Work began again. Morning report as usual, but with quite a few deaths for the weekend, unfortunately. The one that stuck out the most was a child who had come in in renal failure – in those patients, it’s really important to keep track of their electrolyte levels, particularly their potassium. However, the lab’s machines and the unit’s arterial blood gas machine, which could give an electrolyte reading in about 2 minutes, were both down. No one realized that the baby was in renal failure for a day or two, and even then they couldn’t recheck the electrolyte levels to know whether treatment was helping. The baby died. Talk about cold hard reality.
At some point last week, MK and Lina met with Dr. Kung to discuss the devices they’ve brought from Rice. Just to clarify – in some round-about way that I don’t entirely understand, MK and Lina are associated with the Botswana-UPenn partnership, and that’s why they live with us, but they actually both just graduated from Rice, and work in the Baylor clinic part of the time. They were both biomedical engineering majors, and senior design projects for all biomed students are to develop medical devices that could be produced and used in low-resource settings. Part of MK and Lina’s job here is to show off previous year’s designs, and to get ideas for future projects. They asked Dr. Kung to shadow with her for a week or two to get a feel for where new devices might be beneficial, so MK joined us for rounds today.
Things were kind of chaotic because it was Monday and we were getting started late because morning report ran long. We started on rounds, then I got dispatched to print forms for one patient, which turned into a 30-minute long ordeal of trying to find a non-existent paper jam in the printer, etc. On the upside, that meant that I was in the nurse’s office for a while, and someone pointed out my keys that had been found in the bathroom and taped to the window over the weekend. Hallelujah!
We worked our way through the old patients that were left after the weekend, and the new ones that had come in. The last patient we saw was a baby that they had presented at morning report as having dysentery, but it rapidly became obvious that the poor kid actually had an intussusception that the resident hadn’t caught. Dr. Kung was really unhappy, because we had lost over an hour that we had spent rounding on the other, less acute babies that could have been spent on getting this baby into surgery. We jumped into doing labs, etc. In addition to helping Dr. Kung draw blood and start a couple of IVs, I placed my first TB skin test on my own! YAY! Tip: If you have to dress in nice clothes (rather than scrubs) to go to work in a hospital, don’t wear black pants. Especially if the gloves are powdered. It just creates problems.
Before we knew it, it was already 2, and MK and I were both starving. We ran out to the front of the hospital and grabbed some hot dog/sausage things that the street vendors sell, and stuffed our faces. We stopped in the caf and split a pot of coffee (you get a full tea service here when you order coffee, including your own mini-pot of hot water with which to brew your incredibly scrumptious instant coffee), then headed back to the ward.
Dr. Kung was still working on getting labs and things sent off, and everyone was flustered because apparently the intestinal obstruction baby’s labs had been sent hours ago, but it had been discovered while MK and I were at lunch that the lab techs had promptly buried all of the lab work under a pile and not done them. Which meant that the baby’s pre-op hemoglobin, etc. had not been done. Which meant that the operation could not be done yet. Which meant that surgery was pissed, and the baby probably wouldn’t go to the operating theater (they call it the OT, as opposed to the OR, here) till 10 tonight. Great.
Did charts the rest of the afternoon, because everyone was too busy on the ward to give me something to do. Stopped in the ward before heading home, and heard Dr. Kung discussing an interesting differential with Changi and Tiny about a baby that had come in with lower extremity weakness, and had the worst stranger anxiety I’ve ever seen in a child. All Dr. Kung had to do was look at the baby for it to start screaming.
Got home exhausted, but it was Kim’s birthday, so they had invited us to join them at Bull and Bush for dinner. I didn’t feel inclined to spend money on dinner after buying lunch, especially since I was totally cleaned out of cash because the ATM didn’t work on Sunday. We all ate dinner together at home, then crammed in a cab for the ride to BAB. It was fun, though we mostly ended up talking amongst ourselves because the others were mid-meal when we arrived. Headed home around 8:45, then went straight to sleep without blogging because I was so exhausted.
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