"Mr. F died at 6:00 pm. He was treated for a pneumothorax with chest tube and was treated with ceftriaxone, metronidazole for sepsis. At time of death his chart could not be found, but the guardian of another patient stated that the patient's chart seen in the hands earlier in the afternoon of a brown colored mazungu".
I still chuckle everytime i think of this. The patient of mine who had the chest tube placed ended up passing away yesterday. The above quote is what i saw written in the patient log book of overnight happenings. I feel really bad that the patient died but then again sort of relieved as this patent was suffering for a really long time. The quote in the book just makes me bust out and laugh. It's so cute and funny. a mazungu is a foreigner. that's the malawian way of saying "the chart was seen by a brown colored non-malawian".. i'm assuming they meant me. After all i'm the only brown colored person working this week.
Today the president of malawi got married. It was billed as the grandest wedding ever known to man. I doubt it reached that high level of acclaim. But nonetheless all this hoopla was worth checking out. I headed out to the old town of the city and watched as the motorcade made it's way around kamuzu procession road. Unfortunately i could not see Bingu himself (the president) but i'm assuming he was in the huge bus that had the sign just married written on it."
I had an incredible past few days. The hospital always takes me into a world that is none like any other on ths planet earth Often times, i take a deep breath before i step foot in the hospital as you just feel the suffering all around you, and each time you think about the disparities in resource allocation that sends shivers down your spine-as if you were a part of this disparity. After all get to leave in one week-back to my western world, whether technology is rampant and i can bring back a patient who is on the brink of dying by inserting IVs in early vein possible wth a machine to help me breath, medcines to maintain my blood pressure and a tube to feed me. Contrast that with this place... only 2 maybe 3 ventlators in the entire hospital..
I've been busy as anything the last 2 days but I swear the days are just so rewarding. I was able to bring back a patient who came in with a low systolic blood pressure, had not eaten in days, stopped talking and had a very tender abdomen. After doing an ultrasound i discovered his bladder was so full that it was displacing his liver, spleen, and bowel. After inserting a foley he pee'd out 2 liters and his stomach deflated. I treated him for heart failure after he had signs of CHF. crackles in his chest, frothy sputum, and dilated hepatic vessels on a glimpse of his ultrasound. There was his hepatic vessels, and inferior vena cava expanding with each inspiration. A lot of work it took-getting the O2 tank, moving his bed so i could access an outlet to plug the machine in, personaly administering lasix. in 24 hours he woke up, startred talking, sat up on the side of the b ed and started eating./ His family was ecstatic-each of them gave me a great big hug as if i were a saint, and the brother had me pose by the patient with me offering his first cup of porridge in one week. It was so humbling. All the nurses had smiles on their faces. Moments like these make me happy I came to malawi-as with suffering there are also always success stories. But great moments don't always last as the next patient i ended up dealing with was a patient with a hemothorax.. His heart displaced all the way to the right. He was sent to casualty for chest tube insertion however after 24 hours the chest tube stoppped draining. IN addtion he started to develop diaphragmatic pain---reffered to the shoulder blade. Oh great. what is it wth me and chest tubes. Is god trying to tell me my true calling is to be a thoracic surgeon or does he/she just want to punish me for my lack of knowledge on chest tubes by sending me patient after patient. With kussumaul breathing, distended neck veins and his PMI visible in the right 5th intercostal space this much i knew. the chest tube would have to be placed again. but did he also have a perforation. The challege was to get him to the x-ray. this required finding a stretcher and then wheeling him on the stretcher down an elevator to the x-ray machine and then have him sit up to take pictures. Ended up doing an ultrasound downstairs too and after much debate b/w me and the radiologists we came to the consensus tha the small amount of fluid beside the spleen was ascites rather than a splenic laceration.
His chest tube is clottted up from the blood- no clue what to do. next step is to find a pleura-vac. that's what he needs.
I also had an interesting experience wth a patient who i was treating for acute pancreatitis. He has been getiting worse. He has some sort of disseminated infection whch i don't know exactly what it is, but he is on the kamuzu central hospital "big gun" medications. ceftriaxone, quinine and metronidazole. He stopped urinating and the family insisted on a urinary catheter. attempted an 18 french w/ no success and found a 16 french. Slid it up and then a loud yell from the patient, some seizure like activity and then shivering. In an instance the famly members ran to bedside and the evangelical tirade began. PETER IN THE NAME OF CHRIST I BECKON YOU TO WAKE UP. IN THE NAME OF THE LORD CHRIST SUMMONS YOU TO WAKE UP. beating and shakng the patient yelling with loud religious rants. THE LORD COMPELLS YOU TO WAKE UP. i just stood there, stepped aside. and just watched the loud tirade until i started to hear the loud wailing and screams. it was then i stepped in and told the family that the patient is alright. he must have some sort of vesicle in his urethra that caused irritaton and caused him to shake in pain. I am convinced now he has some sort of disseminated herpetic infection as he has vesicles in other areas of his body. today i went to see him and he was not looking so hot.
i have told the family that they should be prepared for his death and that today would be a good time if he were to have any visitors that wanted to see him while he were alive.

Yesterday after work had a great evening as arthur and I headed over to Henry's bar. a great view of the sunset with some drinks with some of the doctors who work with the baylor project. I don't know why, but for some reason i diddn't really enjoy the conversation that much. I felt a lot of it was superficial and ppl were just discussing all of the bad things about malawi. and whenever i would bring up the positive things someone would come up w/ a smart comment to make even that sound negative. I did learn last night that there are rumors to shut down lilongwe airport for about a week. something about redoing a runaway. unfortunately they are rumoring to close it down on the 20th till beginning of may, possibly rerouting ppl via small planes to blantre ( a city down south) and from there to catch a plane to johannesburgh. It's just a rumor though. In any case i don't know if i really do believe these guys. esp w/ all the negativity.
Well it's been a busy few days. saw lots of sick patients but i'm having a good time working. I really felt i have established a great relatinoship with all the ancillary staff and have gained their trust--- as they all have opened up to me and really respect when i tell them to do something.. they actually listen and it's not out of frustration but it's about putting the patient's best interests foremost. I thin when they see that even i will do things like place foleys, change bed linens, get the oxygen, personally administer medications, ask the opinions of them on what they think, they are more open in participating in the care.
They also crowned me the king of central lines. never have they seen a doctor on the medical wards place that many central lines. i guess initially i just wanted to save everyone, but in all honesty now i just let the patient go.. sometmes its better to die than just prolong suffering.