TGIF

May 20, 2016

Good evening friends,

I am in a very pensive mood right now… I just got off the computer “facetime audio” with my dearest friend Marianne.  It brought me back to the Canada I love, the friends that I miss – the healthcare system that I know.

It is Friday night.  I have finished my second cup of tea.  JF and I are relishing in a few quiet moments before going to bed.  The children seem to be high on life.  Spending entire afternoons chasing each other, playing with sticks and friends – they come home wild and can be slow to calm down.  Eventually, after wiping off the dirt and filling their stomachs they crash in there mosquito netted cabin – re-energizing for the next day.  It is really nice to see.

The work week is essentially done.  I round on surgical patients on the weekend, but am done in a few hours and there has not been much emergency surgery off hours.  I’m glad to have a bit of non-medical time.  I have had a few challenging cases again this week…

-       major extensive penile condylomas in a 30y.o. male (HIV+ recently diagnosed – CD4 count 316) – he had been treating them with podophylline for 2 years (? Hoping that they would go away).  There is nothing left of his glands and foreskin – just a 10cm rough, bleeding cawliflower

-       A 59 y.o.female who was diagnosed with multifocal breast cancer in July 2015 – she didn’t have the funds for chemotherapy and presents for advice +/- mastectomy today from Harare with a huge breast mass that extends to her clavicle and to her flank and lower abdomen.  She’s in pain, can’t walk, has liver metastasis and has been jaundice for 2 weeks.

-       We operated on the very frail bowel obstruction patient 30ish y.o. female on Tuesday (HIV + CD4 57) and found perforated small bowel loops stuck onto a large uterine mass.  So we excised the bowel and the uterus – leaving her with a temporary stoma.  I got a smile for the first time today.

-       Finally a 29 y.o  female (healthy, HIV negative) with an 8cm mass between rectum and vagina (biopsy showed a poorly differentiated cancer ? sarcoma).  Should Dr Thistle and I resect it next week? We have no imaging (other than US).  We are not surgical oncologists.  Is going ahead trying our best or potentially doing harm?  All exhausting existential questions…

And on top of that, I got roped into presenting grand rounds on wounds and dressing – so last night I dreamt of wound care nurses in Canada, dressing changes, Vacc dressings.  Sometimes, I think I am loosing my mind.

Writing things down is helpful.  Things somehow seem to make more sense when they have been said or are typed.  For this, I am grateful.  I long to put all of these experiences into a broader context.  What is in the cards for me as a surgeon who has a soft spot for international surgery?  But at the same time, I would really like the ability to live strictly in the now moment, to keep things simple, to cherish my short time here without over-analyzing.

So I will try to practice what I preach, and tell you about a funny moment before I say goodnight.  On Wednesday night, JF was invited to Dr Mumvura’s home (Zimbwean trained general physician – early 30s – lovely guy – huge smile) to watch the Europa league soccer final (Liverpool vs Sevilla).  I chose to go straight to sleep at 8:30pm.  JF came home at 11pm and made tons of noise.  Turns out that he had let a bat into our guesthouse and was frantically trying to get it out.  Ah ! the Zim reality we live in.

On that funny note (just picturing JF makes me chuckle), I wish you a restful weekend.  I am off to read my Murder Mystery novel. I will write soon,

xoxo

Michelle