I’ve been on call today and have had the usual frustrations marked by some truly remarkable stuff. The ICU is a bastion of, what, a system that is such that one can’t admit there without the expressed permission of one of the anesthetists who are conveniently “preoccupied” such that they are impossible to contact or otherwise choose not to return their page. Thus one talks with nurses of various cultures and ethnicities all of whom are intimidated by these bastards and do as they say. I got a call today to start somebody on anti-HIV meds (HAART) as he was on it on the outside, had it at his bedside and needed a medical consultant to write the orders, unbelievable. When I informed the nurse that it a) could be started tomorrow, b) was best done through the clinic that is set up to do so (the infectious disease care clinic here at the hospital), and c) could be done by anyone there- I was rudely admonished to come in and hung up upon. OK, those that know me can fill in the blanks from here. Suffice it to say that he’s on HAART and the head dude and I are going to have a conversation about this tripe tomorrow.
We admitted a woman who is truly the face of HIV in Botswana. She has had HIV for an undetermined period of time, is wasted, has TB and goodness knows what else. She came in because of intractable vomiting and abdominal pain and was found to have decreased breath sounds on the left. A chest X-ray showed the most beat up (L) hemi-thorax I have seen. She had a tension pneumothorax with numerous huge fist sized cavities from TB and lung that was tightly collapsed in very bizarre areas. She was not in respiratory distress so we chose to go slowly with this and will CT the chest to best decide how to decompress this. The chest findings on CXR here are unbelievable. Easily 80% of the exams are grossly abnormal with findings that are present because of prolonged processes that precede admission, something I simply never saw in the States.
Steve Gluckman, my colleague and friend from Penn, and I climbed a hill that overlooks Gabs today. The similarities to Eastern Oregon were striking and beautiful as green is now the dominant color here.
Outreach for good this week, wow. How lucky can a guy like me get?
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3 comments:
Glad to see that Botswana hasn't changed you too much :). We had to watch a number of short videos for the class I'm in right now. Learned that there's a 40% prevelence rate of HIV in Bots. Seems crazy. I can't even think of one person I know with it here in the states. I can't believe how many people you are caring for and truly saving each day over there. I'm completely jealous!
Love you both!
-B
Please tell us more about the outreach! You will be gone Mon-Fri? Staying in the villages, or returning home at night? Anyone traveling with you? To quote your beautiful wife, "inquiring minds want to know!"
You're fighting the good fight. Keep at it!
Love you, Shan
Mike & Lynne,
Hi... We've finally found your website/blog & have time to post. Tereso & I are busy getting ready for winter, it hasn't snowed here in Trout Lake yet, but I'm sure it will before Christmas. We're hoping for only a little snow this year, last years 10 feet was waaaaay too much!! We've been spending time with Eric & Diane Schmid, you delivered their first daughter back in 1986, her name is Linnea. Eric said to ask you about her birth someday, so.... Diane told us she misses you, I gave her the blog address so maybe soon she'll post something. Right now she's trying to get through all your posts. We sure miss you guys, it's just not the same without you. When I set my computer to my slideshow, I see all those pictures of you, Lynne & the kids, it's nice! I'll sign off for now, have more to do outside before it's too dark. We love you guys & miss you so much!
Wanda & Tereso
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