8/28 - a day of rest

I'm sorry for the tone of my previous notes.  I know I have seen a lot, and there is a lot more to see.  If I was too direct, or too hopeless, I will attribute it to too little sleep, and the start of getting sick.

 

On Sunday I felt that ominous feeling of deep, untouchable throat pain that often indicates and upcoming illness.  My Monday, the pain persisted, and more of a head cold has also taken hold.  I had a cough that I tried to squelch as I knew it was too deep and would in an instant lead to a loss of stomach contents.  I was definitely not running on all cylinders, but was managing, and getting by.  I felt too unsettled to eat breakfast or lunch, but took all extra given opportunities to sleep, in hopes of passing the time of illness more quickly, and be strengthened by the added rest.  Throughout the day I would drink a bottle of refreshing, chilled water, and less than 5 minutes later, be impressed that it was still somewhat refreshing, and thankfully free of the harshness of stomach acid.  By evening time my total input had been an egg, and orange and an apple.  Last night I went to bed early, and due to my dis-settled stomach or too much rest, spent must of the night in the bathroom, or tossing and turning.

 

This morning, Tuesday, I awoke thankful for the sleep.  I knew I still wasn't back up to snuff, and had soaked through my T-shirt with sweat in less than an hour.  There was sweat dripping from my head, and even clinging to the rims of my glasses.  After seeing just a few patients, I called for a 10 minute break, and retreated to my house.  After relieving myself of anything I had eaten and not yet repented of, I sat down on my bed, staring into my fan.  I knew I had ample work to do, and was not too sick as to not do it.  My thoughts were interrupted by one of the doctors calling to check on me, and invited me to take it easy; and assured me my patients were being taken care of. 

 

Both he and Lisa checked on me at the 10 o'clock break, and another doctor a few hours later.  At one point I insisted that I wasn't sick, I just didn’t feel well, and at the time it made sense to me.  I didn't have an apparent diagnosis to list on a chart, I just couldn't keep any food or water down, and was suffering some weakness because of it.  I slept most of the day, sipped on Gatorade, as instructed/commanded by Dr. Lisa, and when I had the strength to hold up the book, I read more of Evidence Not Seen.  It continues to amaze me some of her struggles in a Japanese Internment Camp and prison during WW2 that I am now relating to.

 

After drinking one large cup of Gatorade, I felt bold enough to try Ramen.  With the help of the day of rest, and all the praying visitors, I feel better, and have been able to stay out of the bathroom.  With one major exception!  For the first time in two days, I was able to urinated.  My deprived kidneys rejoiced!  I am on call tomorrow, and if I continue to feel as I do now, I will be able to do well tomorrow.  My only concern is standing in surgery, and although I've only been called for one section thus far, don't trust that that pattern will hold out much longer, and may have to ask for a bye in that department.

 

Mondays are always busy.  Seeing and hearing Lisa being called for admissions on Saturday, and having several myself on Sunday, it's hard to believe many people waited until business hours to come in, but our out patient department (OPD) was full!  I took the front desk with the interpreter.  I admitted a few very sick patients, including a diabetic with a blood sugar of 500 who had pleural effusions (fluid in the lungs) filling up half of his oxygen exchange potential bilaterally.  He was responsive to Lasix, and we couldn't risk any fluids to help his very high blood sugar because of how overloaded his lungs already were.  He was one of the few I rounded on this morning, and he had responded well to the Lasix, but still had coughing fits during which he believed he would die.

 

Another memorable patient had ascites (massive fluid swelling of his belly.)  One prior paracentesis I had done yielded a diagnosis of TB.  In this case I was prepared to send off the fluid when he grabbed my hand.  No words were needed to communicate the desperation he felt.  He pointed to his bottom.  Several patients on this day had reported rectal prolapse, or the mucosa of their rectum protruding after a bowel movement.  As one can imagine, a quite painful occurrence.  Within 48 hours, I could help replace it, but after that, the risk of infection goes up, and there is great likelihood that it will occur again.  One similar complaint of rectal prolapse earlier in the day, was actually thrombosed external hemorrhoids.  Anyway, in response to this man's distress, I put on a glove, lubed it up, and tried to do a rectal exam.  I couldn't.  My finger could not enter.  There was stool and blood from the friable area on the tip of my finger, but I could go no further.  This man likely has a very advanced cancer, and likely the fluid in his belly was a late sign of the same disease.  As it was already almost an hour after we should have been finished, and the surgeon's had already vacated their exam room down the hall, I requested that he come back the next day, and that if I wasn't there, that they call me.  I wasn't called today as I rested, but I hope he came back, and that something can be done for him.  There was a haunting and memorable look in his eyes.

 

While I held the front desk with the help of an interpreter (she was also feeling the effects of a cold, and would not have walked into the back room to provide me with any way of communicating with the family or the patient, so with his local language skills and position at the back station, they fell to Dr. JK.  Nearly every other patient he saw was a patient literally carried in and then laid down, nearly or partially unconscious, on the back exam table.  It was a very challenging day in general, and the workload seemed overwhelming, even for a Monday, but he definitely got the brunt of it.  I was thankful for him to be in the back and to see all of those unable to walk or hold up their heads.  I wasn't feeling well and all the smells of incontinence of bowel and bladder, in addition to vomit, were very trying on my empty stomach yearning to release itself. 

 

I was able to return home by 7 pm, and promptly delivered the naan I had made to Lisa, and apologized for not being able to go to her dinner party later that evening.  As I heard later, I think the naan was a hit!  Instead I found my bed, and never heard any of the laughter or joyous exclamations that were sure to have transpired next door.