8/20/12 - First day. Crazy stuff.

First real day.  Phew.

We started rounding at nearly 9 am.  And, had essentially seen everyone by 10 am, when we take our first break - most people eat some breakfast or a snack or tea then.  I was able to buy some vegetables: potatoes, cabbage, cucumbers,  and eggs and apples.  Although they provide a list of what things should cost, everything was more, and without speaking Hausa, it would have been very challenging without a friendly face that helped!

There were a few patients to follow up on in the afternoon, after the morning rounds.  One was a woman, about 50, admitted with diarrhea, who was looking much better than the day before (when she had looked very sickly.)  We were considering turning off her IV fluids if she continued to do well, and maybe let her go home.  I searched all over for her chart and couldn't find it.  Finally we learned that she had died.  Her daughter had also been admitted, in the bed close by.  She had looked much worse today than in the past, and I hope she has a better day tomorrow.  I can't imagine watching a family member die.

On a happier note, there was a little girl, maybe 3 (ages are hard here as nobody knows their birthday, and age is a guess, and kids are very small in size compared to our US standards and obesity epidemic) who had pneumonia and had been requiring oxygen.  She was able to come off oxygen this morning as we rounded, and when I came back about 6:30p, I decided to check again.  I'm clearly a stranger, can't say a word of reassurance to her, and everybody has been poking and prodding her, but when I showed her the O2 sat handheld machine, she stuck out one finger for me!!!  It was the cutest thing, and her mom had the proudest smile!

Outpatient clinic had more, not only malaria than I can count, but also cerebral malaria!  These kids come it with hematocrits often less than 15 (ie, a hemoglobin of 5), and often comatose or seizing.  The lowest hct I've seen has been 6.  I don't know what the survival rate it when kids are that sick, but this has been a very bad year for malaria, and we are seeing several deaths daily.  Out of the hundreds of malaria tests being done daily, I've only seen 2 that have been negative!

I can honestly say that I can palpate a spleen and liver now!  I saw an older gentleman, about 50 yo, whose spleen was AT LEAST 15 cm below the costal angle (whereas it should be covered by the rib cage).  It was so odd to see the kidney in the left lower quadrant!  (But, on the other hand I did see a 56 lb ovary that had grown from the left lower quadrant up to the rib cage while I was in Wichita!)

A 25 year male complained of abdominal pain, and his bladder was the size of a 24 week uterus.  We sent him to have a foley placed, and they couldn't do it, so he was sent on to surgery.  I'm not sure what happened from that point on.

We saw some very wasted elderly people - for whom we've offered hydration, but who could really use a social work consult for hospice, a new diagnosis of HIV, and two kids with likely severe range nephrotic syndrome!

I had too many patients to recall who were carried in, laid on the exam table seizing or in a coma.  Most of our admissions were in urgent need of a blood transfusion.  I don’t think I will be prepared to learn how many died over night.  There is very little we can do after treating patients.  There is little resuscitation that can be done, and even if it can, there are no ventilators or defibrillators! 

One very sick, 70 year old man was carried in obtunded and badly dehydrated and malnourished.  His oxygen saturation was 36%.  And I confirmed this on a second pulse ox, as well.

The labs were also bizarre.  Not that we are trusting or repeating these, but a sodium came back over 200, and a potassium was read as 9.

I have been told that I would see more death here than I would in years in the states.  I believe it will be true; and that I will have seen more deaths in the first week or two, than I did in all of residency.  It still doesn't feel real yet.  It was a shock to plan to check on a patient, only to find that she had died.  I think this will become more and more challenging as I get to know more and more patients, admit and follow patients.  Perhaps not speaking Hausa or French has been a shelter somehow?  I'm very thankful to have Lisa right next door.

Lisa was on call today, and was working in the pediatric clinic.  I heard estimates that there were over 100 patients to be seen in just a few hours today.  And they were all very sick.  As I flipped through charts looking for those I was going to follow up on, I saw her name atop countless ones.  She had many more malaria patients, presumptive cholera, and even DKA.

We had house helpers today!  They cleaned the floors (which get very dusty when it is dry, and muddy after all the rains!  The bottoms of my feet right now are sooo dirty!!  It also means we have clean laundry!

We had a wonderful dinner, our last arranged get to know the neighbors meal tonight!  We also had our intro to Hausa greetings lesson.

For the first time since leaving, I was able to get ahold of my family by phone today!  I spoke with my brother at 6am (he is on vacation! :) but was already awake) and my parents tonight.  I only got disconnected about 10 times for 20 minutes of conversation.  I should probably not call when everyone on the compound is on the internet!  The GoogleTalk experience is much better than the Skype experience of medical school 5 years ago; although I'm sure that is more technology and time than switching providers.  It is just wonderful that GoogleTalk is free to call the US!!

I am on call tomorrow, so will try to head to bed now!