Mr. Wolfe had it right!

Thomas Wolfe wrote a novel titled You Can’t Go Home Again, and the phrase has become a metaphor for “You can’t recreate the past.” For the last three weeks, I’ve worked in the health unit of U.S. Embassy Islamabad, a place where I spent three of the best years of my career, and I’ve discovered Mr. Wolfe had it right!

I was pleased to receive the invitation to cover for a staffing gap in Islamabad. I still have many friends there, both in the health unit and in the city, and it was an opportunity to renew relationships. I was met at the airport by an embassy driver who remembered me and exclaimed, “Madam, you’ve come home!” It actually felt that way, so familiar and comfortable.

But time has not stood still, and the health unit has grown and become even busier than when I was there. Some of the medical resources have changed, and I had to brush up on new consultants and new facilities. I stopped by a free-standing diagnostic center to see a colleague, and we had a cup of tea and cookies, but it became obvious we really didn’t have much to say to one another. We’ve both moved on and don’t share common ground beyond a past fondness.

The embassy facility itself has changed, and I needed directions to new locations of the various service centers. New construction has greatly changed the layout of the embassy grounds. It was almost the same, but not quite; familiar, yet different.

I was busy. There were lots of patients to see, including three patients to hospitalize, while I was there. That is quite a different pace from Karachi, and I enjoyed the challenge of sweeping out the recesses of my medical knowledge and enjoying a vibrant practice style again.

At the end, I boarded the plane to Karachi with some relief. I have a new home, a new routine, and Thomas Wolfe is right. I really can’t go home again.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Spice girl

I have just returned from two weeks in the United States to welcome my newest—and eighth—grandson. He is a great little guy, peaceful and even-tempered, and, considering that his next older brother is a real handful, I hope he stays that way, in deference to his mom.

Lately, I have been corresponding with a couple of people who are interested in what my job entails. I’ve been asked to recount my "typical" day, and I’ve given a great deal of thought about what a typical day is for me. However, there is a big picture to my job, and it can’t be answered as easily as one might think.

First of all, typical, in the sense of the types of patients I see in the clinic, depends a great deal on where that clinic is located. State Department embassy medical units are located worldwide, so health risks differ from location to location. While there might be an allergy or influenza season in any location, acid bug, malaria, dengue or Japanese encephalitis risk only occurs in some locations. However, most patients are seen for basic primary-care causes, just as in a U.S. clinic, but the daily patient load is less, as our responsibilities are broader than patient care.

Patient safety and health issues also vary by location. For example, the risk of gastroenteritis in Southeast Asia, and the community education required to prevent it, far surpasses the risk in Western Europe. When I was in Southeast Asia, evaluation for and treatment of food-borne disease was a daily event. In Prague, I have never discussed food-borne disease with a patient; it isn’t required.

My typical day in some posts might include a visit to the embassy cafeteria kitchen to observe and reinforce proper food storage and preparation practices. Our North American standards of food service are a mystery to food workers in much of the world, and it falls to the post medical unit to enforce the standards we expect.

A frequent task is evaluation of medical resources to use as consultants for the embassy community. In the majority of these cases, a continuing relationship and rapport must be nourished by frequent contact, visits with the consultant and sponsorship of social events. Medical associations in the United States are largely pure business while, in a great deal of the rest of the world, successful business requires social interaction like "tea and biscuits" to keep the relationship active.

In the beginning, I found this very difficult. I was used to calling a consultant and immediately launching into information about a patient. I've learned to be more sensitive to the cultural needs of the practitioners I call, which usually requires discussion of niceties first—"How are you? How is the family? How was your recent trip to X?"—before I launch into the medical conversation.

A typical day for me includes meetings—management, country team, emergency action committee and other committees of various sorts. I may be the medical officer, but my official duties cover many things that aren't medical at all. I admit I’m not a fan of meetings, but they are a necessary part of the job.

If variety is truly the spice of life, I have a very spicy life. Just the way I like it.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.