Thanks so much for your prayers! Chelsea passed the stone last night and is feeling 100% better! God is so good! She even felt well enough to round and work in clinic!
Wednesday went off without a hitch. Again we were super busy (I feel like that is a recurring theme). We did rounds in the morning, followed by some procedures (by the rest of my team) while I went to clinic; I love the clinic! I get to work with awesome translators and nurses, see a variety of patients and problems, and gain more experience. I was especially busy and saw 10 people before lunch! Some were for simple things like headache and wanting Tylenol. Others were more complex, like a woman with palpitations of her heart, shaking tremors, and an unwillingness to talk about what was bothering her…I did not even know where to start. Or a woman who has all the symptoms of TB but completed therapy and has a card to prove it at another hospital in Ghana, who was told she actually does not have TB? Maybe drug resistant TB? Maybe lung or laryngeal cancer? Maybe something else?
For the complicated patients, I often order labs…so that I have more information to base treatment decisions on. The labs here are very limited…blood count for infection or anemia, urine sample, malaria parasite screen, stool screen, TB test, HIV test, Hepatitis B and Hepatitis C tests, and a pregnancy test. I can get a few kidney tests at an outside lab, but they are expensive. I can also get x rays and ultrasound of anything. That is it. So lots of treatment is based on the patient’s vital signs and symptoms. It is difficult when all the tests come back negative…at least I can say that they are not dying today…but I may not always get to the root of the issue.
I was convinced to see two more patients before I left for lunch…one was a man who cam in on crutches; he did not look too good, but after talking with him, his main problem was joint pain…something for which I can only treat the symptoms. Even so, he was grateful to know what was causing the pain and have some relief. The last patient was the woman I described earlier with palpitations…she became tearful as we were talking and was very anxious, but I could never get her to talk about what was bothering her…even using all my skills of empathy…sometimes you just have to leave it at “I don’t know” but will work with you to figure it out; however, the patient also has to be willing to discuss the problem in order to get better.
The afternoon was even busier, with me seeing between 15-20 patients…I stopped counting. This time, Dr. Tim was in the same clinic room so I could easily discuss difficult diagnoses or treatment plans. I also saw several pregnant ladies (and practiced using the ultrasound to see their cute babies!). It was great!
At the end of the day, I went back to the wards with a surgeon to discuss one patient with abdominal pain. She had severe abdominal pain since the day before and her labs and X-rays were normal; the surgeon was pretty concerned and wanted to take her to surgery that night. Perhaps I should have been a more insistent advocate for this patient…on the other hand, I was seeing lots of other patients in clinic and was responsible for several more on the wards. I was definitely pulled in lots of directions. In the end, the lady was diagnosed with severe pancreatitis…something that did not need surgery. However, we did not have the imaging or lab capabilities to give her this diagnosis; instead, a surgeon saw her (as did I and other physicians) and we were so concerned that she would die without surgery that we operated. Now, she has severe pancreatitis and a huge surgical wound; I am praying that both heal well and that her experience at BMC is positive…that she can see Jesus in those that are caring for her.