Apparently I’m Really Bad Luck

Today was a really hard day.  Normally people abide by the rule “don’t mess with a good thing.”  As I described before, we’d gotten pretty good at our system: me triaging and prepping the patients with Anne and Puja doing the exams.  I loved getting to work on my Spanish and truly talk to the patients about their lives.  Puja was really getting the hang of VIAA and maneuvering the patients into the correct position for an exam.  Anne was available for colposcopy or treatment as needed.  It was going well, but today we decided that we should switch it up so that Puja and I didn’t end up getting burned out.  Seemed like a reasonable idea.

In the hospital, providers are often described as being “black clouds” or “white clouds” depending on how the service goes while they’re on call.  Today, I couldn’t help but feel like a black cloud.  It seemed like every time I came out of the room, the lab was telling me about another one of my patients with an abnormal result.  These weren’t borderline, mildly abnormal pap smears, but rather at least two high grade dysplasias with the possibility of being microinvasive cervical cancer in women under 30.  That is in addition to a few lower grade dysplasias and a possible endometrial cancer (AGUS pap, favor endometrial type) – all in the 30 patients I saw!  Instant feedback is a great thing, but it can also be pretty overwhelming.  These diagnoses, of course, come on top of the distressing stories of abuse, violence, loss, and poverty that are commonplace when we speak to these women.  

I couldn’t help but be discouraged, especially as I wasn’t able to recognize the majority of these cases as positive with the VIAA.  Anne thinks this is just further evidence that VIAA is really a poor substitute for a formal cytology program with pap smears.  A part of me knows that she is right, but also worries that it’s also my inexperience.  Again, she reminds me I can’t expect to match her 20+ years of experience after a few days in a Guatemalan clinic!  Good news is that our cytotechs are right here to screen the pap smears and guide our follow up appropriately.  In addition, Mani kept trying to remind me today that finding these abnormal results is a good thing, because we should be able to provide curative treatment for these women that they may never have had access to otherwise. 

Between patients today I learned the Spanish word esperanzar, which means to give hope.  Maybe I need to keep that in mind a bit more.  With that thought, I’m heading to bed now and looking forward to another busy, productive day tomorrow.  And just in case this whole black cloud thing has any truth to it, I think Puja and I will be switching back to our usual roles!