Weekend on call

June 29th, 2019 by Bryce Loder

There has been a gap in my blogging for lots of reasons, but last weekend hospital and ER “on call” duties could be blamed for most of it.  I scribbled notes and found myself overwhelmed by the scope of conditions that presented to the hospital.

 

On Friday afternoon, anticipating the long weekend ahead, I hitchhiked to Balfate for a “last break”, riding with a nearly toothless old fellow (probably my age) in his beat-up pickup with the plastic coating on the windshield being the main source of support for that broken piece of intended protection.  We talked about weather and the dry spell and how it affected the crops.  Wait….was I in the Colón province of Honduras, or was I in McPherson County, Kansas?  He dropped me off at the intersection for the road going into Balfate, and I walked the short distance into town. Strolling around on the deserted beach and watching the big waves while observing the Friday night over-imbibing of the bar/restaurant patrons on the closest bar to the beach, gave me an insight into the social options here on a Friday evening.

 

After buying snacks in little “pulperias” (neighborhood grocery kiosks that have the important stuff) along the way, it came time to go home, and I found myself back on the highway watching every vehicle closely for an empty seat while chatting with the motorcycle repairman. Under his roof supported by a couple of poles along that busy dirt road, he had multiple motorcycles stripped down to the frame, and motorcycle parts and chains were hanging in an orderly fashion all over the place.  He probably had any replacement part one would need for a breakdown in Balfate.  Finally a motorcycle with a scrubbed up “Friday going on a date”  young guy (who really smelled good, too) stopped to give me a ride.  It turned out he was the guy who manages the security cameras which are all around the Loma de Luz compound.  As I rode home without a helmet or any kind of protection, I understood some of the risks, and wondered if I would have been better walking the four miles on that nice evening.    He seemed skilled at dodging the potholes and loose sand, and he delivered me to the gates of Hospital Loma de Luz a few short minutes later.

 

I mention my thoughts on the motorcycle, because after a steady but really pleasant weekend of watching the inpatients, dismissing a couple of hospitalized patients, handling minor emergencies/urgent care type situations and talking to Isaac and Carolina about the ultrasound on a woman who presented with pregnancy problems (triplets, with one having anencephaly – no head), I spent my late Sunday afternoon, evening, and night in the emergency room with motorcycle accident injuries.  All evening, I thought about twice having been the passenger on a motorcycle on our rough road without the protection of a helmet or long trousers.

 

Let me set the stage.  It’s only 93°F/33.8°C outside, but the heat index is 106°F/41.1°C.  Inside the emergency room and the surrounding hallways, the temperature had to be nearly identical, but with the added body heat from four ER patients (a 3 bed ER with another cart rolled in), at least 2 (more often 4) family members for each patient, plus the heat generated by a sweaty foreign doctor (name withheld, but can be identified by this blog) who felt unprepared for what was unfolding, the temperature was not to be measured by a thermometer.  In three of the four beds, there were people who were involved in separate motorcycle accidents.  In the fourth, was a poor fellow who had the misfortune to be hit by a car.  His left leg x-ray looked like the bone grinder in a crematory hadn’t finished its job.  

 

He had been in a hospital in the city of San Pedro Sula for six days, but family was concerned that he hadn’t seen a doctor since admission, so they decided to make the four hour drive to see the people at Hospital Loma de Luz.  After I used WhatsApp texting application to send a copy of his x-ray to the surgeon, he agreed to take care of him after I got him admitted to the hospital. 

 

Then with a quick radio call and texted image of the fracture shown below, Isaac, my sponsor, took over with the stoic 14 year old girl whose forearm was bent into a half-moon curve from falling down a river embankment. 

 

His skills at sedating her and reducing the fracture were apparent.  My job there was easy – hold the arm in correct position while he did the casting after the fracture reduction.  I felt less lonely now with two of the four “accidentados” already part of a long term plan that didn’t require much from me.

 

The other two patients were a little more complicated.  Both had gone down on their motorcycles on the sandy roads, and their injuries consisted of head contusions, less problematic fractures, abrasions all over, and lots of lacerations, some of which became apparent only after the next patch of dried blood was cleaned up.  Without a nurse in ER, I was on my own to find each needed item to take care of these guys– sutures, local anesthetic, instruments, and casting material. Just a hint in case you are ever in this situation: No matter how many packets of clear suture you find in the right size, don’t use it. Keep looking until you find black or blue suture. Your life and the patient’s life will be much easier. Believe me on this. I was pretty overwhelmed when I allowed myself to think too much, but the reminder that “A journey of a thousand miles begins with a single step” kept me focused.  If you happen to be going on that journey and the heat index in the ER is 106°, be sure to keep drinking lots of water.  I’m sure Lao Tzu couldn’t get that little bit of advice into the sentence without ruining the flow of the words that made him famous.

 

Over the next couple of hours lacerations were revealed and repaired.  None were complicated, but they were numerous. X-rays were taken and interpreted and then shared by sending the images via text to Isaac or to Jeff, the surgeon.  An interesting feature of the ER at this hospital is that the bays are theoretically separated by curtains, but they don’t partition well, and the heat necessitates keeping airflow from the ceiling fans and open windows shared by not obstructing it with curtains. As I moved from patient to patient repairing lacerations**, my retinue moved along with me from one ER bay to the next, watching and quietly supervising. The creator of HIPPA regulations would have had a stroke while observing this pattern of “experience sharing”–and then I really would have been busy with one more admission to the hospital. Finally the chaos settled down around 10:00 p.m., and I saw an opening to run home and eat the rice, cheese and orange bell peppers that had patiently waited since lunch time.  It was hot and dark, and I was hungry and thirsty, but I stepped onto the first of the suspension walking bridges with a fierce confidence of having survived a rough evening—so far.  And I just dared a howler monkey to swoop down and surprise me as I headed toward my main goal of food and eventual sleep.  At that point I was almost in a delusional state of believing that I had the power, if not the energy reserve, to grab him, butcher him, and have him on the barbecue grill before midnight. 

 

** Not once did a patient ask me how many stitches I was putting in or when they had to be removed.