I am back in a normal hospital ward for a change, and it feels so relaxed in comparison to the weeks I have spent in the ICU and in the COVID wards. It turns out this is the week of ascites and liver failure. I do not recall ever having so many patients with liver failure at the same time in Kijabe. Alcoholism, Hepatitis A, and still to be diagnosed causes for liver failure fill the wards. I have been opening my computer and looking up possibilities for liver failure and ascites to try and solidify diagnosis. In addition heart failure, intestinal bleeding, and bone infections round out the service.

I am glad to be on the wards, because we have more clinical officer interns and medical officer interns present to know and to train. Frequently I find myself pushed to improve through their questions. This week I am working with one specific intern who begins many of his questions with the phrase “with all due respect”. When I hear that at the beginning of a question, I know that I have possibly missed something and that my intern is feeling pretty secure in questioning a treatment plan. This intern has me on my toes, and it is good. He makes me look into why I am doing some treatments in the manner I am doing them. Have I gotten a little relaxed in a resource limited setting? Am I still pushing for excellence in the care of our patients? He knows what the book says, and he wants to know why what we do does not always match the guidelines. Often there are reasons that are sound because of the financial and logistical constraints of the hospital, but other times I am left with the thought that I should be pushing harder for increased levels of care. In this way it is a good push, despite the discomfort of being questioned. Even as I sit typing the post, I am wondering if all of the internal medicine consultants should get together to see if we should go over our guidelines again to see if we can become less constrained by our resources and push for less limitations in our ambitions.