[Photo: L2R: Linda, Catherine our former guard and housekeeper, Joseph her son who wants to be a doctor and whose tuition etc. we are paying, and Jordan, Linda’s son, an aeronautical engineer visiting from Poland where he lives and works.]
Drawing A Line
21 May 2017
The 4th and 5th year medical students had end-of-year integrated exams this week. For the 5th years, if they pass and have completed all their requirements, they are physicians anticipating their internships.
My part was grading two psychiatry Short Answer Questions for 70+ students, which seems like nothing but took about 6 hours. Seven failed when the two scores were averaged. It is hardL2 for me to fail a student, knowing how difficult many of their lives are and how the added expense will be a huge burden to them and their families. But they may need to repeat the psychiatry rotation if they do poorly on the other parts of the examination, as they’ll be dangerous out there.
The other piece of my work was conducting an OSCE (Objective Structured Clinical Examination). The 5th years had 16 stations to complete; psychiatry had two stations, complete with actors. Mine was an actress whose script called for her to portray a woman with Bipolar Affective Disorder, depressive episode. She was an experienced thespian and her portrayal was so convincing that my mood sank as the sun moved across the sky and she repeated her tale. A few students didn’t do well but most were adequate and some outstanding. I was struck with the creativity of their names as I looked down the scoring sheet: Lovemore, Innocent, Precious, Senior, Fatsani, Yamikani, Wongoni, Ronald, Antony, and MacPherson. Linda rented her car from a man named Godknows. Prince Goliath was one of our 4th year students this year. Honesty, Kindness, and other virtues are common names, as if you could imbue those qualities in your child through naming. We all do it, to some degree.
I was completing a child custody report as an Amicus Curiae (Friend of the Court) a couple of days ago. Since I needed to use the internet to deepen my understanding of Parental Alienation Syndrome, an argument being advanced by one party, I was working at home. For reasons unknown to me, despite having a 3 story building dedicated to IT, the internet at the College of Medicine is terrible. Slow, often non-functional. But that’s another rant… I shut the screened front door gate (Security, you know, locked metal gates and doors. It sounds like East Oakland without the guns.) and went into the kitchen to make a cup of tea. When I returned to the living room I heard some scrabbling and saw writhing around on the inside of the door screen what I first imagined was an iguana. Many small skinks and gekkos inhabit the interior and exterior of the house, as well as large lizards who live in the trees. When I put on my regular glasses I realized it was our mongoose trying to get out through the screen. Damn. Before my eyes flashed the Google Image of a mongoose hanging onto the neck of an immense king cobra while the latter looked down at the mongoose in terror. I was brave and as I approached, he ran behind the couch. I outweigh him by a factor of 65x, at least. I gingerly opened the screen door and sat down at my computer across the room. Soon Mr. M. sallied forth, clearly not as scared as I was, and walked out the front door onto the porch, where he peered around a bit while thinking about his next meal. Then he disappeared into the garden shrubbery. Gekkos, mosquitoes, flies, fruit flies, cockroaches, the occasional sparrow, and large flatty spiders I can roll with in the house. A mongoose? Emphatic NO!
Having finished the report, I took it to a stationers and had it copied and nicely bound for about 75 cents each. Then I took all three to the courthouse. For some strange reason the guard at the main gate made me leave my bike with him, although everyone else drove their cars up the long hill to park at the courthouse. Another reason to get a BMW, in addition to making Psychiatry a more attractive-seeming option for the medical students. Stefan and I also need to wear shoes that take a glossy shine! I entered the courthouse and asked a woman at the front desk where I should take the report. She took it and began reading. Another woman at the desk joined her and they both began to take in the details, including accusations from both sides of pretty heinous behaviors. Despite the fact that it said CONFIDENTIAL in large letters at the top on the first page. I realized they were into pulp fiction and snatched the report back; a man at the desk then told me where to deliver it on the 2nd floor. The women clearly had no idea where it should go but found the narrative gripping. Boundaries, boundaries. I don’t think I’ll do another custody evaluation; the contested situations are very toxic and time consuming. There is only so much I can do here.
