On the first day in Addis, when Rick went to check on a patient who had been scalped by a hyena, I asked Dan if one of the interview questions for his position was whether he had ever actually seen trauma. I realized how problematic it would be for a fellow to get here, only to run away screaming the first time a gruesome case presented itself. He replied that although he had never seen a trauma patient before, he felt he could handle it after his pre-med studies. “Good,” I thought, “then he will be prepared emotionally for what he will see when working with Rick.” As we joined Rick for clinic the next day I learned that I, however, was not.
The first two days in Addis all of the fellows joined Rick as he held clinic and made rounds at several hospitals as well as the Mother Teresa home for the destitute. Rick is a great teacher, and I really enjoyed watching over his shoulder as he explained the x-rays of spine patients and allowed us to listen to the irregular heartbeats of the heart patients. However, there were two patients who really struck a chord with me. The first was a woman in her 70s who was helped in with the aid of her children and had a tumor that took up one side of her face. “Something should have been done about this a long time ago,” I heard Rick telling someone on the phone. A little while later, a teenage boy, clearly distraught, was carried in over a man’s shoulder and after about 30 seconds, Rick diagnosed him as having congestive heart failure. Rick urged the family to take the boy to the emergency room immediately or he would die. Before leaving, the family explained that the boy had already been in the hospital for an extended period of time only just recently. What struck me with both patients is that if they lived in the U.S., neither would have been in such dire predicaments. A close family member of mine had congestive heart failure years ago, and luckily he went to the hospital early enough and is now fine. The boy here will likely die of his heart problems. If she was an American, the old woman would probably have seen a doctor long before the tumor ever presented itself, and would never have faced such an issue. Here, however, she will probably become more and more debilitated as the tumor continues to grow.
The following day was Yom Kippur, the Jewish holiday of repentance, at which time it is believed that the names of those who will live for the next year are inscribed into the Book of Life. Rather than spend the day at synagogue, I decided to accompany Rick to clinic because I felt there was no better way to feel thankful for the life that I lead and repentant for the wrongs I had committed in the past year. As we made our way through Mother Teresa’s, men crowded around Rick. “Dr. Rick, Dr. Rick,” they would say, hoping to get his attention so that he could help with their tumors, bedsores, and crippled legs. Watching these men, desperate for help, I thought to myself, “thank goodness I am not going into medicine; I would hate to have to make these decisions of who can be helped and who cannot.” Then I was struck with a thought. If I pursue a career in human rights, as I plan to, wouldn’t I be in the same position? There are millions of people suffering all around the world, all of whom need attention and aid. Yet, not a single government, the UN, or NGO (non-governmental organization) can help all those in need. At some point or another, whether it is due to lack of resources, donor interest, or political opposition, a decision has to be made to help the suffering of some over others. Without a stethoscope, I may avoid having to look people in the eyes and tell them that I cannot help them, but I won’t be able to escape those tough decisions.
After clinic was finished, we went to synagogue for the concluding service of Yom Kippur. Reflecting on the day while the call to prayer echoed out from the mosque across the street, I thought about how I had literally witnessed the Book of Life being inscribed throughout the past two days. The teenage boy, who will receive free surgery to correct his deformed spine that left untreated, would eventually crush his lungs, will get another chance at life. Yet the adorable three year old, who was bursting with energy and ran up to me to ask in Amharic if we could be friends, has extensive heart issues that Rick does not have the resources to correct. It is one thing to pray about being written in the Book of Life in a language that I only vaguely remember from Hebrew school, but it is a whole other thing entirely to watch, with your heart breaking, a mother quietly sob with grief after hearing that her chatty little boy won’t have the chance to grow up.
A Ferenji in Gonder 
Your blog is very interesting. I look forward to reading it throughout the year and wish you good in Addis! Barb Bayer