First day in clinic

Disclaimer - This is about my first day in clinic and being a “lady daktar” the problems of the patients I saw reflect this. You have been warned....

Yesterday was my first day of full time work, and it went something like this...

6.20am: Alarm went off, wake up feeling slightly nauseous with nerves about the day ahead, feel better after breakfast.

7am: Ward round, reasonably straightforward as I accompany our resident paediatrician. It was very sad to see one baby who had been brought to clinic a bit yellow and needing some phototherapy, but whose family either couldn’t or wouldn’t allow him to be admitted. He subsequently came back 2 days later, even more yellow and having seizures and now seems to have some brain damage.

8am: Clinic starts. Unfortunately the very capable nurse-in-charge has “chuhtti” (leave) today so somehow no-one was really expecting me. After a bit of a guddle finding a room and a clinic helper my first patient arrives. I’d hoped for a nice straightforward case to start with but instead it it was a woman with an 8 years of infertility, polycystic ovaries and possible type 2 diabetes and I rapidly discover as my Urdu runs out that my clinic helper doesn’t actually speak English!

9am: Things improve when I get a new clinic helper who does speak some English and is very good at correcting my Urdu so that the patients can understand me. My next patient is also concerned that she is not getting pregnant but actually only got married 5 months ago, (you have to be trying to conceive for at least a year and possibly 2 before you meet the definition of infertility). There seems to be quite a lot of pressure here for women to have babies in the first year after they marry, even if their husband is working in another country and only home every couple of months or they’re living with their in-laws!

9:30am: Rufie (my clinic helper) and I are both stumped when the next patient launches into discussion in Pashto which neither of us speak. Fortunately she also speaks a little Hindko (which Rufie understands) and has a straightforward problem so we muddle our way through.

10am: A much needed chai break. I wondered why it didn’t taste sweet even after I added 2 teaspoons of sugar but discovered why when I got to the bottom of the cup and discovered the sludge there. The sugar granules are huge and it takes a lot of stirring to dissolve them.

10:30am: My next patient tells me her problem is abdominal pain and it’s only when I go to examine her and find she has a large mass in her abdomen that I realise that she is 5 months pregnant and she’s actually here for antenatal care - oops. (I don’t think she’d mentioned it before.)

The rest of the morning was more straightforward; urine infections, lower back pain, nothing too complicated. I’m informed that there are only 2 patients to see after lunch so go home for lunch quite happy.

1pm: Clinic restarts. I see a woman who’s is probably having a miscarriage but when I do an abdominal ultrasound I can’t see the baby. This means I can’t rule out an ectopic pregnancy (where the baby grows outside the womb, rare here, but a potentially life threatening condition that you don’t want to miss). She needs an internal scan (which I can’t do yet) and when I call our obs and gynae specialist, she’s been called away to the operating theatre to do an emergency c-section. I panic slightly but am reassured when she says she’ll come when she’s finished. Then all the cards for the patients she was going to see arrive on my desk, so I spend the rest of the afternoon struggling through various gynaecology problems, so much for only 2 more patients.

4pm: My day at the hospital finally ends after a short teaching session on internal scanning for the 2 bleeding ladies I saw during the afternoon and checking up on my babies in the nursery. I only managed to see 10 patients in my day in clinic and it felt like a lot more but I survived. Back tomorrow for round 2.