I've been trying to follow my own statistics...how many patients do I see? How many echos do I do? How many heart attacks have we admitted....but I have been doing a bad job of it. I tried starting an excel sheet, tried carrying a book, tried a word document. I just never seem to get it all written down for the day. So, now I have resorted to just a simple tally. My nurse in the clinic writes down every name that I see in the clinic in a ledger. They try to use it to reconcile the billing....plus it helps us find chart numbers and then the chart and the phone number or results when we need them.
So, I do have proof that it's not just my imagination that I am busier this month than ever before. In fact, we sat to look at the month earlier this week. I saw DOUBLE the number of outpatients in the clinic as I had before! June, July, Aug, Sept, Oct we saw about 80-120 outpatients each month (didn't tally the ECGs or echos or PFTs, just the number of patient visits) but in November I saw 203 outpatients!!! That doesn't include all the patients we have had in the ICU, all the regular ward inpatients that I admit or that other doctors ask for assistance with, echos in the wards, patients in the Emergency Department, or any of the QECH and Malamulo patients.
In order to try to capture those, I have decided to carry a little book and just tally the numbers of patients seen: no diagnosis, no little asterisk if it was an interesting case....just a straight tally. I even forget to do that sometimes. It's not ideal...a person who took just 20 minutes for a check up and refill on medications for diabetes, hypertension, dyslipidemia, and GERD gets one little mark just the same as the acute MI given thrombolytics in the ED and then moved to the ICU and airlifted out that takes me 4 hours....But it's better than having nothing recorded about how many patients I see. Which is what happened when the scheme was more elaborate and I was trying to tally how many CHF, how many rheumatic heart disease, how many post MI patients etc. It was too daunting and nothing got tallied. So, last month, I just tallied numbers, trying to include echos, PFTs, ER consults, ward consults, admissions, and those seen at QECH, and Malamulo....and I still am quite sure I missed a few and didn't quite capture every patient (but I thinks it's close).
So....(drumroll please)......the grand total of what I wrote in my book for November is ....... 377 consults/admissions and procedures!
No wonder I feel tired most days. I only took ONE day off last month. We left to Zomba plateau at 6pm on a Friday night and returned by 5pm on Saturday (for anyone counting, that's only 23 hours actually out of town). Darryl wanted me to stay one more night on Zomba and go home Sunday morning early...but I knew that wouldn't work. The last time we had gone to Zomba for the day on a Saturday we got called back: we left after finishing my morning hospital rounds and by 3:30pm we were called back urgently to see the relative of a friend who wanted me to come back to see them right away and no one else. So, for this month's trip, I was reluctant to stay more than 24 hours out of town....and sure enough, we got back to Blantyre around 5pm Saturday night and by 6pm I was called to the Emergency Room for an acute anterior ST elevation myocardial infarction! I gave thrombolytics within a few minutes and they reperfused! Then transferred to the ICU overnight and was airlifted to Joburg early Sunday morning and had an LAD stent by Sunday afternoon (within 24 hours of the start of his MI!!!).
It may seem like a normal thing to those reading this from the US....but I want you to realize this is no small feat here! Most things take much longer to do in Africa than they did in the US! And, there are places in the US that can't get a stent for an acute MI in less than 24 hours!!! Of course, not every patient has the resources or the family network to arrange to fly out. But, some do. In these cases it involves: stabilizing the patient (giving the medications, doing serial ECGs, getting them on a heparin drip, checking the ACT myself (at midnight...6 hours after starting the heparin drip....because our hospital lab can't do it, but the iSTAT machine in the ICU can), getting the other routine labs done (some at our hospital, others get drawn and the vacutainer is handed to the family who takes it to another hospital to do all the labs we can't do at ours, and then they bring me back a report from the other hospital), doing the echo and then writing the referral and discharge letters, copying all the labs and ECGs and getting them into a packet for the patient to take with them), meanwhile, the family members have to arrange for payment of the evacuation (if they have air-evacuation insurance / international medical insurance they must get prior authorization, otherwise, they have to do a bank transfer equal to about $20,000USD in foreign currency - in this case, on a Saturday night! - into the account of the air evacuation team. I honestly have no idea how they would do this! This part amazes me: some of these families can do it! I figure if it was Darryl dying and I had to get $20,000 into someone else's bank account on a Saturday night...he would just die. I couldn't do it without 2-3 business days and some big loans!!!), finding a hospital that is 2 countries away from us to accept the patient, giving sign-out to their doctor, giving sign-out to the flight doctor, instructing the family to arrange for the international airport to be open at 6am for the inbound flight, having the family arrange an ambulance to pick up the flight crew at the airport-bring them to the hospital-get the patient transferred to their monitors/loaded up-and take the patient and a family member and the flight crew back to the airport, and finally getting the patient and the patients' family member's passports and yellow fever cards collected (you can't get into South Africa without a yellow fever card!!). Whew!! All that takes 12 hours and all I get for it is three little hash-marks in my tally book (the ER visit Saturday night, Sunday early morning rounds in the ICU, and the echo).
So, suffice to say, I've been keeping busy.
I also want to take a sentence here to say a special "thank-you" to my ICU charge nurse, Shymol, who also works tirelessly (and long hours) with the patients and nurses in the ICU! THANK YOU.
