Jessica’s Blog

Monday, April 26, 2010

Today was a long day at the hospital. We rounded on the pediatric inpatients. My little girl with multiple abscesses had another abscess today that needed draining. I talked with Dr. Hewitt about antibiotics and he made some recommendations, but also suggested asking the chaplain to come in and pray with the family. It was the first time I wrote an order in the chart for prayer for a patient.

Joyce, the head nurse in clinic, placed me with Neslon, one of the medical assistants, in the front pediatrics room. Most of the patients were less sick than usual. I only admitted one. It was a boy who returned from the lab with a positive blood film and a hematocrit of 14%. Dr. Hewitt called us into his room to see a girl with osteosarcoma of the distal femur. Her knee was almost the size of a volley ball and the rest of her was pencil thin. She had enlarged lymph nodes in her groin and there was not much that could be done for her.

After all the children were seen, I started to see adults and once again felt at a complete loss. An older woman came in with an enlarged right breast. It was four times the size of the left, hard, warm, and with the orange peel skin indicating malignancy. She also had enlarged lymph nodes. I took her to see Dr. Dickens since he told me the other day that he sometimes does mastectomies as palliative care.

A woman came in with lower abdominal pain and a missed period and was thrilled when her pregnancy test came back positive. Nelson told me that occasionally urine pregnancy tests can be done. It was nice to be able to give her a definitive answer since I was not able to diagnose a 6-8 week gestation based on uterus size in a slightly plump woman.

The last man I saw in clinic required help to walk in. He had a stiff neck, headaches, and fevers. I walked him to the theater, did an LP, and admitted him for concern for meningitis versus malaria.  Malaria is always the back up diagnosis here, and often is the culprit. 

I stayed in the theater for the next three hours helping with minor procedures including removing a ground nut from a three year old’s nose, I&Ding the abscess on my seven month old inpatient, and stitching up a split eye brow on a five year old who fell from a tree. I showed him my matching eye brow scar from when I was three.

After everyone else went home, a 12 year old boy came in with a degloved knee after falling on a tree. The story didn’t quite make since for the size of the injury. I scrubbed dirt and twigs out, snipped out sandy tissue, and stitched it up as best as I could. I took an after picture and wished I had taken a before picture.  I have the hardest time snapping photos when a kid is in pain. After I started washing his open wound, the theater tech came in and wanted to know if I had asked the family if they had insurance. I said no since I didn’t even speak enough to ask the boy to get on the table and roll on his back. She was adamant that they either have insurance or collect the money before I started stitching. If they could not produce either, the wound would be washed and bandaged, but not sewn. Thankfully, they had insurance. The boy laid still and watched me scrub and realign his opened knee without as much as wincing.

I made it home by 8pm, had a late supper, showered, and enjoyed my last pineapple Fanta before heading to the school house to blog.  It is hard to believe that we only have two days left at the BMC before flying home.  I will miss the patients who come in so sick and make phenomenal recoveries, the lack of coding terminal patients, the hospital staff, the freedom from computers, the fresh air blowing through the clinic windows, and the simplicity of life.  God willing, this will not be the last time I’m here, and next time, Curt will be with me.