After the crazy eye day on Monday, I presented Tuesday morning on pingueculum and pterygium. I then ran upstairs to show Dr. Estrella the PowerPoints. I told her to look them over throughout the day and give me her feedback when I returned. Then I went down to the road to get a cab to Coxen Hole – I was working with Dr. Molina in the emergency room this morning.
The public hospital does not look like a public hospital. It is a ramshackle collection of buildings on the main road leading into Coxen Hole (across from the Church of God school). I walked into the main entrance and asked for directions to the emergency room. There were patients waiting everywhere. I found Dr. Molina in the ER, a smallish room with sheet-separated bed space, a small office that also functions as two (or three patient areas) and a small room used for pediatric patients.
When I first arrived, Dr. Molina was with a critical patient. The woman had come to the ER around 5:30 that morning after a hypoglycemic diabetic spell. Her glucose was at 15, her heart rate at 10. They ended up intubating her an hour after arrival, but to no avail. By the time I got there, she was being hand ventilated, had minimal ocular reflexes, but was holding her stats. The entire time I was there, a resident was taking a shift pumping the hand ventilator. Dr. Molina told me the next day that the woman died at 2 pm, an hour after I left.
When I first arrived, the social service docs (like interns) were gathered the side room. They were eating chips, talking, laughing, listening to music on a phone and then I realized one of them was having a patient encounter with a young pregnant girl. This was the general theme of the day – I was constantly shocked at the social services’ seeming lack of concern and urgency. Often, patients would be waiting in the hall, eyes pleading to be seen, and they would go ignored. One woman came in holding her son and a bottle of something. She spoke to me and I was pretty sure she said her son drank the substance, but she was speaking very rapidly. I got Dr. Molina’s attention, he listened and gave her a little colored tab that patients take to central intake to get their file.
When she left, he looked at the bottle, saw that it involved NaOH, a caustic alkaline, and moved quickly out of the ER to go find the mom and boy. I then witnessed my first stomach pumping. The poor mom had to hold her son down while he screamed for help. At one point, one of the social service docs brought a little girl with a cut up face into the room to use another area. All I could think was “why the heck are you subjecting this little girl to borderline torture of a kid just like her?” After a few minutes, the social service doc moved location (the girl’s mother rushing her out).
After the nasal tube was pulled out (much to everyone’s relieve), Dr. Molina fed him antiacid cream. Probably the kid didn’t actually swallow any of the liquid. 9 months ago Dr. Molina had seen a girl around the same age who had swallowed the same stuff. She had gotten to the ER faster than this boy and already had severe burns on her lips, mouth and all down the esophagus. She spent 50 days in the ICU and now has no esophagus. There were no visible burns in the boys mouth or lips, but he was fully treated as if he had ingested the toxic stuff. Dr. Molina knew the boy (that’s a neat thing about health care on a small island because you know people’s medical histories over the years of working) and was additionally worried about his bleeding disorder. He has CMV and now has very low platelet counts.
There was a woman with a dislocated shoulder so I got to see Dr. Molina put that back in. Another woman showed up in an ambulance. She was a dialysis patient in kidney failure. There were lots of babies with coughs. In one of them, this second year med student could actually see the pneumonia in the right upper lobe. A boy came in with fever and shakes. His blood was sampled to look for malaria and dengue.
There was a to-do when a truck backed up to the ER and a stretcher was rolled out for a young man who had been in a moto accident. He wasn’t moving when he arrived, but after full body inspection and physical exam, Dr. Molina determined he was just scared, stunned, and putting on a bit of a show. All systems checked out.
At one point, Dr. Molina almost lost his cool because a little boy came in for a 15 day follow-up for his broken arm (his sister who brought him was actually the young girl with pterygium who I saw at the clinic the day before). He looked at the xray which clearly showed a green stick fracture, which needs to be broken the other way and reset. By casting it 15 days ago (and the ortho surgeon was on vacation), the boy is set up for deformed regrowth. There were several other points when Dr. Molina had to correct another doctor’s order, dx, or advice.
I was at the ER until 1 pm. I then walked around Coxen Hole for a little while. I bought a couple bananas and a couple baleadas and then found the bus “station” to get a bus back to Sandy Bay. They pack the buses to the brim and stop all the time. It would have been a lot faster to just take a cab, but when you can save 75 cents… by golly, you do it.
I snarfed down the balleadas while I went through class 4 with Dra. Estrella. She gave a big thumbs up to the whole course! And she’d love to teach it and wants to get going ASAP! All terrific news. I went home to change and get my computer. The rest of the afternoon was spent touching base with Leigh on the teen class and finishing up the girls’ classes.