Sunday, May 12 - Clinic, Call, Church and the Caribbean!

(Written over the weekend, late to be published.)

Another week!

This past week seemed rather slow as most of the compound was gone this week.

Saturday, I was on call and the only doctor on the compound - Everybody else was either in another city at least two hours away, or hiking to waterfalls!  

The OB doctor has been gone for a few days and without his surgical backup we have been turning patients away who are not of lowest risk.  There was one patient that another doctor sent to a nearby public hospital because she was a G1 (first pregnancy) and only 4 centimeters dilated.  The next day, that same hospital sent us back a G1, 14 year old (high risk) at 9 cm (imminent delivery!) whose water had been broke for over 24 hours (high risk of infection!)  Didn't really seem like a fair trade!  But, she matured fast from a pregnant kid at 14 to become a mature mother who would fight through pain to do what needed to be done for her child.  She delivered great, and also tolerated an unblocked MEU (manual exam of the uterus) - my whole hand and part of my arm in her uterus pulling off the placenta and membranes from the uterus) as the cord separated from the placenta.  She had no extensive bleeding, which I'm thankful for, and she was feeling well the morning after.  In another week when the baby has a follow up appointment, we'll see if her name is Marta!  :)

The Pediatrician has been gone for several days now, and I had a kid with fantastic croup.  His seal bark cough was perfect!  If only I had learned the word for seal in Spanish... (foca, but it doesn't translate well to a community unfamiliar with the bark of the creatures.)  This kid was supposed to be the 8th patient on my

schedule, but thankfully the nurses had the insight to let me know he was having difficulty breathing.  I asked for nebulized epinephrine and was met with blank stares.  Even a tour through the pharmacy only yielded the response, "No hay."  "There isn't any."  But there had to be.  What else could I do.  I couldn't effectively humidify oxygen, steroids likely wouldn't help much, and then kid was only 1 year old and couldn't move much air let alone breathe well.  I did give him dexamethasone and started him on nebs while I searched the pharmacy.  Then, I called the Pediatrician out of town and she said the epi was

now kept in the refrigerator in the pharmacy!  Phew!  He had minimal relief with the first one, but after the second the child was able to breath enough to rest.  If you know what the disease is like, can you imagine

a parent watching their kid struggle for A WEEK to breathe before bringing them to the doctor?  I can't imagine the anguish of seeing a child hurt AND knowing I couldn't afford to help them.  I'm so thankful they came when they did.  The kid was exhausted.  He still had a little cough this morning, but did well overnight, which is when the worst of the symptoms usually occur, so I was able to let them go home.  He

is the cutest little thing with curly black hair.  But, he hates me because I've put masks of nebulized medicine on his face and made him get the steroid shot.  At least by the time he left he felt well enough to smile and giggle!  In follow up he was still barking when stressed (ie seeing me) but as long as he was calm he looked better!  Even when he was crying at the sight of me, he still maintained his sats!

Interesting that he was put into my clinic schedule instead of into the ER.  Also on my clinic schedule was a man with a dog bite.  The dog nearly bit off the tip of his finger!  It was the first meeting between a puppy and a bigger dog owned by one of the missionaries.  The big dog started to attack the puppy, so the gardener intervened, and the puppy ended up biting him.  It was deep, but thankfully no bone or ligaments were injured or visible.  Being that the dog could be watched easily, no rabies shots were given, but we did provide tetanus and a deep cleaning of the finger!

I would classify those both as emergencies, but then some of the ones I get at night and on the weekends, make me think life here is not so different than in the states. On a night call I came in to see a 19 year old wearing only shorts.  He looked coy.  He thought he could ask me a question for every one I asked him.  "How is your chest pain?"  "It is gone.  Are you 29?"  "No, I'm older than that.  On a scale of

0-10, how bad was your chest pain." "It's not bad.  Do you have children?"  "No.  Do you have children?"  "Yes.  One.  One year old."  It took me a few questions before I caught onto his game and stopped playing.  He thought he would show off by naming several large cities on the east coast he had visited.  He didn't understand my questions in English well enough to answer appropriately, although it was

hilarious to hear him try.  So, I resorted to asking him questions in Spanish, he tried to answer in English, and by the end, he asked for a date.  He had no chest pain and his symptoms had resolved completely.  His symptoms were that of a panic attack.  I wonder how the visit would have been different if any of the men on the compound had been on call that night...?  A woman was waiting with him.  Turns out she was the girlfriend/mother of his child.  Needless to say, their relationship is struggling.

On Saturday I had another ER patient, a man with rectal pain.  Was this really an emergency, probably not, but with the amount of stool in the vault, the man really could have had some serious complications if he had remained this way until Monday!  The nurse misinterpreted the rectal pain as no stool and no urination, but his prostate was fine, he was merely, FOS.  Full of sh%$.  Literally.  If I had actually practiced disimpaction in medical school I might have given it a try, but with how effective his soap suds enema was, there was no reason.  After getting cleaned out, he came back to the bed weak, sweating through his shirt and pale.  No chest pain, no difficulty breathing, just weak and sweaty.  I look about that sweaty all the time, but this man should be used to the heat.  And he was dry before.  I worried about his heart, and his sugar.  After 4 errors on the glucometer, which could potentially mean a sugar too high or too low, or the machine isn't working...we checked the nurses blood sugar, which was normal, and then were able to get the patients.  131.  That wasn't the problem.  I'll blame the good ol' vasovagal response.  By the time we

checked orthostatics and got the sugar, he was feeling much better and ready to go home.

The social system setup is getting better for me.  There is a family who moved into the hotel/guest housing last week - a young resident doctor, his wife and their two adorable boys.  It is a small world because I remember hosting him and interviewing him for our residency program!  We have chatted together, had dinner, and went to a small shop together.  This weekend, an ER resident and his wife arrived for a week.  Within their first 24 hours, they had been to the beach twice!  So, on the second trip I invited myself!!!

A word about the shop we went to visit: In the past, women of this community did nothing to support

themselves, and if they were single parents, it was even worse.  Some of the missionaries have taught some women how to knit/crochet (I don't know the difference, sorry) and now they have a little consignment type store where they sell dresses, vests, skirts, doilies, purses and other crafts.  It is nice that these women have products that they can not only take pride in, but also make a living from and be able to provide for their families!

As of Saturday I still had yet to put my toes in the ocean.  I was on call and couldn't really leave, but thankfully, Sunday, there was blue sky again!  The ER resident, his wife and I went down to the beach Sunday afternoon, and then shortly thereafter another missionary family came as well.  It was fun to lounge in the waves and chat with new friends.

On Sunday morning I went to a local church.  The Consejeria (Counselor/Chaplain) from the hospital was there, as were several of the other missionaries.  It was Mother's Day, so the kids sang several songs, and I was reminded how much Spanish I have to learn as I tried to listen intently to get something out of the message.  I would have been better off following the kids to make a Mother's Day Card!  The songs were led by a local Honduran, and the pastor was also a local Honduran.  The church was almost entirely women and children.  There was only one young man in addition to the pastor!

On Tuesday I plan on going to the garbage dump to see what life is like there for the families who live there!  Some even have to pay rent to live at the dump.  Crazy.  I can only imagine what I'll see after seeing dumps in Mexico and Africa...

Does anybody have any brilliant easy meal ideas?  I'm going shopping and can get most ingredients, just need some inspiration of what to buy and ideas of what to make!  Thanks!!