Cloudscape

This has been an overwhelming week (not surprisingly) for me. I guess I had forgotten how sick many of the patients on the ward are. I am working with the residents on the men's and women's ward this year, last year I only rounded in the women's ward. Also this year I am working with four residents at a time, and last year I was only working with one at a time. One encouraging thing is that the two residents that I worked with last year have shown notable improvement. It shows that doing this teaching is worthwhile. I am facing a few unique challanges here. First, many cases that would simply be referred to a subspecialist for management in the United States (and thus I am less familiar with the practical management of these cases) cannot be referred here as there are no subspecialists. Second, as diagnostic equipment is limited we are much less likely to come up with a definite diagnosis or clear-cut plan for many of these patients. There is much more reliance on judgement and empiric treatment. I have already seen many interesting cases and am learning a lot myself, and it is only the first week.

The setting for this hospital is beautiful, as you can see from my pictures from last year. This afternoon the clouds came in low through the hospital grounds and surrounding mountains creating a very peaceful and mysterious scene.