On One's Purpose

(Apologies for not having any photos! The internet speed here has been prohibitively slow, but I'll keep trying!)

Today was my first day at the hospital. Although I arrived in Khon Kaen yesterday, my "orientation" was really just a drive-by of the hospital and thankfully, the international medicine coordinator picked me up this morning so that I didn't have to remember the way to walk to the hospital.

I am the only American student in the Pediatrics department, but there is a Laotian hematology fellow who got charged with the task of translating a lunch meeting for me. Afterwards, he asked me,

"Why did you choose to come here?"

It's an interesting question, I guess, because unlike he and a Cambodian told me, they are here for the opportunity to learn about more advanced treatments and to get the education their home countries don't offer. As a US doctor, the purpose of my travel is a little bit different. I am here primarily to see what differences--good or bad--exist between the Thai medical system and our own. Specifically, I am here to learn how integrative and alternative medicine is incorporated culturally and medically into treatment. I even (apparently) get to stay overnight at a wat, as part of a two day observational and teaching session with a monk.

The Laotian fellow seemed satisfied with my answer, but the more that I have the opportunity to practice medicine in other countries, the more that I am struck by the similarities--not the differences. Even though epidemics, treatment choices, and resources will vary by region, some things are inevitably the same. The humanistic side of medicine never changes, regardless of language or cultural barriers.

This morning, I joined the residents and fellows for pediatric hematology/oncology rounds. I became probably the 10th white-coated member moving en mass from bed to bed, reviewing labs, making a treatment plan, and talking to the parents.

When we got to the bedside of an ill-appearing 5 year old, the pediatric heme/onc attending gave me the patient's history. She was presenting with three weeks of intractable fever and bone pain and had had  generalized lymphadenopathy on physical exam. Her labwork showed a left-shift in her WBC and she had blasts on a peripheral smear.

She most likely has leukemia.

Another hematology fellow pulled out her phone and showed me an image from yesterday's peripheral blood smear. The pink and purple blast cells looked unmistakably the same. The envelope opened by the medical student with outside lab results folded neatly, listing the concerning numbers on her CBC, was also the same. And when the oncologist appeared at the bedside, calmly and matter of factly explained to the father the risks and benefits of the bone marrow aspiration that must be done today, it was all identical to a scenario I've witnessed countless times in the US.

As the oncologist walked away, the patient's father, who had been resting his elbows on the patient's bed, began to cry. Covering his face with his hands, he leaned forward, appearing to hold the weight of his whole body in his hands, and wept. The pediatric heme/onc team hadn't yet left the bedside, and the attending put her hand on his shoulder and said something softly. I don't know what she said, but maybe it was a, "We are here if you need us" or "I'm so sorry" or "Is there anything I can do for you right now?" There are a number of pithy things that we say to parents in their moments of grief in an attempt to be helpful and comforting. As the team started to walk away, the hematology fellow appeared with tissues in his hand. He hastily pushed them into the hands of the father as the team disappeared.

I guess that's what strikes me most about international medicine. I might receive an explanation from the resident about why hydroxychloroquine is always used concurrently with steroids to treat autoimmune disorders (because of possible clinical contributions from malaria) or watch with surprise when the ultrasound images presented to the attending are Polaroid-style photo print outs taped to a piece of cardboard. But in the end, my purpose doesn't change. I'm here to learn, to doctor, and to help. It's all the same.