Internship in Africa: Death and Life

Fresh out of medical school, while applying for a residency in internal medicine, I spent a year in Lubango, Angola. This was my internship, to be followed by the United States' version the next year. But in Africa, I think I learned to be a doctor. In Africa, I learned about death and life.

During my first week of internship, a 61-year-old man with cerebral malaria died. He had a large and devoted family, and I had spent significant time with them. It was clear that he was the well-loved patriarch of his family. In the first couple of days, we joked and laughed; in the last couple of days, we were more somber as he became increasingly confused. The story of his death from the night nurses sounded consistent with a massive pulmonary embolism. I had ordered mefloquine for the patient after he had received intravenous quinine, not realizing at the time that this can cause fatal arrhythmia. He received only a fraction of the dose many hours after the quinine, but I could not be sure that my error had not caused the patient's death. I thought of the patient's wife, whom I had gotten to know well. I thought of their 2 grandchildren, whom I had treated for a rash and for simple malaria. I thought of their pain. I thought of my inadequacy and the consequences of mistakes. I thought of how I was not fit to be a doctor.

A few days later, while I was writing a progress note, a nurse shouted, “Doctora, esta paciente está a vomitar!” (“Doctor, this patient is vomiting!”). The patient was a 30-year-old woman with a beautiful, though emaciated, face. She had arrived 3 days earlier, with ascites like I had never seen before. Based on her story, basic …