Another Day in Paradise: My Morning

So, ya wanna know what I did between ward rounds and lunch today? Today was my "half-day", which is one day per week when each doctor has some time away from the hospital to do non patient care work, or catch up from times on call. Whether is is really half of the day, or more or less depends on how many doctors are here, and how busy things are. Sometimes there are enough doctors that we can leave the hospital right after ward rounds. Sometimes we work in outpatient until lunch time. If we are particularly short-handed, we don't take the half-day at all. But this week we tried out a new system; after ward rounds, we see eight patients in outpatient, and then go.

Patient number 5. With his mother.

So, I thought you might like to know about the eight patients I saw. They represented a good selection of the patients we see.

1. A young adult woman with a bladder infection. She had taken medicine for a week, but didn't get better. I was pretty sure that it was really a bladder infection, so I prescribed a different antibiotic.

2. A young woman with a couple of lumps on her arm. I told her that these were lipomas, and were harmless, that they didn't need to be removed. She was quite uncertain, and asked several time if they should be removed. Finally she asked if they were cancer. I assured her that they weren't, and she finally seemed relieved.

3. A man in his early thirties who had recently completed treatment for abdominal TB. He was feeling well, his exam was normal. Those meds really work! And, yes, TB can infect areas other than the lungs.

4. An elderly lady with a chronic cough. She has been treated for both pneumonia and chronic obstructive pulmonary disease, but has recently started coughing up blood. I got her most recent chest x-ray from the x-ray room to review. I then sent her to the TB nurse to start TB treatment.

5. Baby boy with several days of diarrhea. Not sick enough to need to be admitted to the hospital (he was laughing and smiling, for goodness' sake--a sure way for a baby to disqualify himself from admission to our hospital!) I prescribed some meds, and asked his mom to bring him back on Friday, sooner if he should get worse. See photo above.

6. A young woman with chronic pelvic pain. She had been treated several times for pelvic inflammatory disease, without any improvement. When I examined her, I noted that her uterus was enlarged. In fact, it was about the size of a uterus with a 12-week pregnancy. Yeah, yeah, I should have asked her about menstrual periods earlier, but I asked then, and she said that she hadn't had any for at least 2 months. An ultrasound revealed a healthy 14-week pregnancy (2 weeks error ain't too bad in this situation). I gave her vitamins, iron tablets and paracetamol to take for her pain.

7. Young man with a severe cough, fever and a sore in a location that suggested a venereal disease. I sent him to the lab for a test called a VDRL, and to the x-ray room for a chest film. Because I thought he was number 8, and I didn't want to wait around, I asked Dr. Imelda to review his results and write for meds when he got back.

So now I realize that I only saw 7. Wait! There was an old man who wandered into outpatient who thought that when the doctor told him to come back in 2 weeks that meant he could skip paying fees and waiting his turn in the long discouraging line. I had sent him to go pay and wait. I wasn't going to count him, but without him, I only saw 7, so now I think I should count him. He has benign prostatic hypertrophy, by the way, with complete urinary outlet obstruction. He was being treated with a catheter and medicines.

There. That's 8. Good variety, but not fully representative of what we see. There was no trauma in the group, no fractures, no arthritis, no abscesses, no malaria, and no AIDS, which are all pretty common in our work.