Happy to be on the medicine service with learners from the US, Kenya, and Vietnam.

The best part of the job is working with residents, medical officer interns, clinical officer interns and other consultants in the hospital. I am feeling especially pleasant this week because I am working on the internal medicine service. Last week I was in the ICU which is definitely intense. There is a definite lightening of the load when one gets to move away from the care of the deathly ill patients. The worst of last week was a young mother who came in at the young age of 32 years. Four weeks ago she delivered a baby premature. Something happened at her delivery, and she ended up needing four units of blood in transfusion. This happened in a hospital a in a different district. She was discharged and slowly became weaker and weaker with more and more trouble breathing. She presented to our hospital, and she was found to have a very weak heart. This is called peripartum cardiomyopathy. Hers was so bad that she had developed multiple organ failure. Her kidneys, lungs, liver, and heart were all failing. On top of that she had a big blood clot in her heart as well as a problem with the ability to clot her bood. We admitted her and began the fight for her life. Initially she responded to our treatment, and I was hopeful that she would get better. However after 3 days she quit improving. On day 4 she began vomiting blood. I had the sinking feeling during morning rounds that although she had improved and was better than when I first met her, that there was nothing more I could do to improve her more. Unfortunately that afternoon her heart stopped during an investigation to determine why she was vomiting blood, and after about 4 hours of trying to rescue her she passed. It will not be easy to get over. This week my patients are less sick, and I find myself almost skipping through the hospital, enjoying the people I work with and enjoying the patients who are getting better.