Sunday, June 24, 2012

A Day in the Life...

I know I promised to write more, and here I am with mostly regular internet access and I am doing worse at writing than I did when I had only weekly access!  Sorry!  I'll make up for it with two posts this time.

Let me begin by saying that Siem Reap (the city in which popular tourist destination Angkor Wat is located) has a totally different atmosphere both from the villages where I have worked in the past and from Phnom Penh, Cambodia's capital and largest city.  It is very Western because of all the tourists, plus it is a popular landing site for expats and a central place for NGOs.  It is chock-full of restaurants selling Khmer and Western food (meaning you see traditional dishes like Amok, things like morning glory in oyster sauce and fried noodles, on menus alongside things like pizza and cheese burgers, plus you may or may not see Thai, Korean, Indian, or Chinese food as well, or even some sketchy Mexican and Khmer places), and I can't walk more than 50 feet without someone calling out, hello!  Tuk-tuk miss? (tuk-tuks are motor bikes attached to fancier carts), and when I politely decline, asking tomorrow?  See Angkor Wat?  It makes me smile, really.  The upside is that many speak a passable degree of English, so I could do things like borrow a pen from the waitstaff at the restaurant I have been frequenting, and manage to be understood.  I do miss the simplicity of being in the villages though, and the constant interaction with fascinated villagers.  I miss the vieilles and their toothless smiles, the children calling out, hello!, being surrounded by Khmer and forced to practice.

A day starts for me around 6, which is when my body has, without exception, decided it will wake up.  (This is now two and a half weeks in, and still matter when I go to bed.)  Recently at least, I can almost go back to sleep by the time I get up, at 7.  I get ready and come downstairs for breakfast at the guesthouse.  My current favorite dishes are banana-chocolate pancakes (with banana in the pancake and chocolate on top) and bread with vegetables and cheese (because I have a penchant for melted cheese and the mini baguettes are quite toasty!).  I get to the hospital around 8:30, usually walking with the one or two premedical students who are also doing this program, and my translator (who is a nearly finished Khmer medical student) meets us there.  Rounds start whenever the doctors arrive from their morning meeting (which I surmise is a bit like Grand Rounds where a case or disease is discussed, but I am not entirely sure).  Rounds may or may not go quickly, depending on the complexity of the cases, how many operations are scheduled for the morning, and whether one or both of the surgeons is present.  One surgeon is a younger, quieter man, though when I worked with him for most of a morning, I was surprised at how much English he spoke and how much he too seemed to enjoy teaching me.  The other is far more effusive--he has a constant twinkle in his eye and loves to laugh and joke with the nurses and patients.  He is the one with whom I work the most frequently and he really seems to love his work.  He is also a great teacher, prone to asking "pimping" (basically, the questions the attendings love to ask students) questions in French, English, or Khmer depending on his mood and the complexity of the question.  He also loves to look at an interesting patient and tell my translator and I to discuss, leading us on a brief history/physical and discussion between us as to what labs to order.  Sometimes I have to stop myself and remember an ANA or dengue titer is not available for the vast majority of Cambodian citizens.  After rounds, we'll go to the OR (I'll post about this soon) and watch as many surgeries as the morning will have, then we will sit outside for a bit and discuss a tropical disease like dengue, typhoid, or for tomorrow, leptospirosis. 

The afternoons are usually quiet here.  The doctors need to work in private clinic as well as public to make sufficient money (or more than sufficient money...) for their families, so the hospital pretty much goes silent in the afternoon (the moral of the story is if you're a patient, you do NOT want to have a crisis in the afternoon, where there are primarily nurses around and there is also a doctor on call).  The doctors go to their respective clinics after lunch.  Most days, I come back, have lunch, write, sometimes I talk with people, sometimes read.  Lately, the animated surgeon has been telling me if he or someone else is on call and has an afternoon surgery, and I'll go and watch.  In the evenings, usually I meet with the two premedical students and we get dinner.  Our favorite place is Father's Restaurant, whose prices don't exceed $3.50 or $4 for anything on the menu.  They have lovely Khmer food (tonight I had a soup like egg drop soup), coconut water from a coconut, excellent fruit shakes, and so much more, plus the staff is really sweet--and they recognize us by now :) 

I really am having a good experience!  I don't always feel I am doing a lot of good, but I am learning a LOT about medicine in Cambodia and learning how things are done, getting ready for my own rotations at Georgetown that begin in just two weeks....

Thanks for listening :)  I will try and give you a glimpse into surgery in the very near future!

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