A Day In The Life

Now that I have about a month of hospital experience under my belt, I thought it would be a good time to give a quick glimpse into a day in the life of a Tenwek urologist …

roosterOn most days I am awakened by my alarm clock, assuming it goes off by 6 am.  After that time, it’s a bit challenging to sleep through the roosters crowing from the hillsides – God’s reminder for those without alarms that it’s time to start a new day.  I love the consistency of sunrise and sunset on the equator, which is maintained with a perfect rhythm.  The morning begins with a cup of Kenyan coffee and some quiet time for study of scripture, usually alongside my bride.  Gauging for distance, and free from the limitations of automobile travel, I’m out the door a good minute or two before I need to arrive at the hospital!

My current schedule includes two days of clinic and three days of theatre (no popcorn at this theatre … “theatre” is the term used here for the operating rooms).  Starting in July, I will have my own separate urology clinic day.  Until then, I wait patiently for urology patients to sift through those in the general surgery clinic.  One of my favorite parts of clinic is chai time.  About mid-morning, without fail, it’s a short break for hot chai and maandazis (a fried pastry similar to the New Orleans beignets) … no excuses or exceptions.

chai time I knew the Kenyans loved chai, but I was unaware that this tradition permeated even the medical clinics.  On my first day of clinic, I had entered an exam room to see a patient.  At the time, the clinic was a bustle with residents going here and there, in and out of rooms.  I must have only been in the room for five minutes or so.  But when I exited the patient’s room, to my surprise, were five or six residents sipping chai, eating maandazis, and jovially conversing with one another.  Now, a month later, I often find myself checking my watch for chai time.  Such an activity would seem unthinkable in the midst of a hectic clinic schedule back in the states.  More than just an opportunity for refreshment, chai time epitomizes the Kenyan belief that we should never be too busy to stop, rest, and relate.  Something to consider.

On a practical note, there are a few interesting differences in the clinic here versus in the states.  For starters, I am now taking care of pediatric patients.  This has been a bit of a stretch, as my practice in the states was limited to adults, and my last pediatric urology cases were over six years ago during residency.  This is compounded by the fact that many of these cases are not exactly straight forward.  In fact, in one short month I have already encountered several cases that I’ve never before seen and only read about in the textbooks. One month.  I can only imagine what my case files will look like after two years here.

The second variation is that the vast majority of patients in clinic are here for surgically treated problems.  In the states, we generally see a mix of both surgical and non-surgical urologic disorders.  This is not a complaint, because I love to operate.  Also, the potential to bring about a dramatic improvement in a patient’s quality of life with surgical intervention is very high (I can hear it now from the gallery – another surgeon with his “heal with steel” mantra).  Like the pediatric cases, the complexity of the adult cases frequently stretches my confidence level.  I  have learned that it is not enough to come to theatre armed with plan A, but plans B and C should also be well thought out before the gloves go on.

ORIn the theatre, I have been assigned my “own” room, #6, which the Tenwek staff have been extremely helpful in organizing and stocking to accommodate urologic procedures.  When I arrived at Tenwek, there were two surgical teams, the red and blue teams, with their respective faculty and resident members.  Though I usually round with the blue team, I have affectionately been assigned my own “yellow” team :).  One of the greatest blessings of operating at Tenwek is the opportunity to help train general surgery residents through the PAACS program.  They are exceptional not only in their clinical and surgical skills, but more importantly in the quality of their character.

When I heard from the missionary doctors here that there would be time for breakfast, lunch, and dinner with the family, I admit that I was a bit skeptical.  Of course, I’m coming from a work setting where I could probably count on one hand the number of times I’d had lunch with my family during the work week over the last ten years.  But just like chai time, the Kenyans are serious about their lunch break.  There’s no “working through lunch” just because it’s a busy day (unless your surgery just happens to run through the lunch hour).  So, the family has to put up with a mid-day meal with dad, pretty much every day.  I can’t tell you how much it has lifted my spirit to have these times with my family after a decade in the rat race.

I do take call, but only for urologic patients/emergencies.  The bad news is that technically speaking, I am on call every day, unless I’m away from Tenwek.  The good news is that the general surgery residents here cover the urology patients and consults, and their competency in doing so is very good.  That’s not to say that my evenings aren’t busy.  Facing new and unfamiliar urologic disorders has brought me back to my residency habits of consistent reading and researching.  My best estimate is that it will probably take a year or two to get into a good routine and to feel comfortable with the new urologic milieu in which I find myself. But it’s actually very refreshing.

You may be thinking that everything sounds pretty rosy as a urologist Tenwek Hospital.  Yet there are plenty of challenges and struggles.  We’ll save those for another day.  Of course they are all relative, and I can look around at the difficulties faced by the nationals in the area and feel almost embarrassed about what I thought were “trials” .

DSC_0232At the end of the day, when its all said and done, the real fulfillment here is borne out of the relationships … relationships with other missionary families, relationships with the residents, relationships with patients, relationships with our Kenyan neighbors, relationships in my own family, and most importantly the relationship with my Lord, who has so graciously granted me peace and purpose in the highlands of western Kenya.