Day 15 of 46, of my daily Lenten blog journey
Every morning when I arrive at the hospital I begin my routine of surveying the hospital to see what’s brewing. First stop is always the emergency department to see if there’s anyone there that needs attending.
We all take turns each day being the “on call” doctor, who attends the emergencies and admits people to the infirmary if they need to stay for further care. This is generally considered a ‘crappy’ state of affairs. This predicament of being “on call” happens about every 4 or 5 days for each doctor here. Some people acquire a reputation for being a “black cloud,” which means that every time they are ‘on call,’ they get metaphorically ‘destroyed.’ Getting ‘destroyed’ implies that you probably didn’t sleep much all night, you had to deal with complicated medical scenarios that required lots of perseveration, and you stressed over the idea that if you don’t do the right thing you might kill your patient/allow them to die…
As I approach the ER I always feel comforted if the light is off. This usually reassures me that there is no disastrous scenario hiding in there, just waiting for me to stumble upon it. Because usually, in medicine, if you touch it, you bought it.
So if I happen to get involved with something that is going to suck the life out my soul, I always try to find a reason to refer to a higher level of care, which in our hospital, is one of our surgeons (or Dr. Isaac). That way I can punt to them, and backpedal into the darkness. Ok, I’m mostly kidding.
Once in-a-while there is someone in the ER who is left over from the night before. They might still be in there receiving IV fluids, antibiotics, etc. However, occasionally there’s someone fresh off the street. There is a bit of a transitional time in the morning between shift changes when the doctor ‘On Call,’ hasn’t seen the patient yet. If none of the doctors have seen them yet, I sometimes jump in.
This morning, there were a couple new folks in the ER. One of them was a sweet older Garifuna lady with end stage liver disease. We eventually drained her abdomen of the fluid that had accumulated due to her condition. This relieved her pain.
Another fellow looked pretty ill to me, he was trembling with rigors from an infection in his foot. His name was Sam (not his real name) and he was 69 years old. Sam’s infection had spread from his foot to his bloodstream, which we call sepsis. I hopped on his case, ordered some treatment and tests, and put him in the hospital for further care. His situation merits a brief discussion.
His deal was that he had been to the hospital a few months prior, with the same wound on his foot. He has advanced diabetes, which is really the underlying cause of the wound on his foot. Here’s how that plays out: diabetes destroys the nerves in his limb, then he can’t feel a wound on his foot, then it gets infected but it doesn’t heal because of bad circulation to the wound due to blood vessel damage, and high blood sugars make it hard to kill the bacteria… Gasp, breath of air. So, again, diabetes is bad for his wound. Did I mention, diabetes bad?
Here is where I think our cultures collide a little. I was frustrated with him for not taking his meds correctly, for not bringing his pills in for me to look at, for not coming back for his appointment when he was supposed to, for not coming back when his foot got worse, etc…
I haven’t been able to completely figure it out, but I think people here in Honduras just haven’t been taught to be a good ‘Medical Patient.’ Is that to be faulted? Absoultely not. They just haven’t watched enough episodes of House, ER, Gray’s anatomy, General Hospital, and Scrubs. This is where you learn to give a good history to the doctor, groan properly when he touches your ‘owie’, and how to bring a large grocery bag full of your medications.
I have noticed, here, that when people run out of their pills, they figure they ought to be cured. I have got in the habit of explaining to people that I’m not actually going to cure their high blood pressure, they are going to have to take the medicine ‘para siempre…’ (forever).
Also, I will ask ‘how long have you had this pain?” A common response is “ya dias,” which literally means ‘already days.’ This can signify anywhere between 10 and 730 days. That makes it a tad hard to narrow it down. But again, it’s not part of the culture to focus on details like this. When you sometimes have to live with pain a long time, I think you stop worrying about how long it has been. In the States, if we have pain for 6 hours, we’re going to make a doctors appointment.
So, I am trying to stop judging my patients here for not meeting all my expectations of the perfect patient.
But back to the ER… Eventually, as I was wrapping things up with Sam, I heard quite a commotion on the other side of the room. In Bed 1 behind the curtain, there was a lot of thrashing and wailing going on, with people starting to run to and fro. My adrenaline started pumping as I prepared for what I would see. Please Jesus, I hope it’s not a child, or a younger person, dying… Andrew was already on the scene, with other nurses converging rapidly, one of them already calling the dreaded cry over the radio “CQ Balfate, CODE BLUE!,” which is a signal to all the medical personnel to come running. CODE BLUE is sort of like the ‘Bat signal.’ Whether one is at home, or on the road running, or looking at their instagram account while on the toilet, everyone has to drop what they are doing and hustle down to the ER to see how they can help.
So I sprinted over, rounded the curtain, and was horrified to find… Yawn. Geez, I tired. I think I’ll finish up tomorrow, if ya’ll don’t mind.
To be continued…
Photo of the Day:
This is just the kind of authentic traditional Honduran meal that I like to eat to sustain me throughout a rigorous day. I give you, the Baleada…