation” room, where there is only one stretcher. It’s occupied. I ask the woman to sit next to the stretcher with her IV pole, and lay the child on the bare metallic surface. There are no blankets.
“How old is she?”
I am not sure what’s different. I am finding it difficult to find my place in the chaos around me. I am trying to wrap my mind around the fact that Angau hospital is a “referral” center and that there are tons of people in the periphery that get no healthcare at all. It also happens to be “the best” hospital in PNG.
Her little body is under the spell of spasms, her eyes closed. Her heart is thumping in her chest, holding on.
What is different is I am trying to erase the image of the 30-something-year-old women’s breast eaten up by her cancer, and knowing that she has no chance in this healthcare system. No chance either for the 30-year-old man with a broken neck whose quadriplegia is a tragedy anywhere, but here it sentences him to isolation from life as he knows it.
We start an IV on her and give her a bolus of fluid while I ask here father a few questions. Fever. Decreased level of consciousness. Vomiting. Spasms. Meningitis? Cerebral malaria? We bolus her with anti-malarials, antibiotics, diazepam and give her more fluids. Then we wait.
What is different is the gush of mixed emotions that rushes from my heart to my head when the medical student, giggling nervously, translates the story of the 30 year old woman that had a stick stuck up her vagina by her husband in order to terminate an unwanted pregnancy.
I went home waiting.
Back in the ED, the morning sun is steaming the nightly rain. Stethoscope around my neck, pen in hand, I turn around and there she is, looking up at the “white mary doctor” with her dark brown eyes, holding a cookie with her 3 year old hands, her curly brown/bleached-by-the-sun hair making her irresistibly cute. We keep looking at each other, and I smile. Shyness tilts her head down but her gaze does not let go of mine. “White mary doctor” is a novelty to her...and she a gust of relief to me.