Admissions

Friday, October 4

It was a weird morning.  The Swedish group left for the weekend yesterday, the Dutch slept in because they were leaving for the weekend this morning, and Melissa and the girls had to leave very early for appointments in Lilongwe.  So, I was alone for breakfast. It was nice to be able to do my Bible study while the water heated and to sit in quiet for a few minutes before leaving for the hospital. I wouldn’t want it all the time but it was a nice a day.

Morning report went incredibly long today.  Each ward had many to present, there were several issues brought up, and then the pharmacist did a report on malaria data.  They follow several protocols here and the main idea is that medications are paid for by donors and if you don’t do it right, the donors won’t pay and the hospital can’t afford to pay for the meds.  So, do it right people or we won’t be able to treat malaria! He took a little more time to say it but that was the gist. He may have been more eloquent with his word choices as well, but by then my rear end was asleep from sitting on a wooden slat and I was not paying good attention.

I delayed a little bit in getting to the ward.  The new intern had a meeting and I didn’t want to start without him as it is the bulk of his learning.  Also, I kind of wanted to see if the clinical officers would do it in my abscence. Sam had to go to help in the outpatient department again as we continue to be very understaffed.  I saw Catherine (clinical officer) so I knew she was on duty. I went to my office/storage room to change out some supplies and ran into Christina. She is the new long term missionary that will be doing scheduling and internal medicine here.  She came shortly after my arrival. We had a good and honest talk and she divulged her struggles with being overwhelmed, tired, sad, and the struggle of setting boundaries when you want to please everyone and there are incredibly sick people everywhere.  How do you ever say, “that is enough for me to do” or “I am going to take a break.” Full time missionaries have an incredibly difficult job and few who understand or even listen. I was honored to be the shoulder and ear for a few minutes.

I went to the wards.  No rounding was happening and no Catherine to be seen.  I did not see her at all the rest of the day. So I started with rounding with Pempo.  Our group was small today as all the students have left for the weekend. I do not remember my student experience being like that.  Obviously, I should have traveled to Africa then. We started rounding and a few patients in, Christina came and joined us. She is wanting to see a little of the pediatric wards knowing that in a short time I will not be here and as new people come in she wants to at least know enough to familiarize them.  Most of the longer term patients are straight forward as we did plans and med adjustments yesterday afternoon.  

As we moved to the next patient, I saw some of the nursing students scurry to a new admission.  The lack of movement on the part on the patient caught my eye. We went to them next. This is an 8 year old boy who had come in with convulsions and cerebral malaria.  He was responsive only to pain with eye movemement and withdrawing but not conscious. We started him on medications for malaria and meningitis and started IVF as he would not be able to drink or eat.  It seemed very repetitive of yesterday.

We went back to the nephrotic patient and talked it through with Christina.  It helped me feel a little better to have her reassurement that our plan for blood pressure management was good as she does this much more often than I.  She left us then to go back to her ward. We came across a few new patients admitted yesterday evening. We had been told there were not any new overnight but there sure were.  One with pneumonia and one with gastroenteritis.

Marleen came in at that point and had one she was concerned about in the NICU.  There were twins and one had a distended abdomen. Everything else seemed fine. He was eating and stooling well but seemed upset and his tummy was rounded.  We worry with the little one about something called necrotizing enterocolitis that can be deadly with our premies. I felt that he still looked fine. We pushed them closer together and once they were intertwined, he calmed and was happy.

By the time I got back to the ward, Pempo was working on another new admission.  This one with malnutrition, cerebral palsy, cellulitis, and seizures. We wrote up all the orders and discussed with the nursing staff.  We then went and finished up the stable patients that are in traction or have chronic issues. On little boy that has been moved to near the guys in traction asked for cars as well and I was happy to give them.  It was then time for lunch.

Lunch as well was oddly quiet.  I ate and then went to my room to catch my breath for a moment.  I did have my laundry and sheets done today so it was nice to have some cleanliness and good smells in my life for a moment.  Those are highly rare things here.  

Back on the ward, we had a stack of new charts.  We had five and started to plod through. We had another admitted with malnutrition, one with malaria and seizures, one with bronchiolitis, and one with asthma.  The last was a jaundiced baby. He is out of the neonatal age and so the problem is more of a puzzle. He was otherwise stable and the mother never thought he would be admitted and had to go home for the other children.  I just made arrangements for them to go and then be seen back in Pedi clinic on Wednesday.

We wiped our brows and then I started going through charts to ensure nothing had been missed. I found two others that we had not seen yet. One had a diagnosis of malaria and seizures. The other had significant swelling of her right face, mandible, ear, and mastoid area and pustular drainage from her ear. I was very concerned about a mastoiditis and called the surgery team.  It was a miracle they were still around. We worked on a plan for antibiotics over the weekend and will re-evaluate on Monday. This is another case that would typically be an emergency referral and ENT surgery back at home. Those are just not options here.  We will hope and pray. 

All together we had 10 new admissions today.  It was a busy afternoon and we worked past the normal quitting time. 

It is nice to have just a few of us here.  Elisa cooked for us tonight. Sharisa the newest Dutch resident who lives at another guest house came by and sat and talked.  She went with the outreach team to give immunizations in a village today. After she left, Melissa and I ate with the girls and called it an early night.  I slowly showered and put up laundry. I was lucky enough to chat with Chase for a while. I was going to go on to sleep but now the chapel is having a worship service.  The singing is fun but not exactly my plan. As the “Hallelujah”s ring out, I laugh and think that again how Malawi is teaching me to be flexible.

One last funny story. Nicole and Dr. Catherine’s daughters, Maria and Charlotte, go to school in Lilongwe. They had Reading Day at school. The kids all dress up as characters from a book of their choosing. As Catherine commented, “In a room full of princesses, unicorns, and fairies, the girls from Nkhoma came representing the harsher side of life....a skunk and a bee!”