Skills

by Rachel

Eric and I have both been working a bit during our time in the US.  It's been interesting to stick a foot back in the waters of American medicine...interesting and nostalgic and informative and affirming (in many different ways), and sometimes a bit discouraging as well.  Sometimes it feels like my profession is passing me by and I'm losing the ability to practice in the States.  Atul Gawande wrote an excellent book called "Better," which I read several years ago, and as he writes about surgeons who perform better than others and have consistently better outcomes, I worry that in the US my patients would be better served with another doctor.  This is something I don't have to worry about in Burundi because it's just me (that's of course not to say that I don't strive for good outcomes!).

Honestly, working in the US was never part of my plan, ever since deciding on a career in medicine at the age of 16.  After graduating from residency in 2009 until now, I've spent approximately 2 years practicing medicine in Kenya, 1 1/2 years in Burundi, and 2 1/2 years doing a whole lot of different "stuff," but no medical practice.  So for the last six years, I have not once practiced independently in the States.  A job opened up for me to return to my former hospital, St. Joseph Mercy in Ann Arbor.  It's an ideal setup, as I already know most of the attending docs, nurses, and support staff, and I know the building and in general the flow of things.  I've been staffing the resident clinic and working on labor and delivery 6-8 shifts a month, and in general I've really enjoyed myself.

But if I'm being honest, I didn't sleep the night before my first shift.  The things I've forgotten are quickly relearned, and the new updates in standards of care took less than a day to read through.  But the computer system is a different story.  The operating room scares me.  My colleagues talk about robotic surgery and new equipment that lets you perform hysteroscopes in the office.  It's taken my teammates and I six long, sometimes painful years to develop a new set of skills to help us function in Burundi.  Skills like, how to speak in French.  How to deal with the advanced presentations of some common diseases.  How to manage malaria, typhoid, HIV.  How to deal with our patients dying, over and over and over again.  How to function without support systems and colleagues in our specialty.  How to relate to a patient that is literally worlds and cultures different from us.  And I wonder...if these new skills will only serve me overseas, and if returning to the US will only serve to illuminate the ever-expanding gap between what I used to know/US medicine, and what I know now/African medicine.

Several years ago, I attended a breakout session at the GMHC (Louisville conference) led by Suzie Snyder.  It continues to be one of the most influential talks I've ever heard, on the subject of being a working doctor missionary mom (because, really, there's not a lot of us out there).  One of the things she said that day was on the subject of maintaining credentials, staying up to date with your medical skills.  She said, "What God helped you to attain, he will help you to maintain."  I've clung to that many times these last six years, taking my oral boards, coming back into US medicine for a season.  He has brought me to this place, called me to this life, and will equip me with the skills and knowledge I need to do what He has asked me to do.

But there are those moments of doubt.  A lot of them, actually.  And I just wanted to share briefly how God has affirmed me several times these last months, that the skills I've developed aren't just applicable overseas.  That I might just still have a little to offer US medicine, too.

My first day of clinic (after the sleepless night), one of my first patients was French speaking from the Congo.  None of the office staff spoke French (there's a blue translation phone usually used for this purpose).  But I was able to go in to the room, greet the patient and her husband, and discuss the problem, confirming that they understood all the counseling done up until this point.  It was a shining moment in my day.  There have been no French speaking patients since that time.  Maybe it was God's special treat for my first day.

Then, Friday night, I had an overnight shift in the hospital.  A woman came in with twins in labor.  The first baby was head down, but the second was breech (feet first).  The two options for delivery would be a C-section to minimize risks of the breech delivery, or to attempt a normal delivery and pull the second baby out breech.  Her attending hadn't done many breech deliveries and wasn't comfortable with the idea, so asked me if I would help out, as the patient strongly desired a normal delivery.  Now, by the end of residency I had only done about 5 breech deliveries, but after 6 years overseas, I've probably done 30-40.  So, an "African" skill.  The woman did beautifully, and I guided to resident to deliver both babies safely.  Again, an affirming moment from God.

Not every day is affirming.  And then, not every day is overly challenging.  I still look forward, a LOT, to returning to practice medicine in Burundi.  It's what I'm called to do, what I trained for, what I love.  But in the meantime, it's nice to know that God continues to equip, and provide, and help me to grow, for EVERY situation.