Childhood, again...

Tonight's thought is just going to quickly written and only lightly reviewed for errors. I'm tired, sweaty, and ready for bed.

We've been in Salome (Sierra Leone) for almost exactly a week.
I now know how to go to the market and buy eggs. I know a few greetings. The employee’s faces are starting to look familiar (although unfortunately their names are not yet...) I know how to use the internet. I know how to open the lock on my door. I know how to use the toilet. And only in the last few days have I started easing back into patient care. I almost know how to use the patient's chart. I know where to find gloves. But there is also so much I don't know how to do.

But even over this short time, I'm realizing how much of the 'real life' stuff that I know is based on where I learned it. I have felt more like a child in the last week, than any time in recent memory. Every single thing in the paragraph above, I had to learn either by asking or by struggling. Yep, you read that correctly. Apparently I didn't know how to use a toilet. There was a solid 5 hour period this week where everyone I met was asking if I had a plunger yet or not. Apparently there wasn't one in the entire hospital. I haven't started patient care until now because honestly, I'm 31 years old and still trying to figure out the mechanics of daily living.

All of the tools I've learned before seem to almost, but not quite work, here in Sierra Leone.

Today's experience that brought all of these ideas together was when I was trying to ultrasound a woman's thyroid. She's got hyperthyroidism and is suffering. Huge anxiety, rapid pounding heart beat, all for several weeks. "Great," I thought, "I specifically took a rotation and practiced this in residency. I'll just do a quick scan and see if she has an abnormal nodule." So I set up the equipment, darkened the room so I could see the screen, laid the patient down, and put the ultrasound gel on her neck. Nope. I put the ultrasound fluid on her neck. It ran everywhere.

To explain my struggle, let me back up and describe why gel is important. Air is the enemy of ultrasound. So without gel, the ultrasound can't see anything. Because she is laying on her back, her 'Adam's apple' and trachea form a high point and the rest of her neck slopes down and away. The thyroid is lateral to the midline structures. So if you are going to look straight down at the thyroid, the gel has to mound up to make a 'bridge' between the probe and location of the thyroid. So my river of gel meant I had to improvise (more likely compromise my images).

As I have reflected on this experience, medicine is filled with assumptions. Every book, lecture, course, and advice I have received about ultrasound has assumed that I have decent quality gel in an air conditioned room. Well, I can tell you that air conditioning can be about more than just comfort.

Everything I am re-learning about daily life is difficult because there is a core of assumptions that are being challenged. I anticipate medicine will continue be the same. There are so many areas of our lives that go unexamined, simply because our assumptions have always worked. These beliefs have moved into the subconscious and we don't think about or discuss them, unless they are challenged. Perhaps Christ's advice to become like children, in Matthew 18, is a more difficult process than I thought.