Week 06: The Reused Bottle Marked Morphine

Improvision and intimacy in care

This week unfolded in fragments—pungent smells, jarring sounds, and moments that blurred the line between clinical observation and emotional reckoning. From the ride to the hospital, where Lucy and Tito debated pigeons, crows, and the haram diet, to the wards where diagnoses collided with resource gaps, everything felt heightened. The hospital was not just a place of medicine—it was a stage for contradiction, improvisation, and quiet resistance.

In internal, we stood beside patients whose stories were shaped as much by biology as by circumstance. A man unable to speak after a night of drinking was diagnosed with alcohol intoxication and hypertension. Another, Steven, bore the weight of alcoholic liver cirrhosis, AIDS, and encephalopathy—his abdomen still swollen after five liters of fluid were tapped. Edward’s necrotizing sores, visibly painful, were met with surgical consultation, though the path to intervention remained uncertain.

Dr. Noel’s presence was unsettling. His flirtation with a study abroad student and his decision to show graphic, traumatizing images—especially after speaking on patient privacy—exposed a troubling disconnect between clinical authority and ethical responsibility. The girls left to process with Meredith, a quiet act of self-preservation in a space that often demands endurance over boundaries.

In VVIP, Dr. Rachel’s comment—“a shabby doctor can exacerbate pain”—lingered. It wasn’t just about clinical skill, but about presence, dignity, and the subtle ways care is communicated. The Maasai elder with suspected TB reminded us how cultural distance and incomplete histories complicate diagnosis. Even age was uncertain, guessed by tribal longevity rather than documentation.

Tuesday brought a new rhythm with Chief Ibrahim Samwel. Reserved but thoughtful, he emphasized education and accountability. “You need to address the problem or he will be back in two weeks,” he said of a patient with pleural effusion. His teaching style was gentle, his blanket-folding deliberate—a small gesture of care often overlooked.

Cases in female ward revealed the fragility of systems. Jane, who had received five units of blood across multiple facilities, was now too anemic for hemodialysis. Another woman coughed up pus and blood, her diagnosis spanning pulmonary embolism, TB, and pneumonia. The complexity was staggering, and the solutions—CT scans, referrals, dialysis—often out of reach.

In male, stories of violence and fear surfaced. A man assaulted and forced to drink a mystery substance came in days later, afraid it was poison. The chief explained how fear, not symptoms, often drives patients to seek care. Blood shortages, missed medications, and misdiagnoses were common. Edward’s case remained unresolved, his pain visible but his care deferred.

Wednesday in maternity offered a different kind of intimacy. Honey applied to C-section wounds, wooden dowels used to monitor fetal heart rates, and mothers waiting in shared spaces for spontaneous labor—all spoke to a communal, resourceful model of care. The hospital gowns, likely pushed by Italian influence, marked a shift in presentation, if not in practice.

Thursday returned us to internal, where chaos reigned. A patient vomited without warning, interns vanished mid-rounds, and Edward’s condition remained stagnant. Rachel retrieved his relative after he claimed hunger, and Edson—half joking, half serious—said, “Poor? You are the whites.” The layers of power, perception, and responsibility were palpable.

Still, amid the disorder, small acts of care persisted. Edson rearranged discharge papers, called in favors for Edward’s debridement, and cracked jokes to lighten the weight of the day. “I should be a magician,” he said, watching a convulsion stop and then resume. It was gallows humor, but it kept us afloat.

This week reminded me that care is not always clean or linear. It’s messy, politicized, and deeply human. It’s found in gossip at the canteen, in the rearranging of blankets, in the refusal to ignore pain. It’s also found in the failures—in the interns who left early, the images that should never have been shown, and the patients who wait too long for help.

To witness all this is to carry contradiction. To keep showing up is to practice a kind of care that isn’t always clinical, but always intentional.