A nice and lazy weekend. Love it. Spent pretty all of Saturday relaxing. I went into work for a few hours as on Friday I admitted a patient with gross body edema. She presented with a history of past pharyngitis about a month ago and now having problems with black urine. I never thought i would see post streptococcal glomerulonephritis here in africa. classic description of coca-cola smoky brown urine. After talking to one of the other doctor's in the hospital I have started her on oral prednisone, howver given that she is now anuric and is symptomatic from electrolyte disturbances I talked to the dialysis team to get her dialyzed. I ended up personally doing an ultrasound on her to take a look at her kidney's and they were so tiny... makes me believe this may be a chronic disease for her from now on. who knows. In any case my morning of saturday was spent putting a temporary dialysis catheter in her right femoral vein. I'm happy to say, that I can now put in a central line in about 5 minutes.. not bad... After that I removed some nasty empyema pus that was accumulating in a 1 liter flask from a chest tube that i had placed two weeks ago. I don't know why, but this guy keeps draining pus. He goes home and then wa-la a month later he comes back from empyema. I've had this similar type of experience with other patient's before. It seems that empyema can be a chronic pain in the butt. Especially those that have a known history of tuberculosis.
I've treated a lot of other pneumonias and I swear, i've never seen so much pneumonia that was the classic "walking pneumonia" not improved on ceftriaxone but when i started erythromycin they were back to normal. I felt great on Friday. I discharged a patient who came in very sick a weak earlier and through aggressive IVF, anitiboitics, mucking around with his antibiotics i ended up treating him for PCP pneumonia-he's going to complete a 21 day course... but he's feeling the best he's ever felt in quite some time. before he left he gave me a huge handshake and hug and said he would never forget me. That really meant a lot to me and all the frustrations, the hard days, the disappointments the feelings that you have nothing to offer to someone who is dying right in front of you are minimized.
Today, I headed out to the sanctuary lodge. I've been there once with one of the other doctors at the hospital and it's an amazing place. Quiet and quaint. I sat by the shade out on the patio and had a nice cold vanilla milkshake which was not bad at all! I did a lot of reading- leisure reading, and then i reflected a little on my african experience. There was live music- a band that was excellent playing the tunes of bob marley. The restaurant was crowded with malawians having picknics under the shades of trees, expatriates escaping the malawian heat and sunbathers working on their tan lines by the swimming pool. There were some college girls from spain i think i'm not sure? Extremely attractive, who surprisingly were trying their hardest to get my attention with loads of giggling and gestures for me to come over, but alas that only embarrassed me a little more and i continued my readings about pneumocystis carinii and kaposi's sarcoma.
I now sit here contemplating what I want to do for the next 2 weeks. I must admit that I am starting to get slightly homesick as this is my 7th week. I can't believe i've gone this long without driving, or without a television set. I'm glad actually... i think my brain has been happy.
I'm really contemplating seeing Jen Lyden out in Mozambique-- maybe going to pemba to meet up with her as supposedly there are great beaches out there. Looking at the map, it might be a big pain in the ass as it's all the way on the other side and would require multiple bus transfers.
It would be great to see her and really fun. Other options include just traveling within malawi. I haven't seen malawi yet. everyone tells me I MUST go to mt. mulanje or liwonde. That's another option. I've become really good friends with a malawian resident-- who is amazing in terms of his knowledge base. by far one of the most competent doctor's I've met. another option would be to do a mini trip with my malawian mentor. we've talked about it.. but no plans yet.
We'll see.. If it happens it'll be next week. I'm going to do a mini talk on EKGs and heart failure to the malawian doctors late this week. unfortunately this is a crazy week in terms of staffing so i won't be as big of a presentation as i would have hoped. but something is better than nothing.
Well, what else is new? nancy made the best lasagne the other day with real chedder cheese. simply amazing. I've gotten to know her really well- and she's such a great person. It gives me some light on the problems malawian ppl face in this country.
I've also met an amazing person. A girl who graduated from law school in britain and is doing some human rights law work here in malawi just for a few weeks. She really has good intentions and is really caring-- coming to the hospital to see if there are any prisoners brought in-and she works to get them legal representation. This week, i am going to spend one afternoon actually going to a prison here in malawi to get a first hand account of the conditions these prisons are in. I'm interested in doing this because a lot of the patients i admit are from the prison system and are brought in at the point of death. extremely starved, extremely infection and you can just hear the word tuberculosis and opportunistic infection coming out of their mouth as they gasp for air.
Well, about 2.5 weeks left. A little sad, a little happy, a little homesick- i guess a little bit of everything.