Let me first tell you about the ER yesterday/today and then about the trip. My call ('turno') was 7 on Thursday morning to 9AM today. In addition to having an outpatient clinic, Hospitalito Atitlan has 3 inpatient rooms (2 beds each) and 2 beds in the ER itself. Overall, it was one of the least painful call nights ever as I slept for 5 hours (on and off) and worked with a very nice resident. Two incidents of note, and I'll save the nicer one for second. (I've changed patient names just in case any of you knows anyone in Santiago Atitlan.)
1) Elisa, a 38 year old woman, presents with acute mental status changes. Her relevant past medical history is that she had some sort of 'stroke' at age 23 and has since then been both physically (left side) and mentally impaired. Elisa has not urinated in 24 hours and has not defecated in 2 weeks (per family). She sits quietly sobbing, hunched over, with what can only be described as deer in the headlight eyes. Her family's understanding of her illness includes spirits inhabiting her body and somehow causing delerium. Anyway, she doesn't say much but her family reports that she stopped peeing because it hurt. I desparately want the cause of her delerium to be an easily treatable urinary tract infection (which I know, I know, shouldn't cause delerium in an otherwise healthy person). But she won't/can't pee. So the nurses try an in and out catheter which you can only imagine how hard she fights. Then I go to check on her and she is quite literally out of the hospital, still luckily within sight. I still really do think that a urine test might provide the key to her treatment and I practically beg her to return. She returns, but tells me that she keeps seeing 'phantasmas' and deamons which is why she is running away. In order to encourage her to give a urine sample, I say I will give one at the same time to decrease her shame. (Or just increase mine?) So everyone leaves the room and they bring a bucket and a jar. Luckily, Elisa agrees to try first. But, she can't support herself due to hemi-paralysis (from her first stroke). I will not go into further details, but suffice it to say that it is surprisingly hard to hold up a small-sized hundred pound person and that a few drops at least went into the bucket and the sample jar. Oh happy day! But no, not a happy day. She came back only positive for a primarily sexually transmitted disease. And no bacteria. By this time we were feeling increasingly like she might have had a second stroke. We asked to transfer her to a hospital about 2 hours away for imaging and further workup (and also treated her Trich). Well, one after one the family told me that they did not want to do that. They wanted to take her home. They had been in Solola (the other hospital) about 15 years ago and didn't think it would be helpful. Plus, they are extremely poor. Then there was an agrument between these two doctors about whether the family needed to sign (or rather finger print as they didn't read/write) a form releasing the hospital from blame (saying that they left Against Medical Advise). Anyway, they signed the form and were going to leave and then Elisa started crying again and saying she wanted me to go with them. So the family lied to her and said I would visit. And then they dissapeared. I'm glad I'm good at holding someone's hand, but I wish we could have done something more.
2) Juana, a 27 year old mother full term with her 3rd child, came in at 7 PM having contractions every 1-2 minutes and fully dilated (well, 8 cm). She had a beautiful baby boy by 8:25 PM (post meconium clean-up) with no anaesthesia and no yelling or crying at all. There is something infitely hopeful about being present and even helping with the first breaths of air that a baby takes. Also something very comforting seeing a proud, albeit exhausted, family together for the first time.
