JUL-B-7
THE START OF
THE LADAKH-03 MEDICAL
AND ORIENTED TO THE CLINICS WE WILL BE
CONDUCTING
I have made my way to an Internet Café in Leh when both power and the phone lines were up, and waited in a brief queue to send the arrival message from Leh. I attached all the Jul-A-series, which did not detail the group of the 27 I have with me now to conduct the Ladakh-03 mission, which I will attach with this not e and the Jul-B-series. We have mostly gotten over the headachy queasiness of being two miles higher than usual with a third less atmosphere filtering the blazing sun by day and a lack of the usual ambient O2 pushing the pulse oximetry of most of us into the mid 80’s in O2 saturation percentage. It is now time to start the exertion I have been warning them about and postponing it, so the day will begin with a run around my usual course up high on the mountain overlooking Leh and approaching the Gompa that is the monastery overlooking Leh.
With the drivers and helpers added to the 27 members of the expedition, we are over 40 of us, and we will have to move this group from one clinic to another for day long sessions in several nearby villages from the base of operations in Hotel Kangri in Leh. This may mean that we will have access to at least the intermittent electricity, and a bucket bath of cold water somewhat more frequently than we might have had on the road out to the Lakes Tso Morari and Pangong. I might even be able to catch up with the messaging by forwarding notes from an Internet Café when there will be the happy confluence of both electrical power and phone line service.
THE DIVISION OF THE GROUP INTO FIVE
TEAMS
FOR THE INSTRUCTIONS AND CARE TEAMS
At the final assembly of the whole 27 students and the others amounting to almost 50 people to move to our first clinic site on Monday morning, I outlined what I expected of each of them. There would be four clinical teams, one family medicine, one general and headed by me, and a women’s health team and a pediatric team, then a dental team, a pharmacy group and an entry level triage and BP and chief complaint group. We would need a few tools for each of the clinical teams, most preciously the rate limiting steps of an effective translator for each team.
With the organization and the drill
clearly understood as to how they would work, and how they would need to select
one patient for two members of each team to be presented in the evening after
dinner on their :”first day in the office” these freshmen clinicians seemed
rather excited to be started. One of
them,
I believe all of them discovered at least one big feature immediately on their first hard day at work: medical care is hard, the hours are long, the task is never ending and wearying, and there will always be more patients and problems than they will have information or enthusiasm to treat!
In fact, a couple of them would stand up to address their professor with the following crowd pleaser introduction: “I am really tired and am falling asleep, so we really do not think this would be worthwhile to try to pursue this and I believe I will just be leaving now.” With this introduction they had hoped to go off to drink beer and play cards rather than squirm under the work and embarrassment of trying to learn the clinical concepts at which they were so brand new and fresh and so overwhelmed. I would respond that this may be a problem for them individually, but we were not addressing those problems of theirs which might be cured by a cup of coffee or chai, but the problems we would be addressing in whatever condition they found themselves now or in the future belonged to the patients that they were allegedly interested in helping, and that these problems are not dependent on their being comfortable and ready to address them.
So, we did complete the required two patient presentations per team before ten PM so that thy could then go off—not immediately to bed as they had alleged they needed to do, but to sit and talk or compare notes in a situation less uncomfortable than comforting what they did not yet know. They were measuring their enthusiasm for medicine against the few small triumphs that they had seen or contributed to in the nearly overwhelming flow of 300 patients beating down their doors today, and wanted to avoid the much larger burden of the problems that they had not addressed through ignorance, weariness, or the failure of their enthusiasm for a given problem since it was not as interesting to them as a few others that they might rather consider. In other words, they got a very large dose of what the rest of their professional lives would be and how it would often make them uncomfortable and infringe upon their personal preferences for what they would rather be doing. They learned several big lessons today, some of them overwhelming, but seemed to understand the process to which they will be returning tomorrow.