a hospital can be a happy place. a place where you are able to make people better, healthier, keep them alive, fix them when they are broken… it can also be a sad place, a reminder of all of the accidents and crimes and bad things out there that can hurt people, make them sick, and end lives. yesterday was more of the latter, and those days are tough…
surgery rounds were yesterday, sad, but very interesting. part of what made it interesting was, obviously, the patients we saw, but also, on this particular day they were painting the hospital. unlike in the U.S. they do not close the wing to paint, instead they paint around the patients and doctors and nurses, so as we did rounds people kept bumping into walls and doors with wet paint. the docs are examining patients with painted hands and the nurses have paint in their hair and the med students are getting it on their white coats. were the smell a little less toxic, the whole thing would have been quite comical.
a few of the more interesting surgical cases: a patient, who I noticed when they uncovered him, had wet himself. this was a full grown adult so I found that strange. turns out he’s a spinal, no feeling in his legs up to his abdomen. really tragic to see in someone that young. he looked absolutely terrified, and rightfully so. I’m not sure what they can do for him here… probably couldn’t do much more for a similar patient back home. it is patients like this that make me take a step back and appreciate my good health. we should all take a moment, far more often than we do, to appreciate how fortunate we are.
a young kid, another motor vehicle crash, who was very out of it. thu and I wanted to perform a neuro exam on him, until we realized our swahili isn’t nearly proficient enough for that. I checked his pupillary reflex and his left pupil was totally unresponsive. first time I’ve seen that.
we visited the burn unit as well. probably the most traumatizing experience I’ve had since being here. in my opinion, burns are one of the worst injuries you can sustain. so painful and completely devastating, especially when they cover large areas of the body as we saw with most of these patients. they have wire ‘tents’ on the beds, covered in blankets, to keep the patients warm without touching the raw burns. they basically try to keep the skinless areas clean and cover them in vaseline in an attempt to prevent too much water loss. frequently children, usually burned from hot oil or water because so many the people here live in tiny huts where kitchens and beds are side by side - it is all too common to see severe burns. arms, torsos, and legs, all covered in deep burns. really awful to see, and so much suffering. the worst was (warning, you might just want to skip to the next paragraph) a young girl, maybe about 1 year old, who had burns all over her face and head. when we went through our section this year on child abuse, one of the things we were taught to look for when a child comes in with burns is patterns and submersion burns (with a neat line where you can see the hand or foot was held under the boiling water). this child had a neat line all the way around her neck. the only way I can figure a child would get a burn like that would be if she was literally dangled by her feet and her head was dunked in boiling water. it is seriously too awful to think about, but something we must consider. I had dr. lee ask the mother about the burn, she said the child fell in hot oil. the problem is, there’s not exactly a social services worker here we can call. furthermore, im sure it is not the mother, sitting patiently with the child and comforting her, who is responsible, but the male of the household, whoever that might be. sadly, these cases are not unique to developing countries, they happen in the U.S. too and it is heartbreaking.
after surgery rounds, which took us through four wards and past countless terrible breaks from motor vehicle accidents, I went downstairs to catch up on peds. lost a kid last night, so that’s always hard, and you can’t help but wonder if the outcome would have been the same in a better facility. all you can do is evaluate the death, make sure no mistakes were made, and move on. apparently dr. james says they usually lose about a kid a night here. that was staggering to hear but some of the kids do come in really sick. we had a new admin there, a young child who had aspirated kerosene. that was interesting. there was a 2 year old maasai baby who weighed only 9 kilos. and another massai baby with a Hb of 1.4, low enough to warrant a blood transfusion, something you rarely see here. the family must be willing to donate in this case, blood is so scarce. we have several cases of ventricular septal defects, a heart defect, with the peds patients right now. great practice for listening to mururs but sad because there’s not much we can do for them here. we also saw our little boy with an abscess on his chin that was huge the first time we drained it, probably 40ml of puss came out. we drained it again today, so disgusting, but oddly satisfying. poor kid is never going to go to a doc again in his life, it is traumatizing, and very painful to have an abscess drained. we brought him m&ms today to try to make up for it… not sure if he considers it an even trade.
No comments:
Post a Comment