Better, bordering on great..

Sunday afternoon, 26 October 2008

I got a bike! And not just any bike, a Supa Hamba, a Chinese knock off, made in India, that is almost exactly like the one I rode in Sudan. It’s “all steel” which makes it heavy and indestructible. It has fat tires, and a coaster brake (here it differs from the one in Sudan in that I can stop this one). I bought it for under $100.00 as the exchange rate is P8.00 to the greenback, up (actually down as iy were) from P6.00/$1.00 on our arrival. I’m now about a 2min ride from the hospital, faster than by car as I can ride it on a dirt strip that cuts through the neighborhood straight to the hospital gounds.

Where we had a legitimate couple of saves! We had a guy with sepsis and a systolic pressure of 30mmHg for who knows how long before we got to him. He was comatose, wasn’t making much of a fuss and besides seemed comfortable so the cubicle nurse just dutifully recorded his pressure as “unrecordable” and moved on. We got to him on routine rounds and began vigorous resuscitation with gobs of fluids and what has become the antibiotic cocktail of choice here; cefotaxime, metronidazole, and vancomycin. Today, Sunday, he is alive, awake, and wondering what the big deal is. Another came in with sepsis and a CD4 count in negative numbers and is slowly doing better. The energy expended on simple vigilance here is staggering and takes its toll by weeks end.

On Friday we reviewed the death of a 22y/o woman who died with and from an acute abdomen. The old saw about how one should never let the abdominal wall stand between you and a diagnosis doesn’t play well with the surgery folks here, or at least some of them. We have an old ex-Soviet surgeon who is fantastic. Unfortunately for the patient he was off call. She came in with classic signs of infectious cholecystitis (a serious infection of the gall bladder). Before she would be accepted for “theater” she needed a chest X-ray, something that takes two days on average. Interesting that virtually everyone is admitted through A&E with a CXR that is many times of little use. So the surgeons have deniability built into their refusal to manage an acutely ill patient for whom surgery is clearly indicated , even without a blasted chest X-ray, and radiology continues to stumble along in all its passive-aggressive glory. Nicola and I have vowed that this is the last time this happens on our service and that the theater might just be the next site of a harried attending wheeling a sick patient across its threshold for definitive care, a la the ICU and me about three weeks ago.

We are moved in and things are definitely better. Today I worked on my bike, did some yard work, went shopping for tools, drank some coffee at a local shop and watched the amazing array of peoples that populate this capital pass by. Many had kids with whom I’d play around and it was a hoot.

It’s the beginning of a new week that promises to bring change and challenge as I start outreach on Friday part time. It should be interesting. Thanks for joining this stream of consciousness.