End of Life?

It's the last day before my residency officially begins. I spent part of the morning relaxing in our new living room where the clutter of our recent move is less prominent. A cup of coffee, the last chapters of Tuesdays With Morrie and an unusually cool June breeze accompanied me on the couch. I didn't really know what this book was about when I picked it up the other week, sparing it from the boxes to which our other books were relegated. On the surface it is about dying, but really, it's about living. Although our "Western" (or American) culture attempts to divorce aging and death from the journey of life, the story of Morrie Schwartz calls for a counter-cultural view of life and death. I have always thought that a quick and painless death would be ideal, but Morrie's long ordeal with ALS gave him time to face death head on, reflecting on what his life had meant and, most importantly, living fully despite his physically crippling illness. His conversations with the author are a powerful challenge to live life thoughtfully, with love and purpose. Some see residency training, particularly intern year (that is, the first year), as a figurative end of life. I'm taking a more optimistic view, but check in with me in a few months.

Match

On Thursday I found out that I matched to the combined Emergency Medicine/Internal Medicine (EM/IM) residency at Christiana Care Health System in Delaware. Amy and I are now in the beginning stages of planning a move to Delaware! We will miss Baltimore, but are excited about what lies ahead.

Reflections Before Flying

Today is the day we leave Africa. In many ways it feels as though we've already left. Nonetheless we know we have not yet arrived at home. It remains to be seen how this experience has affected and changed us. Although we are very ready to be home, there is some apprehension about the transitions ahead. Perhaps that is a good sign, evidence that we were really here and engaged in life.

Leaving Macha seemed a bit unreal, as though, after a couple of days we'd surely find ourselves on a bumpy ride up the Macha road once more. Even though our time there was only about six weeks we had grown used to being there. As we were preparing to leave many friends asked us when we would be coming back. One friend taught us a Tonga phrase appropriate for this transition: "Akabwenene taabuli kuswangana." Loosely it means, "Those we have met we will meet again."

The Match

Match Day is one week away! It's amazing how much seems to hang on just one day and how great the anticipation can be. I will certainly not miss having this question mark looming overhead.

What's in a Name?

Tonight we had dinner at the MIAM cafeteria and got into a discussion about local names. Some of our favorites have been: Hairness, Loveness, Sameness etc. I've always liked my name and checking my email after dinner I found out that I will actually be allowed to have it printed on my med school diploma. Apparently there was a policy against first initials on diplomas (not middle initials). But now, after several trans-Atlantic emails and "a lot of deliberation and several conversations with other campuses around the system" the policy is (apparently) a thing of the past. It will read: J. Daniel Hess.

Tired on Saturday

Lying down on a Saturday afternoon
Distant singing wafts into the open window
On the tail of a wasp looking for a new home
Alongside the broken-record calling of African doves
And chirping song of winged others
From the trees beneath which children giggle.
There is also the far off horn of a truck honking
Someone riding by on a bicycle or walking by on foot
And the memory of last night's rain on the roof
Which dropped two inches in an hour and carried me
Off to sleep.

Daily Life in Macha

Perhaps you're wondering what our our life is like day to day in Macha. To help with the illustration, we've included some of the differences in everyday terminology below. We both report to work at 7:30 in the morning. Amy rides her borrowed pink bicycle to school about 10 minutes away (20-30 by foot) and Dan walks 5 minutes to the hospital.

Amy's day at MICS begins with a staff prayer meeting before the students arrive. This is followed by a chapel service with all the students and staff and then classes are underway by 8. There are six grades at MICS - Reception (Kindergarten) through grade 5. Amy teaches sewing (FACS!) to each grade and language arts (spelling & phonics) to grade 3. She also helps with library and art on Thursdays and Fridays. From 12 - 1 she has some planning time, but she's found she often has planning to do at home too. Her school day is over at 13hrs (that is, 1pm).

Dan's day starts with a morning report of sorts with the other students, physicians and medical officers. Then it's off to round on the wards where you're assigned (Maternity, Paediatrics, Male, Female). On Tuesdays and Fridays, rounds are brief and problem focused allowing time to get to the operating theatre (that is, the OR) for the bulk of the morning. There the "major room" is kept busy with exploratory laparotomies, bilateral tubal ligations, hernia repairs, etc, while the two minor rooms are a flurry of dressing changes, wound debridement, incision & drainage, dilation & currettage, casting, etc.

By 11am much of the cases are finished and some of us head off to the Outpatient Department (OPD) to see patients there (OPD is open daily at 11 except for Sunday). If all goes well we can break for lunch at around 13hrs and resume our duties in OPD at 15hrs (3pm) working until there are no more patients to be seen (usually not too much later than 17hrs). If there are other things to take care of on the wards, then the late morning or afternoon is a good time to get that done, OPD will go on without you. Saturdays start with rounds at 8 and are followed by OPD until lunchtime (i.e. whenever all the patients are seen).

Lunch, of late, has been nsima (the Tonga word for cooked maize mealie meal) and relish (sides of veggies or meat). We've hired a local woman to help with some things around the house, namely lunch prep and some laundry here and there. After lunch Dan heads back to OPD while Amy rests from her tiring day (or plans for up-coming lessons), or goes to buy bread, eggs or vegetables from a shop or the market. She can also sometimes be found at the local library - a small library housed inside a large shipping container.

There used to be four med students here, so we established a Q4 (every fourth day) call schedule. Now there are just three of us, but we've kept the schedule. We have a cell phone that gets passed around so that we can be reached if necessary. Being on call means helping the main person on call with evening rounds at 20hrs (again problem focused) and being available if anything (e.g. a C-section) comes up overnight. Sundays the on-call folks make morning and evening rounds and take care of anything urgent in between.

After "knocking off" (finishing) at work the evenings are our own. They are usually filled with cooking, reading, watching a borrowed movie or perhaps visiting some others in the area.