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Internship Experiences

After the euphoria upon completing medical school, I quickly settled into the life of an intern doctor.

The new doctors were given a choice of two attachments ; one in a medical and the other a surgical discipline for six months each. I chose General Surgery and Internal Medicine . I was posted to Mulago Hospital in Kampala the same hospital in which I had had my undergraduate training. I therefore knew my way around; this however did not make the gruelling program much easier.

I started with General Surgery which was one of the busiest, with a 1:3 on-call rota consisting of sleepless nights as well as  long days on the wards and in theatre.

In Uganda the primary healthcare services are still underdeveloped and virtually non existent in many rural areas. During my training and work, I saw many patients who were in the advanced stages of illnesses very rarely seen in developed nations. It was not unusual for instance to see women with large ovarian cysts that gave them the appearance of a seven months pregnant woman. In places where health facilities are more accessible, diagnosis of ovarian cysts is by a routine ultrasound scan, and rarely get bigger than a golf ball size.

I recall one such patient Rose (not her real name). Rose was about 40 years of age. She had a large ovarian cyst that had become so big that the complications to her other organs had become a threat to her life. The doctors decided to operate. I was the young doctor assisting the surgeons in theatre on the day of her surgery.

This picture shows a large 5 stone ovarian cyst being removed from a young Mexican woman. The picture was taken from a story shared widely on the internet last year.

This is exactly how I recall the appearance of Rose's cyst in theater.

During surgery, unfortunately, one of the most dreaded complications happened. The cyst, or tumour, that now had several blood vessels on its wall, started to bleed. The surgeons were having great difficulty in stopping the bleeding. The blood prepared for this surgery was not enough.

As the junior on the team I was asked to get changed and to go to get some more blood urgently but there was none in the hospital blood unit. I was then provided with a car and driver to take me to the blood bank in Nakasero, about 5-10 minutes drive from the hospital. I did get the blood, and the patient was able to make it out of theatre alive, but the effort was not enough to save Rose's life. She died the very next day on the ward.

There was no functioning intensive care unit at that time even in this main national referral hospital.

I still remember Rose's nervous laughter in theatre before the anaesthetic, I remember reassuring her that she would be fine. Sadly this was never to be.

During my Internal medicine attachment I did have another patient encounter that has stayed with me since. John (not his real name), was a young man in his 30s, dying from AIDS. At that time the available drugs did not offer much in treatment as they do today. In any case, the majority of patients could not afford these drugs as they could only get them privately. For John and his family, as his health continued to deteriorate they saw no point of remaining on the hospital ward. He decided he wanted to go home which was about 200 miles away.

I was woken up one early Saturday morning by a knock on my door. At the door was a young man, whom I recognised as John's brother. He said John had deteriorated, and asked whether I could go to the ward to arrange his discharge.

At first I was taken aback that he had come to my residence instead of taking this up with the staff on the ward; however, knowing there would have been no other doctor on duty, I followed them to the ward. when I arrived I understood their desperation. The nurse in charge at the ward was very upset that John wanted to discharge himself. There was an almighty argument between the nurse, and the patient's family, right in the middle of the ward.

I took the nurse aside and we had a discussion after which we both agreed that we were not offering the patient much else by keeping him on the ward. The kindest thing we could do was to let him go home with the medicines we could provide to keep him comfortable around his family.

To this day I have never forgotten John's words to me as he left the ward. He thanked me 'from the bottom of my heart, and I wish you well in your career. You will be a successful doctor.' This meant a lot more to me than the words themselves; I was a young doctor about to complete my internship, the future was uncertain.

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