A woman came into my office in the clinic this week, sat down, and began talking about her depressive symptoms. A man entered with her and was sitting next to her on the bench. After a few minutes I asked her, “Is he your brother or your husband?” Turns out she didn’t know him and had never seen him before. He just came in the room with her. I laughed and ushered him out. The windows of the office face a parking lot busy with pedestrians. Occasionally one will step up to the open window and put his face in, listening, and I’ll have to ask him to leave. Of course, the wall between my room and the busy nursing office stops 3 feet short of the ceiling, so confidentiality is a futile hope. Perhaps that is why Malawians tend to speak very softly. I always thought it had to do with some inhibition of their assertiveness but maybe it’s a recognition that everyone will know your business if you don’t protect it.
Linda and Jordan, her youngest son, have toured Malawi from south to north, driving through many lovely areas to Karonga where she was a PC volunteer in 1979-’81. They’ll return today. I contracted a cold, with sore throat and gushing nostrils 3 days ago and I hope it ends soon. I’m imagining how I’d feel to be ill, seriously ill, and have no one else around. I had a bit of that with my lung cancer, although my family took good care of me. However, when you are the one with the cancer, there is an aloneness that isn’t eased by company. “Do not go softly into that dark night.” This time it was good to be left alone. But I feel for those who are alone and seriously sick.
DT’s (If delirium tremens is an acute, often irritable, confusional state, DT seem like apt initials to describe him.) blundering about is so worrisome. Embracing Duterte’s vigilante approach to drug abuse is so evil and so counterproductive. Cost-benefit analyses of the War On Drugs (Begun under Richard Nixon 48 years ago, it costs the US Government—us, we taxpayers—many, many billions per year!) demonstrate the primary beneficiaries to be law enforcement and its associated industries (guns, planes, boats, the private prison industry, various instrument makers, dog trainers, etc.), not to mention politicians elected because they are “Tough on Crime”. Street drugs are more plentiful and inexpensive than they have ever been. Generations of young men have been introduced by the hopelessness of prison to pursue a life of crime. Obama’s gradual move to approach substance abuse as a public health, rather than law enforcement, issue, a la the Portuguese Model, is being dismantled and punitive sentences are being reassigned, despite Portugal’s great success and our total failures. Generally, a few exceptions noted, people don’t come out of prison more prepared to lead a productive life in our society. It just doesn’t work. Why are we so reflexive? Do something bad (use a drug), pay heavily for it (long prison time). Of course, the numerous creative and extremely successful prison pilot projects demonstrating significantly decreased recidivism if you provide prisoners with skills, training, and college education, as well as hope for their futures, die. There are powerful forces wanting to scale up the entire operation as it is. Follow the money. And read Daniel Berehulak’s article:
in the NY Times to get a sense of what DT suggests is a laudable model. The slaughter of innocents. Not only is he a fool and a bully and a liar with the attention span of a flea, we have chosen a very cruel and self-centered man to lead us. He is correspondingly dangerous.
As I went through town yesterday I saw a skinny, immobile, old woman in dirty clothing sitting on a dirt path with her hand outstretched, begging. Shortly after, I saw a young man in ragged clothing striding down the pavement with one boot on and one bare foot. I felt a pang of many emotions for each of them, then looked about me on the street and realized that most of the crowd were a few steps away from a similar level of poverty. I don’t want to overlook it; I think the constant exposure threatens to numb me, however. The head of one of the clinical departments at the College of Medicine mentioned to me as we both gathered to administer the OSCEs, “Our lives aren’t very long here in Malawi, not like in the US or the UK.” I am a freak of nature here at my age, in a way, and even as I am anxious about losing my physical capacities, to point out my age (in my condition) is more than rude. I’ve certainly thought about the struggles of The Poor, but never felt it so fully. It is sobering to think how it would be to do little pick-up jobs all my life, sometimes having food, clothing and shelter, sometimes not. And, worse, not being able to provide for my children. And never a sense of security.
I’ll rise from bed, eat a bit, tidy up the house, get Jordan’s new shirt from Kenny the tailor, pay the water bill, buy a solar-powered flashlight and a plastic chair for the guards, and find a filet of beef to grill for supper. My nasal flux is subsiding, my throat isn’t as sore. It is nice to lie in bed and read and write, however.
A psychiatrist in Malawi 