Tuesday, May 17, 2011

Finding My Footing

This week has been up and down so far on the wards. Towards the middle of last week, it seemed that a few of our sicker patients were getting a little better (whether because of or despite our interventions, I'm not sure.) However, over the next few days they all seemed to get worse again, though one did go to the ICU over the weekend.

Monday started off particularly rough...as I walked in to meet up with my Kenyan resident and intern they were seeing an elderly patient who looked absolutely terrible, in respiratory distress and non-responsive. I'm not sure if it was due to her initial illness or management overnight, but as we started to get together basic equipment like oxygen, blood pressure cuff, etc, she stopped breathing and lost pulses. So far I've deferred starting CPR/coding patients to my Kenyan counterparts...given that we don't have cardiac monitors, defibrillators, OR the ICU capability to manage them even if the resuscitation is successful. It quickly became apparent that this attempt was not going to be successful. No matter where you are losing a patient is never a good way to start the day.

Today when we got to the last room we had not one but TWO patients that were in significant respiratory distress. It was an interesting dichotomy - one is a young (30ish) patient with HIV and probably an opportunistic lung infection called PCP who was just admitted on Sunday. The other is an older woman with HIV and meningitis which we have been treating for over a week with no real improvement. I felt that for the young woman we have a chance of getting her through this, but for the older woman we don't have much left that we can do for her, and it takes so much labor to get anything accomplished.
Though it's hard, I tried today to focus more of my energy on helping her...making sure she was on the right medicines, and getting blood for a transfusion. We did get the blood in a matter of hours (which is AMAZINGLY FAST) and hopefully she will make it through the night, as I doubt our other patient will.
At home, I always tell students that the most valuable skill to learn is how to figure out a hospital system and how to get patient care accomplished. Now is the time to put my money where my mouth is - since we have so many sick patients I am getting a little better feeling for how to get things accomplished here...how to call consults, get lab results, etc. Much like the hospital at home, you can dial the operator and figure out how to get ahold of who you need to talk to. If the operator can understand your American accent.
And yes, some of our patients are getting better and being discharged! It's just not as therapeutic to write about.
Now, because I can't figure out captions - the pictures are 1.) The grounds of the hospital, with the large white AMPATH building in the center, our wards are off to the left behind the tent. 2.) The entrance to the medicine wards - Umoja (unity) ward is the men's ward and Amani (peace) is the women's ward. 3.) Rounds, with my intern Shamsa and resident Kaguri in the center. The rest is a gaggle of students and nurses, only half of whom you can see in this picture! 4.) Our pharmacy intern Marion with the treatment sheets (medication order sheets) She is a lifesaver on rounds and helps make sure all the orders are written as we are talking about them.
Just for the record, it's not nearly as dark on the wards as the blue paint makes it look.

Thanks for tuning in...more pictures of fun animals and weekend adventures in the next day or so!

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