The Moose

Went on ward rounds with Dr. Moosa today in King Edward Hospital. Dr. Moosa is the authority on clinical management of HIV/AIDS in Durban. He did an infectious disease fellowship in the states and even has a PhD in microbiology. Knowing this, I imagined him as a crochity, old professor who was so high on himself that he couldnt see down to his patients. But Dr. Moosa was quite the opposite. He was young, energetic, friendly, and powerfully dedicated to his patients well being.

 

King Edward Hospital is the large facility where the University of KwaZulu Natal's medical school does their training. Its a massive, completely rundown complex of old decaying buildings. Absolutely nothing like a hospital in the states. All the beds were in one room, the floors were filthy, and patient's charts were messy piles of soggy papers. Still, it was much better than hospitals I have seen in other parts of Africa.

 

I find hospital medicine in America to be quite confusing and overwhelming. Even if you are able to master the clinical knowledge to diagnose and manage a patient, inumerable impediments seem to keep patients ill and in the hospital. Lab tests take too long, X-ray machines are unavailable, you need a dermatology consult, but they cant see your patient until next November. Pushing a patient through the hospital system is separate skill one must master in addition to the massive amount of clinical information.

 

So imagine all those logistical problems I have run into in the states, and multiply them times 1,000. That is what Dr. Moosa faced with his patients everyday. Cetainly, his patients tremendously confusing in their clinical presentation. Almost everyone had HIV and TB. They almost all had liver problems, but it was often impossible to tell if the liver problems were a result of the TB/HIV medicines, their possible hepatitis, or perhaps TB of the liver. But even if he knew exactly what was going on and what to do (which was rare, even for a very bright guy like Dr. Moosa) it seemed impossible to navigate the disorganizational nightmare of King Edward Hospital. Nurses never did what they were told, labs took days to get results, patients couldnt afford their medications, and the list goes on. To me, it seemed like an impossible and terribly frustrating place to work.

 

Yet, Dr. Moosa plunged through all this. Sure, he got discouraged when the nurse failed to write down how much fluid a severely dehydrated patient had recieved, but he never gave up. He flew from patient to patient, told them to hang on, that they were going to get better. He grabbed nurses, and made them put in NG tubes right then and there, for fear that his requests would not be answered otherwise. He showed incredible determination, and seemed to have mastered both the clinical and logistical complexities of the hospital.

 

But to me, it still seemed like some abstract nightmare. Dr. Moosa himself said that he acted on instinct much of the time, that he rarely knew exactly what to do. I dont operate well in situations like this. Things need to be clear, tangible, and easy to see. I felt the same frustration in my internal medicine rotations. It just all seemed so gray, when I wanted it to be black and white.

 

Right now, all this contributes to the notion that I should go into surgery (if you can understand that mental leap, I am not sure that I even do). I really do wish that I loved internal medicine and infectious disease. I wish I could do what Dr. Moosa does, and enjoy it. But aside from the fact that I dont think I would be very good at it, I dont know that I would enjoy it. Its a shame, because I think the world needs more medicine doctors who can treat HIV patients. But as fickle and indecisive as I am, who knows where I will end up.

 

Regardless, I am glad there are people like Dr. Moosa out there who still really do care about their patients and work through all that mess to make them better.