Nalerigu Day 25

Hello friends and family!

Well my call was again much better than my first. PM rounds went quickly and I didn’t get contacted again until 6am this morning. Unfortunately, I am too neurotic and awoke every half to one hour thinking I heard the nurses knocking at my door. I wasn’t correct until 6pm when a nurse from the OB ward handed me a chart. The chart had no writing inside other than a note that said there was a female woman who was pregnant with twins. She delivered the first twin at home, but then developed severe bleeding and became unconscious so was brought the med center for further evaluation. The note at the bottom of the page said, “Please doctor, kindly please come to assess this patient. She is bleeding and unconscious. There is malpresentation with a retained second fetus.” The bells went off in my head saying “this is not something a pediatrician can handle”. So, I went over to the Wichita house as they are excellent at obstetrics patients, but unfortunately could not wake them up, so I headed (quickly) to Dr. Dickens’ house as he is the staff OB and his house is also on the way to the hospital. I knocked as loudly as possible, but everyone must have been tired from the evening before since there was again no answer. By this time, I had spend a few minutes trying to wake people, so quickly drove our “on call” truck to the hospital and figured I would stabilize the situation and in the meantime have someone go to try harder to get the help I would need. As a side note…I am very thankful to my father for insisting/forcing I learn how to drive a manual transmission or I wouldn’t be using the “on call” truck. When I arrived in the OB ward, the patient was alert and there was a large mass of tissue on the bed. I went over, realized that the bleeding had stopped and the patient was awake and then looked down at this blob. What was it you ask? The second twin (twin B) had been inside its own sack and the sack was attached to the placenta. The baby delivered still inside the sack with the placenta. Unfortunately, due to the placental bleeding the baby was already gone at the time of delivery. We still removed the baby from the sack, started chest compressions and bag mask ventilation, but there was no response. It was a sad story, but I was thankful that the mother was able to live through the problem and the first baby (twin A) was also doing well. You have to look at the bright side here.

I then returned home where I showered, ate breakfast, took my anti-malaria medication and then headed back to the hospital for am rounds. Rounds were good this morning. I discharged most of my children today. One child who had severe respiratory distress was singing for me this morning!! It was wonderful! After rounds we headed over to the theatre to do some procedures before clinic started. Well, I only did one procedure that took an exceptionally long time. There was a dilation and curettage to be done on a patient who had a failed pregnancy. For those of you who don’t know, a D&C is where you go in to remove the remainder of the fetal tissue as this can be a source of infection or bleeding if left in. I’ll be quite honest, this is not a procedure I enjoy doing and I enjoy it even less today. John (one of the Wichita residents) and I decided that we would team up and he would be my mentor to complete the D&C. The problem was that this particular D&C was exceptionally complicated. I won’t go into all the details, but the procedure took us about 4 times as long as normal and was very sad. Thankfully, the patient did very well and didn’t have any problems. Getting the tissue out was the difficult part.

After we finished the D&C we all headed off to our prospective spots in clinic. As usual there was a vast array of people to be seen in clinic. Jessie was in the pediatric area today so I saw mainly adults which the exception of some scattered kids in between. Patients had the usual complaints of generalized body pain, waist pain, dizziness, scanty urine, fever (but not really fever), etc. The most interesting patients of the day were the following:

1) Child with a slow growing facial tumor of which a biopsy was done and sent to the US. We’re still waiting on the results.
2) Family with obvious Marfan syndrome
3) My baby with Down syndrome returned with her mother and is doing very well. She is now tolerating nursing which is very exciting!
4) Child with severe hepatitis due to a prior blood transfusion for whom transplant or treatment are not options here. We gave her extra stickers today. She melted my heart.
5) The most interesting patient of the day….untreated osteosarcoma. See the pic for more information.

Clinic was exceptionally busy today. We got our usual 1 hour break in the middle for lunch, but stayed much later than usual since there were so many patients. After clinic finished, we all headed back to the theatre to help out with any further procedures that needed to be completed. Here’s where things got interesting again and where I realized what an absolute wimp I can be. Drew saw a patient earlier in the day with puss draining from his scrotum. I knew this information, because you could smell the patient down the hall. Well, lucky for all of us, he was left to the end of the day to have his abscess drained. The minute he was brought into the theatre area I began to gag. Not kidding, this is the absolute WORST thing I have ever smelled. Dr. Dickens, who has been working here for 2 years, says this one was in his top 20 which is definitely saying something because many things smell here. Thankfully, John and Drew VERY kindly said they would help out with this one. He apparently had the diagnosis of the day, which is necrotizing fasciitis of the scrotum (google this for more info). I couldn’t even be around the room without honestly gagging. Lucky for me, a nurse from the hospital came to ask for help in a different ward for which I raised my voice quickly to volunteer my services. What I didn’t realize is that the patient I was going to see was someone I knew and he wasn’t doing well. I grabbed the chart from the nurse, read the information and then asked him to show me to the patient. I was very confused when he walked me into the OB ward when I knew the patient was male. That’s when I realized I was headed to the “VIP” area. It was dear, sweet Moses, Dr. Hewitt’s translator in clinic who was lying on the bed. Unfortunately, Moses has a chronic disease for which he has intermittent times of worsening symptoms. Today, he was admitted by Dr. Hewitt because of similar concerns. I was called to his bedside as his blood pressure was dropping. I have a particular fondness for Moses as he is one of the people in the clinic who encouraged me on my first day when I had absolutely no clue what was going on, but was left to see patients on my own. He is truly a kind and gentle soul. I am wishing the best for him. We all are. After a bit of talking, I wrote some orders and then headed back to the theatre for more smelly-good.

Again, I was rescued from the deadly odor when I heard a woman screaming from the pediatrics ward. Here is the story:

A child was admitted by one of the medical assistants for respiratory distress. The pediatric nurses (who are excellent) received the orders and started getting ready to initiate them when the father of the child who was intoxicated grabbed the child and took him out of the hospital. Sadly, when the mother returned with the child, he had already died. The floor was a disaster. The mom was hysterical as any mother would be and the nurses were irate at the father as they felt they weren’t given a chance to help the baby. I tried to help the mother first and then proceeded over to the nurses’ station. They were discussing their frustrations and wished for the child to be sent to the morgue as they didn’t want the child to return home with his father. I told them that we should do what is in the best interest of the child, which would most likely be to return home with his mother for a proper burial. There motive was mainly to teach the father a lesson, but I reminded them that the father was really in no state of mind at that point to be taught. They finally agreed and the situation settled. It was very crazy for a while and of course sad that another child had to die.

I then returned back to the theatre at which point the smelly-good procedure was complete!! Good timing on my part. We then all walked back to the house for some dinner which was one of our favorites, chicken enchiladas (not exactly a Ghanian feast). Now, I’m doing some blogging, hoping to skype with my hubby and then headed to bed for a good night’s rest. Tomorrow we have am rounds, several procedures to do and then we are hoping to all visit the chief (also known as the king) of Nalerigu. Should be fun!

Two more things that happened today that haven’t yet fit into my story. Today, we greeted another new volunteer to the group who is actually a fourth year medical student from Midwestern in Arizona!!! We even know some of the same people. Amazing.

Today, I am thankful that my husband allowed me to leave him for the month to travel over the ocean, to an unknown land, in order to pursue my dream of serving in Africa. I had compassion for people in poverty before I left, but now I have understanding and hope that change is not an unreal expectation. Thank you Joe for being such a loving husband! I’ll see you soon!

What are you thankful for?

Jill