The ward on a Tuesday

The service has expanded to about 24; 4 with meningitis of various varieties, one with TB meningitis and hydrocephalus (pressure on the brain), some with the “feel-bads” that are refractory to any attempt at intervention until today when we one dressed and ready to go (something about a woman), many with somatic complaints that resolve before we can effectively start treatment, and most with HIV and co-morbidities. We did three LP’s today (make that Kathleen did them) and all were successful. One of our patients started to decompensate at about 1500 and was showing signs of elevated pressure on the brain by his posturing; arms extending with wrists flexed and comatose.

To get a CT scan on an emergent basis one must get on bent knee and address the chair of the radiology department:
“Good afternoon Dr._____, how is your beautiful family”
“What do you want?”
“We really need an emergent CT scan of our patient who has decompensated in just the last half hour.”
“Can’t it wait until tomorrow?” (it was about 1515h).
“Uh, no because you see it is and emergency at this is happening rapidly and indicates worsening clinical status.”
“Can’t it wait until tomorrow?”
(“No you officious and power hungry b-----h, it’s an EMERGENCY!!, but maybe you haven’t heard of that as all you do is read films and do crosswords all day!!!”) “It really can’t as we would like to know if there is an intracranial process and affect treatment as soon as possible.”
Gesturing, “OK, sigh, bring him here as soon as possible and it better be quick.”
(“Thanks you OB”) “Thank you, I’m sure the family is grateful, as are we.”

The CT was revealing for communicating hydrocephalus secondary to presumed TB meningitis. Unfortunately the treatment will be too little too late.

We are getting a little bogged down and need to thin the service before the weekend. On occasion we try to discharge only to be met with resistance on the part of the family as they are either scarred or simply want their family member to stay longer to give them a break, something that happens a fair amount around the Christmas holidays and is perhaps the underbelly of the “socialized” system here.

In any case I came home with a monstrous head ache, am now recovered, and ready to try again in the morning. We continue to get closer to moving in. The place has been cleaned but not painted and it is more difficult to know who is responsible for what. We leapt at this in the first week of our stay here and it may not be the best option for us for several reasons. Still we look forward to our own turf if only so we can move in and put away the suit cases.

We have been blessed indeed with the home in which we live. Still, it’s time….