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Chase's First Call (dictation taken by Jenny)
Saturday, March 8, 2008
My first patient in the ER was a 68 year-old woman with altered mental status. Her daughter reported a history of heart failure, liver failure, and kidney failure. Her EKG showed atrial fibrillation with rapid ventricular response. The nursing staff thought she'd had a stroke, and my first thought was "Great, does she need to go two hours away to get a CT scan of her head?" But we ordered labs, and it turned out she had pretty bad liver failure and kidney failure as well. There are three medicines that are thought to help in "hepatorenal syndrome" but we didn't have any of them! So, we admitted her to our "ICU" and started gentle fluids in hopes that her kidneys would respond to hydration. Sadly, they never did throughout my call, and at the end of my shift Dr. Hardin discussed with the family making her DNR. Probably couldn't have done anything in the USA anyway, but it's sad when optimal medical therapy wasn't available to even try.
My next admission came as a hand-off from a fellow resident from her morning clinic. All residents except the resident on call have Friday afternoons off. This 36 year-old man lives in the mountains in the city of Riobamba (I think?) and had a history of cough for three years. He had been told three years ago that he had TB but was only treated for 15 days and was then told that he only had pneumonia and was sent home. However, he's had cough with lots of sputum for the last three years. His chest X-ray showed a large bulla in his upper left lung field and the lower left lung field was filled with infiltrate with a small cavitation. His right lung field was hyper expanded, suggesting COPD. Apparently his community is at 10,000 feet in the Andes and the women use a smokey burning wood to keep the house warm when they cook so many people there get COPD at a young age. Despite the fact that he'd lost 50 pounds over the past 3 years, he looked surprisingly good. We're testing him for TB now with daily sputum cultures for 3 days.
My third admission occurred while I had 4 patients waiting in the ER. It was a Hospital Vozandes Del Oriente nurse in labor. I hurried to the delivery room as Dr. Hardin had checked her and her cervix was complete. In her first delivery she had needed vacuum assistance, and this one was no different. I had never done a delivery with vacuum, but Dr. Hardin was there to help. Unlike in the US, we kept using suction after three lost seals, rather than going to C-section, and the baby was fine. She had a small second degree laceration which I was left to repair. No problem. The fourth admission was her baby, who fortunately had an APGAR of 9,9 and did very well.
The fifth admission was a surgical consult in the ER for a 5-year-old who had gasoline burns from her waist down. She had been treated in a community hospital 3 days earlier by debridement and bandaging and sent home. On presentation in our ER she had too much pain to remove the bandages, so surgery was consulted to do it under anesthesia. She had eaten not long before arrival so she was admitted with plans to take her to the OR the next day.
Just another day at Hospital Vozandes Del Oriente!
Thebault, MD
Posted byJennifer Thebault at 1:36 PM
Any plans to translate this post into English? :-) I don't speak doctor fluently, and only caught bits and pieces. I think I picked up that some people were sick and a baby was born...how did I do?
Hi friends!
We sure do miss you. Thanks for sharing your blog with us. I just finished reading it all. You guys are having such an adventure--what fun!!! We are praying for you. Keep sharing and we'll keep reading. Love you, Patricia
Hey Chase,
Man o man, I thought our patients were sick. I hope you are doing well and able to adjust with the whole speaking spanish thing. I would love to be down there with you in the trenches; maybe Lord willing someday.
Awesome (except for the no sleep part)! I feel like I'm reading Grey's Anatomy in Espanol. Thanks for the updates.