In Review

Day 35 - 39
June 20 - 24

Now that we've settled into a weekly routine at work as well as at home, I decided that I don't have enough interesting material to make a daily post during the week. Instead, I'll summarize the funny/interesting/sad things that happened during my week, and devote the most time to that. Here goes...

Monday
Morning – report, Ward rounds w/o Tiny (not fun)
Lunch w/ Kat
Afternoon – back to chart sorting in the A&E

Tuesday
Morning – report, clinic
Afternoon – charts

Wednesday
Morning – report, rounds
Afternoon – ward work, clinic (briefly), more ward work

Thursday
Morning – report, rounds & ward work
Afternoon – ward work, charts

Friday
Morning – report, ward work, Mma Obama!
Afternoon – M&M, finished April charts!
Dinner at Embassy!

Interesting/funny/heart-breaking things that happened this week:

Interesting:

Michelle Obama came to Botswana. I was within 50 feet of her as she entered the site for the future “Baylor Adolescent Center.” Yeah, be jealous ☺ Fun fact: that lot has, up till now, been completely abandoned, full of discarded trash/junk, and overgrown with weeds. Two days ago, in preparation for her visit, they cleaned up the lot and started painting a random mural on the wall, which they were still finishing as of 7 am the day she arrived. That’s Africa (TIA – it’s a thing).

Heart-breaking:

One of our patients this week was a severely malnourished child who had Kwashiorkor, a life-threatening protein deficiency. The mom had been following a strict feeding regimen monitored by a dietician, but the child still had a critically low potassium level of 1.93, which is virtually incompatible with life. In the U.S., that child would have been started immediately on a potassium infusion and placed on continuous cardiac monitoring. Here, they don’t even carry IV potassium on the units because the nursing support isn’t there to provide the right kind of monitoring, and potassium has to be given very, VERY slowly, or it will stop your heart – they used to give IV potassium solution orally, and a nursing student misunderstood and pushed it FAST, via IV, and the patient died. So now, families have to buy multivitamins from the chemist and bring them to the hospital pharmacy for special preparation. We told the mom for two days to get the potassium, but the family took a long time, and by the time they brought it on Thursday evening, the hospital pharmacy had closed and refused to mix the preparation until the next morning. (What kind of hospital pharmacy is not open 24/7?!?) The child died that night.

Frustrating:

In order to diagnose our patients who have TB, we collect gastric aspirates, which I've written about doing before. However, what I didn't add is that said samples get sent out of the hospital for culturing. The PMH lab is able to do the first part of the test, which is a smear, but the most important thing is the culture. Seems pretty inefficient, but whatever. Well, at the beginning of last week, Dr. Joseph mumbled something to me about the lab no longer doing TB cultures, and I ignored him. Then, over the course of the week, three different nurses told me the same thing, and I had no idea what to do, so I still kept collecting the aspirates when told, and marking down the culture on the order sheet. Someone finally mentioned the issue again in front of Dr. Kung, and she unequivocally said, "No, we need the culture, it's the most important part, mark it down." When the nurses persisted in following me around telling me I was doing it wrong, she took action and called her husband, who is an infectious disease specialist, and the true story finally came out: apparently the lab contracted by the hospital to do the TB cultures had closed last weekend for renovations, and there was no other lab to do the cultures, so they were being cancelled. Thanks guys, think you could have told us sooner? Or, I don't know, arranged for a different lab to take over while you're closed? AUGH!

Funny:

Kat has joined me working in the paeds medical ward office on chart entry because all the outlets in the room she usually works in randomly stopped working. She told the doctor who’s the head of the A&E (because it’s the A&E’s office), and he told her to tell one of the nurses, because they can fix it. Honestly, some things never change – do they think that nurses just have a toolbox hidden somewhere that we can use to fix anything and everything, but we'll only bring it out to use if you pester us enough?

I drew blood on one of the kids on the ward on Thursday afternoon, and the mom roughly translated what the child was saying as “I want to eat your guts.” I suppose if someone was sticking a needle in my wrist and I was three years old, I would probably express similar sentiments myself.

One of the attendings, Dr. Brewster (AKA “Prof”) is not afraid to vent his feelings about the adequacy of the residents’ skills (or lack thereof). This morning a resident was presenting a 2 year-old patient, which he diagnosed with bronchiolitis (an inflammation of the airways in the lungs, basically, usually a viral infection in young children). As he’s said more than once before, Prof pointed out that bronchiolitis can only be made as a diagnosis in children under 2, but he let it slide on this patient. Then, the resident presented another patient, this time a 3-year-old, and again diagnosed bronchiolitis. This time, Prof lost it, and said something along the lines of, “That’s an inappropriate diagnosis, and if you persist in making it, it’s simply shameless a display of your ignorance.” Seriously, Prof, tell us how you really feel.