EIQ Δ

α) “I think we should get an EKG on this patient…”

--blank stare.

β ) Pouring a bowl of cereal for breakfast while Blessings is in our kitchen

--a long stare.

Γ ) “I am Dr. Elizabeth Hutchinson. I am doing an orientation here (in the Emergency room) for two weeks.  I am happy to help in whatever way I am needed but I need a bit of guidance to see how things work.”

-- Chechewa words exchanged among the group followed by laughter. 

Δ ) Since moving here I have realized something about myself.  In my day-to-day life I rely heavily on a well-developed Emotional IQ (EIQ).  This realization has come out of an appreciation of the delta: an increment of a variable —symbol Δ.  Allow me to illustrate the vast delta between my EIQ in Seattle and my EIQ in Malawi.

α ) I have been working in the Emergency room for the past week (my 4^th of 6 weeks of orientation). The Emergency room here is called “AETC” or Accident & Emergency Trauma Center.  This great hall of a department welcomes patients from all over Malawi who have an undifferentiated medical concern from minor to severe.  There is an elaborate triage system involving patients moving through a series of check points at the door, registration, triage, nursing assessment and then they are seen by a medical provider.  As is the case when you are standing among a group who speaks a language that you don’t understand, you can see that thoughts and emotions are being communicated but you have little idea about what is being said. Looking on this scene on my first day, I could see many rows of benches arranged in different locations in the hall.  I could see some people walking around in scrubs with stethoscopes and other people in white uniforms with small white hats on their heads. People were moving in barely recognizable patterns, caring for patients behind rooms made of hanging curtains.  I could see single sheets of white paper with name and ID labels on the top. I saw people with bleeding wounds, people sliding off their bench onto the floor, I saw pregnant women grimacing, and cachectic people coughing.  I saw people who appeared well and were chatting and other people who were being held upright by their guardians.  Not only the language was unrecognizable but also the system.  My task was to see patients – because I am a doctor after all.  I quickly realized that in order to see patients I needed to know something about the bench system, the medications and lab tests available, a way to communicate with patients and the people in the scrubs who were unidentifiable to me.  After a series of futile attempts to see patients on my own, followed by attempts to “help” one of the medical providers (who did not want my help, and did not know what I was doing there), followed by asking the nurses about the bench system and how things worked, I finally came upon a patient who spoke English.  A 62 yo woman who was having left sided chest pain for several hours, radiating to her arm and jaw and she was nauseated and short-of-breath.  This is a language I understood and I understood it to be an emergency, a heart attack.  I asked the nurse how I could obtain a blood pressure, some oxygen, aspirin and an EKG. She told me that those things are only available in “resus” and walked away.  The next challenge--to find “resus”--involved questioning a few other people until I made my way to another cluster of rooms which were teaming with nurses, students, people in scrubs all attending to patients who were clearly sick.  There was an open bed and I asked if I could bring my patient back for evaluation.  I relayed the symptoms to the nurse.  In my experience these symptoms switch on the green light for things to start happening quickly.  Unexpectedly, instead I received just a blank stare.  “Maybe she has malaria” said the nurse after a long minute of looking at me from head to toe.  “Perhaps she does, but I think we need to rule out MI first with an EKG” feeling as confident as I have yet since coming to Malawi.  After getting the okay to bring her back, I put the woman’s arm around my shoulder as if I was helping a tired friend to the finish of a marathon and brought her to “resus.”  With my plan detailed on the piece of white paper, I set it next to the nurse and asked politely, “does this look okay to you?”  Another stare and she nodded her head vertically.  I left the patient and went back to the neighboring room where there had been a trauma thinking that maybe I could help while my patient was getting her O2, aspirin and EKG.  About 10 minutes later I came back to find my patient in the same position as when I had left her.  If I were to detail the next 15 minutes you would live along side me in the discomfort of “what am I missing and why isn’t anyone talking to me or my patient?”  I figured out that it was me who should do the EKG… using leads without stickers or gel…and it was me who was to figure out that the O2 machine was in a different location and being used by another patient. The EKG showed up on the screen and I took a picture of it because there is no paper to print it out.  I was relieved to see no ST elevation; no Q waves…no heart attack.  Feeling the pressure to get my patient out of the resus room, I communicated to the nurse that the patient could go to “short stay” where I was going to do a malaria smear and re-assess. With the same stare I had received 45 minutes earlier she said in a matter of-fact way “patients here don’t have heart attacks.”  This type of interaction occurred over and over again for several 9.5 hour days in succession at AETC and will continue again next week.  Many feelings were mingling around in my brain.  Of the feelings that I had, the one that is “wow--I have a lot to learn medically” was the most relaxing feeling.  The other feelings such as “I am a burden to the system, I don’t understand how things work, I can’t tell if people hate having me here or not, I am not sure who is who, what kind of training they have or if I can ask them for help.  Above all was struck by the stillness of the place.  Patients in pain do not make noise, medical providers dealing with an emergency do not seem stressed or in a hurry, and people respond both positively and negatively with stares.  The feelings that are a burden to me now are not the feelings of medical inadequacy but rather the feeling that my emotional intelligence has not been trained in this culture.  In the past, I have said in many situations ranging from medical student interviews to conversations with friends that being a doctor is much more than what you know but this experience is proving that to me.

β ) Blessings has continued to be a very important part of our lives.  His singing voice continues to bring us peace in the mornings and resilience continues to inspire and teach us.  He is staying near us now and we see a lot of him. He works for us, yes, but he is also becoming a part of our family while we are here. Micah and Blessings have a special bond and laughter comes easily when we are all together—which is good for our souls.  As per my routine, I had poured myself a bowl of cornflakes for breakfast.  Blessings was doing some dishes and looked with great interest in what I was doing.  His look of interest was more than a passing glance at my breakfast choice; I could feel that he was deep in thought about something. I had time to try to interpret his look—as I think you would all agree is the emotional intelligence’s natural response when someone is staring at you.  Perhaps he wants me to offer him some breakfast, perhaps he is looking at the gigantic box of cornflakes that costs as much as a day’s wages for him, perhaps he is wondering how many more dirty dishes I was going to make for him, perhaps he wants to discuss cornflakes.  So (subconsciously, with my well developed emotional intelligence) I cycle through the following thoughts of hospitality, guilt, social justice issues, how to interact with someone who is washing my dishes for me who is also my friend with whom it would be natural for me to discuss cornflakes.   I looked back at him questioningly.  In response to my glance he asked, “How do you make those?”   

I was not only off the mark… I was way off.  Did he really think that I had made the cornflakes?  Yes.  He did.  I have developed another neural pathway for what a stare might mean here.

Γ )  The final anecdote helps symbolize the reality that am here, 100% committed to the work that I am here to do. I know I am in the right place: this has been confirmed spiritually, emotionally, intellectually and practically (we are not going to get on a plane anytime soon.)  I am incredibly grateful for the collegial relationship I am making with my Malawian family doctor counterpart. I can see the vision that I held before coming gradually unfolding.  And beyond what I ever expected or imagined possible, I am strengthened by the support of friends and family in Seattle.  I am doing what I can to be competent, confident and carry on even when things are challenging.  At the same time, I do not take myself too seriously.  Along with learning the delta between my EIQ in Seattle and my EIQ in Malawi, I am learning that there is abundant grace in this country.