Responsibility

Captain of the Ship....that pretense is gone. Captain of the Lifeboat is almost gone. The concept that requires rethinking is this whole captain thing. Living in a wealthy country, born of supportive middle class parents, I have had an intellectual appreciation of God's providence. Mostly there has been the illusion that I was in control. Granted there have been profound failures as when my nephew Charlie died after liver transplant surgery. That wasn't supposed to happen. I have seen more death here in three weeks than I saw in a year working back home. What exactly is supposed to happen?

A 3 year old the second day with large, sad eyes strapped on his Mother's back in colorful cloth had swollen lymph nodes all over, a facial mass and diffuse facial and leg swelling. I thought he had Kaposi's sarcoma, an HIV related malignancy. Sure enough, his rapid HIV test was positive but his biopsy was an inadequate specimen. He died before it could be repeated. Yesterday an older woman with abdominal pain transferred to Weill Bugando after being in a referral hospital for 3 days. She was cold, clammy in obvious pain with a firm, tender abdomen. She was tachycardic with a blood pressure of 120 over 90. I ordered IV fluids and x rays and consulted surgery. Today the intern tells me that she" collapsed" on return from x ray and died. The thin man with a swollen neck described in my first post died in the hospital within a day. A tiny 1 month old grunting in his Mother's wrap, another transfer from the same referral hospital died after a few days in the ICU. A 53 year old woman who collapsed complaining of abdominal pain. I could palpate a pulsating mass in her abdomen that was slightly tender. An ultrasound confirmed a large aortic aneurysm. Her family could not afford the cost to transfer her to Nairobi. As far as I know she awaits her fate on a medical ward in the hospital as I write. I could go on....

I have a selection bias in that I am intentionally gravitating toward the patients who appear to me to be the sickest. Amongst these, there have been some remarkable success'....the woman with a tension hydro-pneumo thorax (fluid and air in the chest cavity where there should not be)
presumably from a bronchial fistula secondary to tuberculosis. She got a chest tube and when food particles were noted in the drainage, she was taken to the operating theatre by 2 surgical registrars and a tear in her esophagus was repaired. She is currently alert and walking around the ICU.

It is actually a good thing to relinquish captaincy. I must admit that I knew enough before I arrived to expect a relinquishment. How to relinquish captaincy without relinquishing responsibility is one of the many unanswered questions at this moment in time.