Reflections from Vietnam: On the Ward

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Written by: Brian Sheridan

Vietnam 2026

Weekly Reflection #1

Reality breaks when the work begins.

Every medical professional who has worked multiple shifts in a row knows this. Location

becomes the defining trait rather than the passage of time. For that reason, I will describe

my week’s experiences in two settings; on the ward and in the operating theatre. This

separation reflects the way many medical professionals, myself included, compartmentalize their work.

The ward rounds began at the end of morning meeting. Dr. Quốc came and sat beside me, opened his tablet with keyboard attached, and began pulling up patient cases. We went through several cases from the previous day and sat a moment before stepping onto the ward. He asked me questions about where I was from, I pulled up a map and showed him. I asked him and he did the same. That was enough to begin working together, although we would get to know each other more in time.

We stood up and began our shift. The ward halls were hot but breezy, with the walls of the hospital being composed of vertical iron bars against the open air. This airflow made the rooms and halls less oppressive compared to the inner portions of the hospital. The ward was oriented much like a surgical ward would be in the UK, where I had trained previously. It was distinctly not how a ward or “floor” would be oriented in the United States, however.

There were no individual rooms, but rather one large room with many beds. The constrained space necessitated beds being placed in contact with one another. Patients and their families were tightly packed together. Assessment by the healthcare team required brushing past other providers and patient families. The first four patients we saw had unique complaints each.

One had presented for stenting to drain the biliary tract following surgical removal and

subsequent stenosis of a previously placed stent. One presented for the placement of an

external drain due to stricturing that occurred five years after the resection of a

choledochocyst, a congenital anomaly that is exceedingly rare in the United States. One

was there for a liver segment resection due to high burden of intrahepatic stones, once

again something that is not often encountered in the United States. One presented due to adenocarcinoma of the head of pancreas. He was scheduled to receive a Whipple

procedure but first required nutritional support due to severe malnutrition.

Wednesday, Thursday, and Friday followed similar patterns. While discussing the details of each case could be academically illuminating, it is not my purpose to detail case reports within these pages. Rather I will comment more on trends and patterns I noticed.

First, I noticed that there is a significant case density of intrahepatic stones,

cholangiocarcinoma, and choledochocyst. All of these conditions are very rare in the

United States. Next, I noticed that despite the significant overcrowding, the workup and

clinical reasoning of the team was excellent. While they do not have every resource

available to them as compared to the United States, they make use of what they have and they are experts in the use of that equipment. Beyond the clinical reasoning, the plans of care were very reasonable and well supported.

What I noticed next was something I have thought about frequently since witnessing. There is something I can only describe as bravery, or perhaps fortitude, although neither of those words quite capture my meaning. Many patients and their families come to the department with a poor prognosis. Often a very poor prognosis. They seldom cry. They understand. They express fear, hurt, uncertainty, and every other emotion they must be going through with expressions I cannot recreate or describe. You feel it deeply, but you do not see it.

The acknowledgment behind their eyes juxtaposed with the calm expression carried on

their face cuts through you as everyone in the room knows this patient will likely be dead in a matter of months if not weeks. In that moment, you hold to your training, you hold to your experience, you hold to the safeties built over the years. I did not feel but I knew, same as the patients.

This situation elicited a response in me that I have long struggled with. I worked for four

years in an Intensive Care Unit starting at eighteen years old. The first time I saw someone

die was ingrained into my memory, and for a time, was etched into the back of my eyelids

so I saw the scene whenever I closed my eyes. This is no way for a professional to carry on,

however. So, over the years it would seem I have developed the ability to sit stoically in the presence of great tragedy.

Often, I do not take the time to reflect because I do not have the time or incentive. This

exercise of writing about my experience here triggered many memories on reflection that

went unresolved over the years. I would not be being truthful if I said it did not make me tear up. I had thought of cutting this segment out of this writing, but I feel it is important as an often-overlooked aspect of being a physician, or any medical professional for that matter, is carrying deep trauma, whether witnessed or personally experienced.

The final thing I will note from the ward is the sense of camaraderie. The sense that we are in this together. The laughter and smiles in the face of serious conditions, even at the

prospect of death. A lightness that does not make light of the seriousness of what is

happening but instead lessens the burden. A sense that you are seen beyond the clinical

sterility of medicine.

We sat one morning in the handover room, the one designed as a classroom. In came, one at a time, patients with particularly complicated cases. The head of the department sat with them and spoke to them, their records circulated the room as physicians oAered

input. They were assessed and a plan was made. Finally, they were dismissed for the

process to be repeated with the next patient.

I found this to be beautiful. To show the patient they have whole teams working on their

case to ensure the best outcome. I have spent a lot of time explaining to patients why we

don’t have a plan yet, ensuring that we have several physicians working on their case,

telling them they are not being delayed because we are kicking the can down the road, but because we are working diligently to find an answer. They almost always think I am being untruthful. Inviting the patient into the room during the discussion grants a level of

reassurance I think could be potentially helpful back home.

The last patient we saw had a complicated case, not unlike the rest we had encountered

that day. This patient, however, had a suspected ovarian mass. I turned to Dr. Quốc and

asked him which service would be handling her care once we had completed our portion of her case.

“No one.” He replied. “We don’t have gynecologists in this hospital so, gynecology surgery is handled by HBP.”

The statement was immediately striking. In the United States, it is difficult to imagine

surgeons operating outside their specialty training. My first reaction was concern, but this

was quickly accompanied by admiration. Necessity had created a breadth of operative

experience that would be exceptionally uncommon back home. I made a mental note to do everything possible to observe the surgery if it was scheduled during my rotation.