All in a day's work

Meals eaten in the last 48 hours: 2.
Sleep in the last 48 hours: 13. (3 + 10)
Self-medication (opiates! wheee!): lost count.
Dead people seen: lost count.
Open heart surgeries witnessed: 2.

I got up - note, not woke up - this morning. Showered. Put on my pants. Took off my pants because they had a dead woman's blood on them. Rummaged the laundry basket for my relatively cleaner white coat, the one that's not also contaminated by bodily fluids (at least not visibly). Swallowed codeine. Jumped on a taxi.

I was wrong, or unconsciously taking poetic license, because the floor and walls of ED are not white, but light grey, though they are indeed reflective. When I first came in the room was quite empty. God must've wanted to punish me for thinking so because before 9am there were already at least two brain-dead (I checked their pupils), a swathe of old people, five or so parties involved in a stabbing, an emaciated 30-something with massive cirrhosis, a maybe renal colic and more. One of the patients was about to be certified dead until he started breathing on his own! But I think he was still gone. All that before breakfast.

I haven't learned enough about death. I mean the clinical side of it. There was probably a learning target in first year that I pooh-pooh'd as fluff, but it's critical. When to stop CPR. When there's no hope of return. This is something that happens daily here. The first few days I just walked by the mini-ICU in ED a few times, not really knowing what was going on, but now I realise that the air pumping and chest thumping is most likely to be fruitless. My PBL training leads to determining causes, mechanisms and solutions, but leaves me high and dry when it comes to The End. As for the personal side....seeing the relatives grieving shook me up a bit, but the thing is, when someone's brought in barely alive, the transition to mostly dead isn't that obvious.

There wasn't a whole lot for me to do and I think Mr Intern wanted to give me a break from, yknow, death and destruction, so he took me upstairs to the cardiac surgery department. So, c'est vrai, surgery is just cutting stuff up then sewing it back together...but when the "stuff" is a LIVING BEATING HEART....dude, that is wicked rad. The heart guys are cooler than the ortho surgeons as well - the professor (God Himself) joked with me in excellent English and another one explained the repair of a Fallot's Tetralogy. When I started hacking up my lungs and swaying, I thought that was time to retreat.

My intern is becoming a friend. Imagine a small, deft, fine-fingered fellow with blinky myopic eyes behind thick glasses, square-cut hair, conscientious, finicky with hygiene at mealtimes and in surgery as befits an open heart surgeon to be. He spends his spare time studying (I KNOW!) and playing soccer and stuff with his friends, sometimes martial arts. He's so cute and gentlemanly - took me to the coughfakebookshopcough today and even offered to pay, and then drove me home. And he's a role model now too. He actually cares for his patients, in a setting where that's hard to do, and he is always seeking to learn more. Now I go around stage-whispering "he's a darling!". I sense he's got a little in reserve but I don't think this idol will turn out to have clay feet.

You know what I've been thinking about? Here doctors are really poorly remunerated, yet patients can still get an excellent standard of care. I have to give Mr Ortho props for the six gruelling hours he spent on that thumb...it only garnered him about 75 000 VND, which is about $7 AUD. The buying power isn't a lot either, given that a hospital lunch is about 30 000 VND. He could've just stitched the thumb on for aesthetic purposes, but instead took great care in connecting each tiny vessel and nerve. And Mr Intern probably gets paid even worse, but he stays overtime to make sure that his patients survive the handover and is meticulous in examining them. I've been taught (brainwashed) to think that a nation without rule of law must be corrupt and collapsing, each man for himself - and indeed there are horror stories about doctors giving sloppy care or sending patients for unnecessary operations because they have side deals with specialists. But there remains the integrity of individuals, the drive to excel at one's work and do good. It's heartening.