This morning we had a 20 yo G2P1 roll in at 38.4 weeks contracting every few minutes with ruptured membranes. Several hours after her arrival, I heard a desperate call over the radio for a doctor, amidst a screaming patient in the background. I ran over to the hospital and checked the patient, who sure enough was complete. In the seconds between that and grabbing a pair of sterile gloves (we check patients with non-sterile gloves due to the limited supply of them, but deliver with sterile gloves…I don’t know), the baby was crowning. About a second later, the rest of the baby flopped out onto the bed before Vance or I was ready to catch her. Everything went fine though and it was fun to tell the mom “Feliz dia de las madres” immediately after the delivery.
The antithesis to that story is the one of this lady I’ve mentioned I’m taking care of in the hospital. She’s just not getting better and is still on 8 liters of oxygen. The steroids and antibiotics aren’t working. It looks like she has an effusion, but several doses of Lasix haven’t helped. It looks like maybe she has a mass in her right lung, so Peter and I took the ultrasound into the room and found a pretty good sized pleural effusion. We gathered up all the stuff to tap it, and were able to drain off about 40 cc of serous fluid. Even that didn’t help as much as I had hoped. She still has air-hunger and looks pretty uncomfortable. I’m sending the fluid off to the lab, but I’m guessing she has a malignancy of some sort. We don’t really have the means to treat her here, and frankly there’s probably not really anywhere else around that does either. If we intubate her, she’ll never come off the vent. Most likely we’ll end up shipping her out to La Ceiba if the family wants to pursue more aggressive treatment (assuming we can get her stable enough for the trip). She may want to just go home, which is reasonable as well. I don’t think the family wants her to stay admitted here if she’s going to die anyway, but at least we’d be able to give her morphine and some other stuff to make her death more comfortable. Unfortunately we only have one hospice bed available, which I believe is currently occupied. Assuming this is in fact a malignancy and she has as poor of a prognosis as I think, that would probably be the ideal disposition for her…but again, we’re dealing with extremely limited resources and those types of things aren’t always an option.
To lighten the mood, here are some pictures of a monkey I saw while going for a walk today:
