Well, I’ve been back in my house 4 days, and today was my 2nd day at work. I’m feeling the need to vent. (grin). This post will be of more interest to those with some interest in medical things. I am just going to review 3 of today’s patients.
There was a family waiting when I got to the clinic this morning: 3 adults and a 5 or 6 yr old with a really distended belly. They had been seen briefly in the outpatient department yesterday by Dr. Milan (my new co-worker from Nepal), who asked them to come to the clinic this morning so he could drain some fluid from the child’s belly. This child had been seen by the health care workers at a mission station about 45 min away, who declared that he had abdominal TB and he began taking those drugs 3 months ago. Because he subsequently got worse, not better, the family took him to another clinic, where he was seen by an expat doctor, who (according to the report) did an ultrasound and found his belly to be full of fluid, and gave him a referral letter to go to Goroka. Well, Dr. Milan spent 4 weeks working with those folks in Goroka, and knew that they would likely not even see the child for some days, AND knowing the procedure is a simple one, he asked them to come by this morning to remove what was reported to likely be a couple of liters of fluid in his abdomen. But when we looked at his belly there was almost no fluid. That was all liver. Had anyone simply gone by the report and tried to drain the fluid, they likely would have punctured his liver which can easily cause hemorrhage. With just a cursory exam we discovered that this expat doctor was wrong about many things. Both Dr. Milan and I were dismayed. This referring doctor has lived and worked without other health care workers in the bush for many years, and just recently moved to this other mission station nearby. There is a phenomenon in missions known as “going native,” which occurs when the desire to please the nationals (in order to reach them presumably) one aggressively denounces their own culture and indiscriminately embraces the new culture. This is the first time I’ve witnessed it in a health care worker; who appears to have adopted local health care standards. We still referred the little guy to Goroka, but told them to stop the TB medicine.
The second case was a man in his 50’s with AIDS, who has been struggling with shortness of breath for some years. He also was capriciously diagnosed with TB 4 times, and has been nearly continuously taking TB medicine for a few years. Once again, his symptoms have slowly worsened since beginning the TB medicine. At first glance he obviously had a low oxygen level; since his lips and mouth and fingers were a sooty gray. His oxygen saturation was 70%. His fingertips were bulbous from being low on oxygen for quite some time, and the veins in his neck (jugulars) were standing out like stout ropes. The xray of his chest showed an enlarged heart and liver. The ultrasound reinforced that finding, and also revealed that his heart was floating in a bag of water. His lower legs were spongy with fluid, and his raspy breathing made it evident everything was a struggle. Once again I took away the unnecessary TB medicine, and gave him medicine to pull off the extra fluid. He is supposed to come back in a couple of weeks. His AIDS and heart failure are not a good combination, needless to say.
The 3rd case was a lady that Dr. Milan saw a couple of weeks ago, who referred her to Goroka for possible breast cancer. She had been to the Goroka hospital 5 times in the intervening days, and was turned away every time; with the explanation that they were too busy. When I examined her it was obvious that she has inflammatory breast cancer that has spread to the skin on her shoulder and her lymph nodes. I know this cancer, because I had a friend in Kansas who died from it a few years back. I went to her oncology appointments with her. It is nasty and aggressive and deadly. I suspect it just began it’s relentless march to her other breast. I informed her that surgery is not particularly helpful, and is usually more harmful in these cases. I further told her that she will likely stand before God’s throne by the end of the year. I have had these conversations with so many terminally ill people now that I have a routine: “Don’t think this is the result of someone cursing you… you’ll only waste what little time and money you have.” “Don’t die before you die.” And I let her know that I will help any way I can, and that if she needs something but can’t come, she can send someone to the clinic to pick up medicine (pain medicine, probably). These folks usually don’t hear much of what I say this first visit, and return with other family members a few more times. Their return visits are usually better opportunities to more thoroughly share the Gospel. My hospice patients can come any time they please and the door is open. But I also write them down for an appointment about once a month.
So maybe you can see why I needed to vent. I see these kinds of cases ALL THE TIME. It just happened to come one right after the other today. Oh. And the bank called and now they want 3 documents before they will receive the deposit of funds from the USA. I certainly can’t explain that either. Thankfully it has been a quiet evening. I did a load of laundry, and I’ll finish up the dishes and head for bed. G’nite.
