Tuesday, August 14, 2007

A daily routine?

My weakening sprit was not ignited much this morning on rounds.
I transferred a patient to the ICU with a blood sugar of 20 who was unresponsive when I arrived to round on her and had been that way for some unknown amount of time. No one had noticed on the crowded wards where beds are separated at most by a curtain. I am grateful for the donated glucometer since a “stat lab” is a term as weighty as supercalifragulisticexpialidocious (just watched Merry Poppins this weekend with Liam… good flick, highly recommended.)

I had to tell a 52 year old woman with T2 paraplegia (for 4 weeks) from metastatic thyroid cancer who has been sitting waiting for the arrival of a neurosurgeon from the states. The hope has been that she could regain some function after decompressive surgery and she could go home with her husband and live with palliative care for her cancer. He was promised to come last week and we heard on the day of his expected arrival that he was delayed a week. With a smile and with much gratitude the couple requested that they stay in the hospital. Everyday we talked about Tuesday the 14th of August as the day she would have her surgical evaluation. A small note written in the chart today said his trip had been canceled. Without hope for recovery at all, the couple agreed to leave the hospital. They reiterated their gratitude for my “help.” Simultaneously—I admired their peace and contentment with the outcome but felt bewildered and almost uneasy about their lack of frustration with me… the hospital… the doctor who did not arrive… the cancer…

I had to tell a 67 year old female that she was HIV positive. Her tribe shuns those with HIV. Her eyes welled with tears as she told me that she has never been unfaithful. She told me that she does not know anyone her age that is “positive.” In short, she did not believe me, did not want me to tell her family members and told me that it must be a mistake. She requested politely to be discharged later in the day.

I watched as the ICU doctor extubated a 10month old with an unknown 2 day illness thought to be meningitis or an intracranial bleed of unknown etiology who was rapidly decompensating. His parents stood by to watch him die. The ICU needed the ventilator for another baby.

In the afternoon I worked in the outpatient clinic.

A 50 year old man with a bloody knee effusion from a probable ACL tear (diagnosed clinically of course) came in with a septic joint. He had stopped at a local dispensary on his long journey to Kijabe for some “treatment” there. I tapped the joint to discover thick, bloody puss.

I have worn off as a novelty now. The nurses are not too happy to answer my questions about the functional flow of the clinic. For me, the flow is less than intuitive, perhaps it is because I am American that I can not always understand who goes to the cashier when, how the charts get to the pharmacy, how quickly I can expect the lab results come back to the unlabeled cubby hole, who can help with interpretation, which rooms are empty and available for a patient to be seen in… everyone else understands these things perfectly.

A 73 year old female who was seen last week for a “CHF exacerbation” by one of the clinical officers and told to come back this week for a “therapeutic tap” of her right pleural effusion. He asked me to perform this. In addition to a nodular thyroid and an exam that was not at all convincing for CHF, her pleural fluid was grossly bloody and her son was mortified at the news that his mother may have a malignancy.

The intern class is a group of very smart, talented, gregarious people. They joke around with each other, shake hands and exchange hugs and stories in the hallway. When I see them, I think of my own cohort at Swedish and long for the comradery that we had. I do not expect to have that connection here with this group of people, but it would certainly be nice to feel a little bit more on the inside than I do. I acknowledge this requires time… of which I do not have much left here.

Bill and I discuss coming back here for a longer time. Despite all of the challenges that have marked the past few days, the thought of being an insider here is quite thrilling to me. I have a lot of wisdom to gain before that is a real possibility. We will wait on God’s direction.

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