Math is relative.

It's 3 am. Perfect time to blog, right? With the baby sleeping through the night, I can't sleep anyway.

I want to write about work, probably not for the last time. I'm currently a burn and trauma visiting research fellow in Lilongwe, Malawi, for the upcoming academic year. Kamuzu Central Hospital, one of the country's 4 central hospitals conceived of as tertiary care referral centers, is a half hour's walk or 5-30 minute drive from our house, depending on traffic. This, taken from the hospital website, is what you see entering the visitor parking lot:

According to dictionary.com, a "hospital" is "an institution in which sick or injured persons are given medical or surgical treatment." But that's the factual definition; the cultural load of a word is where stories lie, and where misunderstandings arise. For example, if I free-associate on the word "hospital" for 2 seconds, I come up with: "white, clean, nurse, love, drugs, pain, death, friends, disinfectant, recovery, fear, babies, surgery, pager, large building, cockroach, elevator, work, hope, despair, emergency room" etc. Your list will be different. The list of a patient will be different from that of a doctor; the list of a woman who delivered a healthy baby different from a son who's just put his mother in palliative care, the list of a Malawian patient different from that of a Malawian doctor, of a Polish patient from an American one, etc, etc, etc. Language operates on an agreement about the factual underpinnings of itself (that is, word definitions), or else all speech would be a subjective hodgepodge of un-translateable experience and we couldn't communicate at all. One of the things I love about traveling is that it forces you to reinterpret and question those factual underpinnings of words and concepts which we take for granted in our own culture.

Hospitals are frequently described in terms of the number of beds and operating rooms they contain. Those numbers help to illustrate a hospital's volume of patients, its importance and function. And they should be easy enough to get, right? Count the beds per unit, add up the units, and voila. Ditto for ORs. But KCH is variously described as having anywhere from 700-1200 beds, depending on the source. How can that be? Math, after all, is supposedly universal. Does 1 bed magically become 2 beds, or half a bed, depending on who's doing the counting? Can Malawians not count? Are they so bad at keeping records that they don't even know how many beds one of their flagship hospitals contains?

The answer, of course, isn't that simple. For starters, the definition of a "functional" bed may include the one placed in the outdoor hallway that connects the rooms, which aren't technically part of the hospital census but which are routinely used to increase the treatment space of a hospital that was built for a much smaller population. Like this, taken from the Malawi Project website:

Next, "functional" beds aren't, when they're in a unit that's under construction. For example, all the main operating rooms at KCH are currently closed for renovation. If you need your leg pinned with orthopedics, it will happen in the dental operating room; if your baby needs a stoma because of her imperforate anus, she will receive it in the burn OR because the main ORs are just, simply, closed until further notice. So I can't really tell you how many ORs there are at KCH at this time, nor when the main ones will be available again.

Finally, I bet that in your free association on the word "hospital" you did not picture a bed containing more than the patient, and neither did I. At KCH, they do. In the privileged wards, like the burn unit, it's because the whole family might sleep in the same bed with the patient. In the most overcrowded wards--the pediatric ones, for example--it's because there are multiple patients per bed. So depending on how you count, one bed does become two, or three, or maybe even 4.

The thing is, you don't need your own bed to heal. We expect it, because that's our cultural and socioeconomic norm, but your healing isn't contingent on private sleeping quarters. OK, maybe if the patient next to you has tuberculosis or leprosy, that may not be too conducive to health, but in general, a single bed occupancy could be thought of as a luxury; especially when you consider all the other things we take for granted. Like a trained surgeon, or morphine for dressing changes, hot water, air conditioning, blankets, food. But more on those in another post. I do have to get up in 3 hours.

This entry was also cross-published with minor changes on my travel blog, malawijo.blogspot.com

Hello, from Paris; or an utterly disorganized hodgepodge of introductions and Father's Day musings

Now doesn't that sound fabulous? I'm sitting on the terrace of the one-room-with-a-kitchen-and-bathroom apartment we VRBO'd for this week, and writing my first blog while the children and husband sleep off their jet lag. And I'm wearing all black! My former poetry major self rejoices. My surgical ego wants to know: What's next? Is this the right thing for me? For my family?

I'm a PGY 4 in general surgery who took the optional 2 years for research, and this June we are on our transit to Malawi, Africa for the second of those years, where I'll be doing trauma and burns research. First year was an MPH and part-time clinical burns work. We are on a stop-over in Paris to visit my brother in law, who's a French citizen and hasn't met his newest nephew yet. My kids are 6, 4, and 7 months. The oldest worries that she won't make any friends in Malawi; the middle recently confided that he's worried about being eaten by a crocodile; only the youngest continues to smile at me every time he sees me with that untouched, utterly trusting smile of an infant who hasn't experienced any parental disappointments or discipline yet, and who just knows that I'm the best thing ever.

Most people who hear that I'm moving the whole family to Africa for a year divide into two reaction camps: one thinks that I'm crazy, period. The other thinks that I'm crazy, but mixed in is a healthy dose of jealousy for this opportunity. I totally agree with both. I'm so excited to have this incredible chance to travel to a country, make a difference and have it count towards some sort of a career; but it also reminds me that I'm insane and that at this point, that's unlikely to ever change.

But I think the truly insane choice was to have 3 children as a surgical resident in America. Next to that, moving them to a developing country seems small potatoes. As all working mothers do, I beat myself up daily for my inability to have it all and have a shred of energy left; I resent a society that reveres "perfect motherhood" while being unable to define what that is and unwilling to support it with policies that make sense for all mothers, working or not; I sometimes resent myself for my inability to be satisfied with "just" raising the children--why do I have to be a surgeon, of all things?--and then I have to laugh, because for this gender-role bending sworn feminist, the idea that one could be jealous of the stay at home side seems preposterous. But it's there.

Any successful insane person has someone as a rock. My parents have always stood by me, in their way, even though they don't understand how I make most of my choices and don't always support where they lead. But my husband--this is the Fathers' Day part of this post--he's my rock, or some would say, my enabler. When I go to work, he works at home, and faces the same isolation and loneliness as a stay at home dad who's not a "stay at home dad at heart," as I do as a surgical resident with kids who actually enjoys both work and kids. At some point I will unpack that statement but it won't be in this blog. Anyways, he makes me and us possible, and I am forever and utterly grateful to him for always in the end coming around to supporting this craziness that I call my--our--life. I work hard, and I get the credit--but he works just as hard, if not harder, and it's not always appreciated or acknowledged. There are "fathers of the year" who get kudos for making it to their kids' soccer practice--and that's important, and legit, and awesome--but he changes diapers, makes dinner, buys groceries, makes sure the kids are on the school bus in the morning and remembers to pick them up after school--and he never complains. He puts up with a wife who's more like a bad college roommate, who is rarely at home, never cleans up her laundry, eats all his food and sleeps most of the time when she is there. He's the steady to my mercury and the rock to my water, and together we seem to make this circus work somehow, if sometimes only with duct tape, some sticks and a prayer. Here's to all of medical moms everywhere--may you find your rock, or if you've already got one, may you always cherish him or her. Happy Fathers' (or Partners') Day!