I need a case of beer

Ahhhhhhh. The past two days have been insanity. I can't believe how underserved this hospital is. For starters, the medical wards are divided up into 3 teams. I am on one team and I round and see all patient's on my particular team. Unfortunately for the past 2 days there has been no clinical officer to lead the team. So guess who was in charge. Hint... not some phantom or ghost... it was ME. On my team there was only one intern who just completed medical school and just starting out. The medical assistants or "students" are all out on vacation for the next 2 weeks so guess what. I saw 20 patients yesterday and 20 patients today with no guidance and I was responsible for making all the decisions... not to mention that there were 5-6 patients that weren't assigned a team and were never seen for the past 3 days. IN the US i never seen opportunistic infections from HIV, and tropical infectious diseases is completely foreign to me. so really i am just learning on the fly.

It was pretty chaotic-although I did keep my cool and calm as always but still what the heck. Everyone was super sick, had meningeal signs, HIV positive, possible TB and there were no labs done. As each day passes I begin to learn about the system and it is very easy to get annoyed. On the HPI's, clinical officers just write obtain blood work, cbc, malaria smear--and it is "hoped" that things will get done. I've come to realize fast that you pretty much have to draw the labs on the spot, not just write it down and give precise instructions. "Draw the blood work". I end up carrying bottles with me and i draw them as i round each day. I've already done tons of LPs and thoracentesis not b/c i was told to. but b/c i had as I am in charge of these patients. the little experience i have had in the past supringly has helped and i haven't made any procedural mistakes so far. but still, i felt like banging my head against the wall at least 100 times today.

the intern I work with, is super nice we get along well but i often get extremely frustated. ppl just write their daily notes and say, start IV fluids, continue antibiotics obtain labs and just move on-- and the thing is that nurses are so overwhelmed that it never gets done.

today we had a girl who had not been seen for 3 days. she was HIV positive came in with nonspecific complaints, llooked sick as hell and i rounded on her. checked her BP and guess what it was... systolic of 55. the person working with me just wanted to write down start IV, start fluids and move on. the mentality of i've done my part by writing stuff down in the plan and leave it up to the rest of the ppl to carry out orders is what really frustrated me today. but like i was told by a collegue back home. I am here for 2 months. this is their life. they job every single day.

I guess all in all i was pretty exhausted. 20 patients to round on, no one to supervise, all sick patients most of which had meningeal signs and sick as hell, and only one intern working with me. half the time the frustrating part was just trying to get a story as often the translator and the patient would break off in a conversation. I feel like I did injustice to my patients. the plan for a lot of them was track down labs, do an LP, but it never got done today b/c I was busy rounding.

i'm learning tons just super busy i guess. I plan to start getting to the hospital super early.. maybe 6ish. sometimes i feel there just aren't enough hours in the day. We'll see what happens.