Some mornings, my father would say that he’d done a “second shift”. This meant that he had relived the previous day’s work in his dreams. It’s happening to me now. Perhaps it is because I am sleeping lightly because of the heat, so I wake up during the rapid eye movement phase, when dreaming occurs. Or maybe it is because my brain has such a lot to process from the preceding day. I think it is a little of both, exacerbated by the sustained effects of drinking a litre of coffee at the Forester’s Arms on Sunday.
The clinic has been busier than usual recently. I have seen so many people living with HIV who have complications that one pleural effusion blurs into another. Some sights are pretty ghastly, and those images are seared into my cortex as well as my camera’s memory card. Don’t worry, I’m not posting any horrific pictures with this blog. But the poor middle aged lady who kept complaining of a vaginal discharge, who had been unwisely treated as though it had been a sexually transmitted disease with antibiotics for over a year, did rattle me. The upper part of her vagina was rotten with cervical cancer. The unfortunate lady stank. So in my dreams I am treating her all over again. I can even smell her. And see her uncomprehending but grateful face when I tell her what’s wrong.
I diagnose and treat people in my dreams but sometimes I wake up with the feeling that I have missed something, forgotten to do order a blood test or an X-ray. Interestingly, I don’t dwell on my mistakes in my dreams. Maybe that is a psychological defence mechanism, protecting me from self doubt and recriminations that I could have done better. Perhaps it is because I am not aware that I have missed a diagnosis. People often shop around for medical care in Swaziland, so if my treatment didn’t work, the patient tries someone else, rather than coming back to confront me with failure. I continue in blissful ignorance.
Sometimes when there is no clear diagnosis and I can’t do all the fancy tests that would be done in UK, so it’s a question of let’s suck it and see. A trial of treatment. If they get better, then it is likely that my best guess was correct. If they don’t, think again. When it goes well, you pat yourself on your back. A little victory that makes work enjoyable. When it goes wrong, you justify your action by telling yourself it was worth a try.
Yesterday, I genuinely didn’t know what was wrong with one chap, who just kept on getting progressively worse, despite our attempts to cure him. I sent him to hospital because I had run out of ideas. I didn’t dream about him last night. My brain had already been wracked and found wanting, so there was no corner left to probe, no point in dreaming about him. Or, thankfully, he was no longer my problem. That is, until the hospital discharges him, having found nothing treatable.
Unlike “Who Wants To Be A Millionaire”, I can’t remove two wrong answers. I occasionally ask the audience if it is a local problem of management – “What would happen at St Elsewhere’s Hospital if I sent this patient there, do you think?” But my favourite decision making aid is calling a friend. I have a swarm of specialists in UK who pander to my needs and respond to emails with digital photographs attached.
Getting up in the morning after having “done a second shift” is tiring. I don’t feel completely rested, refreshed and ready to start the day. But after a couple of cups of strong “Five Roses” tea and some Weetabix, I perk up and by the time I get into the LandCruiser to go to the clinic, I’m fully charged.