Tuesday, August 26, 2008

My morning

One of the things I enjoy about working here is that each day is different. Among other things there are different patients on the wards, in the clinic, and ER, different illnesses to treat, different problems that arise, different procedures to do, and different diagnostic challenges. Today was no exception. I started this am checking my labs and Xrays for the pediatric ward. Yesterday, I drained a large leg abscess on a small baby, and now her Xray showed periosteal elevation a sign of osteomyelitis (infection in her bone). I consulted Jim and got the plan to try an aspirate and find more pus, and then open it up. So I planned to do that after rounds. I rounded on all my peds pts - pts with meningitis, pneumonia, dehydration, heart disease, neonatal sepsis, and more. Then I went to the ER to try and find pus in this baby's leg. While there I found a 5 yo boy who had fallen into a fire on Friday, and had 1st and 2nd degree burns on his abd, legs, arms, hands, and face which needed debrided. I found the pus in my osteo baby, and cut into her leg looking for more, then I debrided the burn kid, and saw some more pts in the ER and clinic.
I admitted a college of nursing student with a bad infection of his arm and hand which will need IV abx and may need surgery. I diagnosed a 20 yo male with a hepatoma (inoperable liver cancer) today, and had to tell him and his family that I didn't have anything to offer him to cure his cancer, but we talked about Jesus and prayed. I saw a 8 yo girl who had one of her ribs protruding from her skin since Friday. Her only complaint was pain at night when she rolled on her R side. She has osteomyelitis (quite common here) and what is protruding out is sequestrum, bone that is destroyed from the osteo, and needs removed. She also has osteomyelitis of her R foot and I referred her to Hagen for surgery.
I admitted a pt with pulmonary TB, a baby with dehydration from diarrhea and vomiting. Saw a kid with heart disease who hasn't been seen since June, so now he came in with worsening shortness of breath and cough because he hasn't been on meds for 2 months. I saw a guy who fell from a tree 2 wks ago and continued with back pain, so on Xray found that he has a compression fracture of his spine now. There was a kid who was beat by a security guard at a coffee plantation for trying to take coffee, and now had a large abscess on his buttocks. He couldn't even stand up straight due to the pain, I did an incision and drainage, got out a lot of pus, and he felt much better. I got to tell a pt she was pregnant today, she was excited. I treated a MAF pilot for sinusitis which has been bothering him for 6 wks now. I assessed a pt from the TB ward who has worsening mental status changes, likely not secondary to TB. And many others.
I also saw a pt, Peter. Peter said he had swelling of his face since April. He has been losing weight and isn't eating much. He was cachetic, his L eye was swollen shut, he had a hard mass on the L side of his cheek, a mass protruded into his mouth and in his L nose. Just looking at his face you can see an obvious abnormality of the L vs R. An Xray showed bony destruction as well. I asked Dr. Tom Staton, a volunteer ENT doc, to take a look at him. He confirmed that he has a massive tumor of some sort that is killing him. Peter and family were quite sad to hear the diagnosis. I was encouraged as I talked to them about the Lord, and found out that he was a Christian. We prayed and despite his prognosis, I know Peter is looking forward to that new body that he will get in heaven.