Anyway, those were the two major things on Call #1. I will be on call again Monday (approximately every 4 days). However, Call also means the next day off! So today after I left the hospital at 9, Guatemala was mine to attack! I went with Jay, the resident I worked with on call, to another city across Lake Atitlan, called Panajachel (or Pana for short). We had a delicious lunch (after I made my shrimp look more like pop-corn shrimp at a greasy spoon fish place and less like the animals you find in aquariums with eyes, legs and tenticles). We also went to a huge market -- Pana is similar in some ways to Santiago (where I live), but about 5 times more touristy. It was kind of nice to be somewhere for a little while that was a little bit brighter and cleaner. We even went to an art gallery. My most exciting purhcase was lettuce. I almost want to go downstairs right now and just nosh on it! But, it is for making a salad to take to Las Milpas, which is the place that the majority of the volunteers working at the clinic live. Anyway, I'm looking forward to it :)
The sun hath set and so must I,
So please write a comment, or at least try :)
1) Elisa, a 38 year old woman, presents with acute mental status changes. Her relevant past medical history is that she had some sort of 'stroke' at age 23 and has since then been both physically (left side) and mentally impaired. Elisa has not urinated in 24 hours and has not defecated in 2 weeks (per family). She sits quietly sobbing, hunched over, with what can only be described as deer in the headlight eyes. Her family's understanding of her illness includes spirits inhabiting her body and somehow causing delerium. Anyway, she doesn't say much but her family reports that she stopped peeing because it hurt. I desparately want the cause of her delerium to be an easily treatable urinary tract infection (which I know, I know, shouldn't cause delerium in an otherwise healthy person). But she won't/can't pee. So the nurses try an in and out catheter which you can only imagine how hard she fights. Then I go to check on her and she is quite literally out of the hospital, still luckily within sight. I still really do think that a urine test might provide the key to her treatment and I practically beg her to return. She returns, but tells me that she keeps seeing 'phantasmas' and deamons which is why she is running away. In order to encourage her to give a urine sample, I say I will give one at the same time to decrease her shame. (Or just increase mine?) So everyone leaves the room and they bring a bucket and a jar. Luckily, Elisa agrees to try first. But, she can't support herself due to hemi-paralysis (from her first stroke). I will not go into further details, but suffice it to say that it is surprisingly hard to hold up a small-sized hundred pound person and that a few drops at least went into the bucket and the sample jar. Oh happy day! But no, not a happy day. She came back only positive for a primarily sexually transmitted disease. And no bacteria. By this time we were feeling increasingly like she might have had a second stroke. We asked to transfer her to a hospital about 2 hours away for imaging and further workup (and also treated her Trich). Well, one after one the family told me that they did not want to do that. They wanted to take her home. They had been in Solola (the other hospital) about 15 years ago and didn't think it would be helpful. Plus, they are extremely poor. Then there was an agrument between these two doctors about whether the family needed to sign (or rather finger print as they didn't read/write) a form releasing the hospital from blame (saying that they left Against Medical Advise). Anyway, they signed the form and were going to leave and then Elisa started crying again and saying she wanted me to go with them. So the family lied to her and said I would visit. And then they dissapeared. I'm glad I'm good at holding someone's hand, but I wish we could have done something more.
2) Juana, a 27 year old mother full term with her 3rd child, came in at 7 PM having contractions every 1-2 minutes and fully dilated (well, 8 cm). She had a beautiful baby boy by 8:25 PM (post meconium clean-up) with no anaesthesia and no yelling or crying at all. There is something infitely hopeful about being present and even helping with the first breaths of air that a baby takes. Also something very comforting seeing a proud, albeit exhausted, family together for the first time.
Anyway, those were the two major things on Call #1. I will be on call again Monday (approximately every 4 days). However, Call also means the next day off! So today after I left the hospital at 9, Guatemala was mine to attack! I went with Jay, the resident I worked with on call, to another city across Lake Atitlan, called Panajachel (or Pana for short). We had a delicious lunch (after I made my shrimp look more like pop-corn shrimp at a greasy spoon fish place and less like the animals you find in aquariums with eyes, legs and tenticles). We also went to a huge market -- Pana is similar in some ways to Santiago (where I live), but about 5 times more touristy. It was kind of nice to be somewhere for a little while that was a little bit brighter and cleaner. We even went to an art gallery. My most exciting purhcase was lettuce. I almost want to go downstairs right now and just nosh on it! But, it is for making a salad to take to Las Milpas, which is the place that the majority of the volunteers working at the clinic live. Anyway, I'm looking forward to it :)
The sun hath set and so must I,
So please write a comment, or at least try :)
4 comments:
Hi Rebecca, Sounds like an adventurous but not too painful call night :) Your blog comes up on my iGoogle page so I follow day by day. Priya and I just enjoyed reading your entry after our lazy Saturday breakfast. Alexis stopped by this morning on behalf of team Obama :) Thinking of you, Gabe (and Pri)
Hi Rebecca! I missed your call by 5 minutes :( Do you have a cell phone yet that I can call?? Your blog is great :) I'm glad things are getting a little better. I can't believe you just helped deliver a baby. Far more exciting than my life at the moment. Chris' mom is in town so we're going to Catalina Island for the day. Should be fun...
Love and miss you!
Meryl
Hi Rebecca,
I like the pictures. It helps me visualize what's going on. Good job at the clinic.
Love ya,
Gary
Oh, Rebecca, I am so proud of you! It sounds like you are doing wonderful work out there. I am very curious about your lab facilities/ diagnostics out there... what do you have available for STD testing?
This weekend, I was out in Beaufort at the marine lab for our department retreat. We went out on a boat for "dredging and trawling". I didn't know what dredging and trawling was before, but it was awesome! We saw squid and crabs and jellyfish and normal fish. We also passed by some dolphins in the water -- it was so beautiful!
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