Before coming to Zimbabwe I had been warned that many of the patients I was going to see would die. These words intimidated me, but after five weeks I have yet to be stared in the face by death. Instead, patients disappear from their beds. The man from Ward C8 that spoke no English and only wanted to lay on his right side was simply not there one morning. The woman with labored breathing and severely decompensated heart failure; her bed was empty the next day. So was the bed of the woman with Kaposi Sarcoma on her vocal cords and that of the very skinny man with a history of strokes and HIV. One morning, they were just gone and new patients shortly took their places. For the number of patients that have died in the wards, I feel like we have seen just as many discharged. In the ICU, however, the ratio does not seem to be quite as even. The man with tetanus, the woman with goiter, and the girl with the necrotic uterus…all three disappeared, leaving behind empty beds. Many of these patients seemed to be stable or improving. Staff are not fazed by losing patients, and it seems to be dealt with very subtly. This speaks to the normalcy of death in the hospital. I think it would be a difficult adjustment to work in a system in which there is often very little that can be done for someone who is really sick besides accepting the fact that they are most likely going to die.
However, this week, what stood out to me most was a patient from the neurology clinic. The patient was a thirty-two-year-old mother of two, separated from her husband and unemployed. She presented with progressive chorea of her shoulders and arms, and some short term memory loss. The patient’s aunt was with her and explained the patient’s history of worsening symptoms. When the patient was asked to describe the problem, her answer was simply “my shoulders,” and when asked to, she was unable to remember a series of four numbers. Through discussion, it was discovered that her father and uncle had both experienced something similar which continued to worsen, eventually leading to their deaths. With the patient’s symptoms and family history, everyone’s thoughts jumped to Huntington’s Disease.
And right there, my mind stopped. The idea that this woman, at the young age of thirty-two, had already begun an irreversible, steady decline was hard to grasp. Huntington’s is something I have read and learned about. I know that it is inherited in an autosomal dominant manner and that the length of the trinucleotide repeat correlates to how early and severely the disease presents. But knowledge of the disease is very different from comprehending how it affects a person. To actually observe a patient facing this death sentence was emotional. As the doctors began discussing how to make a formal diagnosis, whether genetic testing would be useful and for whom, and how to best inform the family, I was stuck thinking about this woman’s children and what their future holds. I also thought about the patient’s mother who already had to watch her husband suffer from this terrible disease and now is most likely going to have to face it again. And finally, my thoughts landed on the patient and what lies ahead for her. Honestly, I cannot imagine what her experience must be like.
In other news, so far the third and final set of attendings have been awesome. Their fresh energy has been much appreciated and needed, as well as their interest in spending time with us outside the hospital. For dinner earlier in the week, we all gathered at Dr. Oltikar’s apartment. During much of the evening, I sat back and listened to an interesting conversation about medicine and the differences in systems throughout the world. Conversations like this are always enlightening as there is so much I don’t know.
What stood out most to me was the statement, “Before you can connect with a patient as their doctor, you need to connect to them as a person first,” which was then modified to emphasize that this is especially the case if one wants to be a good doctor. This thought touched me because it demonstrates that the human element of medicine still exists. No matter what technology is invented, the number of patients that need to be seen or the amount of paperwork there is to complete, good doctors make the effort to connect with their patients. This human connection is part of what drew me to medicine. It was incredible to hear that even in our system in which testing and imaging play the lead role, this element has not completely disappeared.