Maskalyk in Ethiop

Reading Life on the Ground Floor: Letters from the Edge of Emergency Medicine (2017) by James Maskalyk. It flips, somewhat clunkily, between his work as a Toronto ER physician and volunteering at Black Lion Hospital in Addis Ababa. Working in dangerously uncomfortable adverse conditions in the Third World is not everyone's cuppa. See prev adrenajunkies David Nott or Stan Brock.

Maskalyk also pops in reflections while minding his recently widowed  grandfather at the old trapper's cabin in Alberta. On the last day of one care cycle there, Jim does triage on The Meds. As a doctor, he knows about NNT [number needed to treat, whc prev on statins - Ringer's - prostates] aspirin for heart-attack: 2/100 users benefit. BP meds 1/100 benefit. At least aspirin is cheap-as-chips. The old man is in his 90s, for the last 20 years, at least, each hospital consultant has added a drug (or two) which they believe will 'work'. Patient, GP and family stick with them in case there is a benefit they, unexpert, might miss. Or, esp if nobody is paying, the drugs accumulate in a drawer unconsumed . . . because they have adverse side-effects. The list spools bigger regardless - never gets shorter.

Pat the Salt, my aged FiL, has gone to his rest nearly a year now. He was rarely sick and never went to the doctor until he went, reluctantly [resistance is useless] for a check-up in his mid-80s. They found he had high blood-pressure. At peak he was on 10 different meds and supplements each day. Active intervention by his adult children prised him off two from the list. Jim's grandpa has a qualified advocate and they go into visit the GP together to simplify the drug list. Then the grandson sets off for the trauma of strangers in Addis . . . where there are, to the nearest whole number, 0 drugs available for each waiting patient. So much unfairness.

The book - I like this touch - is sliced into an alphabetical list of chapters: A is for Airways; B is for Breathing; C is for Circulation; D is for Drugs . . . Flow . . . Hurt . . . Kind . . . Love etc, etc. I suspect that this conceit contributes to the reader's feeling of clunk: O for blood group scrapes enough copy to warrant a chapter by wrenching material from elsewhere in the story. According to the catalogue, Maskalyk's other book about medicine at the edge Six Months in Sudan (2009) was sitting on a shelf in our local rural part-time library. Last Tuesday, being in town with a burst wheel-barrow tyre, I used My Open Library [we were inducted a couple of years ago] to self-serve it for me.