June 26th, 2013 by Maggie Higgins
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Our 7:30 conference topic was all cephalosporins: the different generations and their MOAs and targets. After the learning, Julia and I got down to patient business. Our first patient was an American-turned-islander with a 15-year history of recurrent UTIs. She was also recovering from an allergic reaction to ciprofloxacin, which was after an allergic reaction to chloraquin, which a pharmacist had given her (3 tabs a day!) for her UTI. The poor lady was a little loopy because she had taken a codeine to kill the immense pain she was in, and she burst into tears twice. We couldn’t take a urine sample because she was on pyridium (which I learned turns your urine bright orange) and had only finished her round of antibiotics (I can’t remember which one it was now) 3 days ago. We put her on a 14-day cycle of the antibiotic that had worked for her and then told her to stop taking all meds for at least a week and get a urine sample.
After that first patient, the rest of my day was in Spanish. We had a lovely woman with GERD, osteoarthritis (the grinding of the knees on examination were serious), and pterygium (a new one for me – overgrowth of the conjunctiva of the eye). I fit her for reading glasses and she was so grateful to be able to read again.
Our next patient was a 17-y.o. gal with several issues. She had a fluid pouch near her outer malleolus, minor foot fungus, lower abdominal pain, and three palpable masses in her breasts with nipple discharge in one. This is the tough thing about working on an island with limited resources. The only place she could get a quality breast ultrasound was on the mainland, to which a trip and doctor’s visit is prohibitively expensive for most patients. She denied any family history of cancer, and perhaps the lumps are benign fibrocystic changes, but it’s alarming to feel such lumps in a young girl’s breasts.
The next young woman had a ganglion cyst on her wrist (which I diagnosed correctly when Dr. Raymond asked me what type of cyst that would be), chronic allergies, and neck stiffness. There’s a lot of neck pain and stiffness here. I should start teaching yoga to patients. Then there was a woman with a UTI. While Julia was taking care of the UA for the woman, I helped Eric with the debridement of an adorable little boy’s leg. Hot soup had spilled on his leg and he didn’t come into the clinic until 12 days after the incident (his mom had put butter on the wound – regardless of how that worked for the kid, his wound was free of infection when he came in). This was his second trip to the clinic to get the black eschar off the burn. He had walked by himself this time, and was so brave as Eric scrubbed the wound. He almost bit his shirt off from the pain, but man, was that kid a trooper.
Back in our exam room, we saw a woman with probable bacterial vaginosis and an old man with H. pylori, hypertension, and pterygium (2 in one day!). Since I’m writing this a bit delayed, there might have been a few other patients that I failed to scribble a note on.
After wrapping up with patients, Julia and I went up stairs to see Alana, she’s the volunteer who was badly burned on Monday night. I saw a picture of the burns – mostly partial thickness, but some areas of full thickness burns all over her chest, neck, and lesser burns on her arms where she tried to push down the flames – and an abrasion on her chin from when they threw her in a pool. It was a total freak incident. She was at a bar ordering food and the bartender was making a flaming drink. He wanted more flame, so a waitress poured more 151 rum on the drink. She’s a bit fuzzy on how the flames got to her, but I can only imagine the bar was liquor soaked. In any case, the flames flew down the bar and her freshly applied bug spray acted like a torch. She was still in a bit of shock at the surrealness of the experience, but was in pretty good spirits. What a crazy freak thing. Thank heavens for the clinic.
I walked with Angela (a peds ER doc from Wash U) to Golosinas Josue (the baleadas place at the end of my block) and then went to the store to get some ingredients for my gourmet lunch of eggs, beans, over-ripe avocado (the same one that was not at all ripe the first time I tried to eat it), corn tortillas, and some hot sauce that I found. After that feast, I went for a roam up my street (doesn’t go to far before the road ends) and then on the main road east. I then did some lounging and reading and peanut butter snacking – and then after the sun went down, I headed down to the dock. I was going lobster hunting!
I met Roger, Edison (brothers), and Anthony (all Island guys), and Austin at the dock with my snorkeling gear. We split up into two groups, to divide and conquer. I went with Anthony and Roger. I should mention that this is a secret because the reef off our beach area is a protected area and technically this is not a legal activity. I did not get a spear. This was a good thing. I was too busy dumping my mask, which is now leaking at an obnoxious pace, and trying to stay out of the way. These guys are unbelievable. They each make their own weapon. Roger uses a lance attached to elastic so that he can spear it and give it some moving space. Anthony works magic with a hook tool.
We swam out to the reef in darkness. I was enrapt with the luminescent algae. It is a wondrous sight and made me feel like I had magic coming out of my fingers as I swam along. Once we neared the reef, Roger beamed the flashlight and I hung by his flank to see where I was going. First of all, they could spot lobster way before I knew what was happening, and there was a while when I didn’t even see the capture, but Anthony would be ripping the tail off. That’s something I didn’t realize, we were only keeping the tails – so after the kill, they rip the tail off, put it in their pockets, and drop the rest. Lobsters make this weird squeaking and I felt a little bit bad for the fellas. It was always exciting to see a hunt go on. Roger would spot one and Anthony would dive down and hook it. If it got away (not too often), we’d pursue until it escaped the light beam. Most of the time, I was floundering in the back trying to stay out of the way and dumping my goggles, trying not to choke on the sea water. It was also the first time I’d felt cold since being in Roatan – I would periodically shimmy to stay warm.
It was all very exciting. Roger pointed out a slippery crab, a flounder (which is not at all like the Little Mermaid’s Flounder – it’s white and lies flat on the floor, looks more like a ray than a fish), and my personal fav, the octopus! There movements and their ability to change colors are so cool. We finally met up with Roger and Austin (who had caught an octopus which I was kind of sad about) and headed back to the dock. I played with the luminescence the whole way. All in all “we” caught 39 tails.
I chatted with Kempfer for a bit, then went home to shower, then returned to the Beach House where the cooking had started. Roger and Austin both love to cook, and they came up with a feast. We didn’t eat until after 10 pm, but yummo! It was so good. And while they cooked, I enjoyed Roger’s island jams that were bumping the house.
This is a good place to mention Island speak. The black islanders have a dialect of English that is absolutely fascinating. When they talk to each other, it is nearly indecipherable to me. Very Caribbean in the tone. So throughout the day, you hear Spanish, Island English, and English – it’s quite a hodgepodge of lingos.
I washed the dishes and walked home with a full belly and a cool night hunting experience.