I Must Be in Heaven

A Surprise Worth Writing About

I am living this year at the Presbytery for the Roman Catholic Diocese of Guyana.   I wasn't sure what to expect;however, it is wonderful.  It is large and airy.  There are three priests living here on the third floor: Pastor Monty, Michael and Andrew.

I have my own bathroom; there is a small kitchen where I have put my coffee pot! And a refrigerator for cold water and beer!  There is a lounge area with a tv that gets specialty channels, including English Football.  I'd be excited about this but Man U lost today.😱

What I am really excited about and usually had to wait till I got home to get any...    [No, not that.]  Hot water.   Funny story:  I had taken several showers and I noticed that I must be getting tougher as the morning shower was not as cold as I remembered.  May have been a brilliant engineer who put the water tank on the roof to get warmed by the sun.  Then, Wednesday I was cleaning up some dishes in the main kitchen and I noticed that the water was hot!  I fell on my knees and would have kissed Father Monty- if he had been there.   Now I don't have to wait as long as I would to have the sun heat up the tank.   Such luxury!

Twins?  It is always good to see Bhiro.
/before my Guyana haircut. 

I have been walking to the Public Hospital; however, I do need to get a taxi to get to Mercy as it is quite a hike ..... however, many times I have had a ride from Bhiro or a colleague.   All in all it is working out well.   And after 9 am, if I do walk my shirt is soaked very quickly.

My New First Year Students

This is my first time ever to be here for Nursing Orientation Week.   So naturally I told them that they were clearly the best batch I had ever seen at orientation.  It never grows stale; I remember, way back when, giving my friend Raj a book inscribed "To My Best Resident of 1979".   He was the only one.

There are a few missing from the collage... but they are coming "Just Now", i.e., sometime ….. some time …..

I did have some time during their orientation to hand out the Tablets to which many of you contribute.  This year's batch was extremely thankful.  I heard several official speeches of thanksgiving.   Many have never received anything like them.   I make sure that they know I didn't buy them and that they are from my family and friends - and some even from people who just want to see me go away for awhile.

The Guyanese people are many things and mostly they are grateful for anything that can assist them.   I too appreciate all your contributions to my efforts here.

I have also started getting all the printing that we need for the course.   I need to do it at the Nursing School as I do not have access to a printer here ..... and my laptop is already programmed to be connected to it.

Another piece of good fortune is that the classrooms have been repainted and extra outlets have been added to keep the tablets charged.  As well, it seems there will be a new high speed router in the classroom.  Holy Smokes! I won't have anything to complain about!!

And the Reason that I Came Early

The Psychiatry Master's Programme that I helped shape and guide through the University of Guyana will now be in a position to graduate its first psychiatrists... if the pass their final exams.    I have come down to help them with the reviews and focus!   They like most students have realized the closeness of the exams, so are studying hard.   I go to ward rounds, sit in on their consultations with clinic patients and spend an hour of so in a more didactic session ..... and then go home for my nap!  I am not used to working all day ..... and really not even a full day.  I am getting back in shape though.

 A mix of medical students and psychiatry residents.

I forget to get a picture of the potential three graduates.

A Real Ethics Case

I do like to teach at the bedside and I have been given opportunities so far.  I was in clinic with Stephen Henry when a surgeon came in because he had an emergency psychiatric consult.  A 73 year old man had been admitted six days earlier with pneumonia, underlying diabetes; he had developed gas gangrene  and needed an immediate foot amputation.   The gentleman had repeatedly said he did not want the surgery; however, a family member from the North had given the surgeon consent to do the surgery .....whoa!   The surgeon knew that was not the best form, but wanted some support for not doing the surgery.

Dr. Henry writing his consult note.

Stephon interviewed the man and he was responsive, though quiet and weak .....   He was asked if he wanted surgery to amputate his foot.    The patient had also said on admission that he didn't want any more surgery, and although it was not documented, most staff had heard him say that.

He lives with his wife of many years who had not been in to see him because she is unwell; there, were no other family members in the country.   His pneumonia meant there was a serious risk in proceeding to surgery and there would be increased pain from the amputation if he survived.

It was the first time there was a discussion on the ward with nurses and doctors about the ethics of refusing a treatment. (And the resident was ready to be a Consulting Psychiatrist!)    I did suggest that they find some way to bring his wife in before he died.  She was there that night.  The end .... almost.

A surgical resident came down to psychiatry the following morning because "his staff" person wanted to know whether, if the patient became incompetent, they could accept the family's decision to proceed with the surgery😕😕.    

I would have loved to think that the love of ethics had blossomed in Guyana, but I know that the driving force was to have a stronger case if the family got upset after he died.  In any case, it has been a good first week.

Thanks for reading.

John

Next week's blog may be late as I am going to the Guyana Interior, Mabaruma, with Psychiatry on Friday and will be back sometime Saturday.