Polaroids

Thursday, October 17

The long term missionary doctors are out of town.  That means I was the keeper of the keys to open things up for morning report.  I felt truly local to be the one to open the doors and windows and set the chairs.  Not a visitor anymore, which makes it weird to think of leaving.

Morning report had only one death to report and it was not Wisdom.  His case was presented by the pediatric nurse, however. She read every note and intervention-it was like having to relive the last 3 days.  Not exactly super fun. After she finished, I gave my summary and discussed the poor prognosis and plan. The concept of a “Do Not Rescusitate” order is not the normal here.  It brought up a lot of discussion. All of that is good, but it is a little interesting given that most patients are just discovered and pronounced dead without resuscitation efforts.

Ward rounds went fairly smoothly with the med students and Marleen.  Wisdom was much less responsive this morning. We tried to wean down his respiratory support some but he did not tolerate it.  I discussed his case with Sam in detail. He agreed with our plan and we discussed that since for three days we have used maximum anticonvulsants without notable benefit and the seizures are now focal, that we would not continue to treat the seizure activity except for his daily maintenance dose of phenobarbital.  He also agreed with the plan to not do any resuscitation. I asked him to exam the patient and the chart to ensure we had a cohesive team plan. Given that this weekend, the clinical officers will take over his care, I want to avoid disagreement in treatment that could lead to confusion for the parents or staff. Wisdom did have some slight jerking of his left arm but really had less seizure activity today, at least what was observed.  However, he did not awaken or become active in any way.

We did have several patients that were able to be discharged home today.  We also had several who were improved. Immanuel was able to come off of his oxygen and hopefully will go home tomorrow.  We did have a 4 year old admitted with decreased consciousness. A child friend had offered her something from the house to eat and she had eaten it.  The parents had no idea what it was. On admission, she was hard to arouse. This morning she was awake and complaining about being hungry. Praise God!

We still had about an hour before lunch time, so I took the students to the NICU and talked this group through exams for gestational age and other key concepts.  We then returned to the ward and came across my least favorite chicken ( I have made Melissa promise that if she is still here for Thanksgiving that she will eat it for dinner).  Sam had examined Wisdom and had talked with the parents again. He was in full support of our decisions and plan. We had a new admission with abdominal pain and vomiting. Weirdly, they had taken a chest x-ray and I really can’t explain why.  We went and checked on the x-ray and it showed a pneumonia. Often, younger kids complain of abdominal pain with a pneumonia but at this age it is unusual. It was great that this was done as it is not what I would have treated him for.  

We headed for lunch and I enjoyed my taco from Tuesday on a Thursday.  Lunch was fast and then it was time to return. I really thought about not returning.  Catherine, the clinical officer has been present on occasion the last few days and is supposed to be there today.  However, with the students and Wisdom, I decided to go back. It was good because I never saw Catherine.

The ward was fairly quiet and all stable except Wisdom.  I had brought all the medical supplies from my room that I plan to leave here and moved it into my office space.  Then, I decided to have some fun. I broke out the Polaroid camera. I got one of the students to translate and started with the little guy in traction for a femur fracture.  We took his picture, then the family’s, then the student nurses’. It was so fun to see. Little elderly women who were amazed as an image of their loved child appeared. They cradled the pictures in their calloused hands like they were precious jewels.  Words of thanks.

We moved on bed to bed.  Lots of smiles with the idea but the boys make a serious face for the picture.  Interesting. I would take one picture of the patient and then the guardian. Often this was mom, with another child on her back.  The moms beamed. The head nurse, Esu, who is a wonderful man and who works hard and seriously, joined me and made faces so the kids would smile.  

Then all the student nurses and nurses wanted pics.  We literally had a little glamour shots booth going. Then group pictures.  I took one inside the ward. Given the poor lighting and the distance you could not make out faces at all-all you could see were the nurses white hats.  So funny! So they all piled outside!!!! We took some group shots and they hung one up on the bulletin board in a place of honor and pride. You have to appreciate the thumb tack. Again, the things we take for granted.

We did go back to work.  We did have one admission with sepsis vs. pneumonia that we settled in.  Then in walked another puffy kid. Oh no! I assumed it would be another diagnosis of nephrotic syndrome.  I was wrong. This one had normal kidney function and urine. However, her abdominal ultrasound showed massive ascites and liver cirrhosis.  She was only 7! She had been taking traditional medicines for over a month. There is really nothing that can be done. She will be reviewed by the palliative care team tomorrow.  

I actually left the hospital on time tonight.  It was been a nice evening. Today did get very hot but there is now a cool breeze.