We were checking on our first patient who was a labor induction when the triage nurse brought us a chart for an emergency patient. Snake bite. The first I've actually ever seen here. Praise God that they were able to kill the snake and bring it in a plastic bag with them. I couldn't get closer than about 3 feet from the table it was on out of fear that it would twitch and somehow strike me but our surgeon/resident jungle expert picked it up and identified it as a pit viper. Our lab director brought a photo of a fer de lance that looked pretty close.
We have three kinds of venomous snakes here: pit vipers, corals, and sea snakes. There is one kind of antivenom for pit vipers, one for corals, and none yet for sea snakes. The pit viper antivenom is from horses and can cause a pretty severe allergic reaction. Gracias a Dios I happened to move offices this week into another doctor's office while he is away and happened to find a snakebite treatment protocol which I had placed in an easily found location for the rare eventuality that I would need to use it. It contains detailed instructions on how to administer the antivenom, what dose to give, how to score the severity of the reaction, etc.
The most deadly side effect of this type of snake bite is a failure of the body's ability to clot- think Ebola. Our lab did the very time intensive tests measuring bleeding time and clotting time, which includes poking an earlobe and checking to see if blood is still dripping every 30 seconds, and putting some blood in a tube and checkin to see if it clots. His still wasn't clotted at 4pm from the 9am tests which is very abnormal.
When we got those tests back we decided it was time to give the antivenom. I asked Liz to supervise the process and I tried to power through some waiting clinic patients.
By 2pm we had finished seeing our clinic patients (which included getting to look at Giardia under the microscope- cue nerdy excitement) and Liz got to eat her first baleada. Yes, I just included a parasite and food in the same sentence.
I had a meeting and a music practice in the late afternoon and meanwhile Liz saw a patient in the ER who was a bit of a diagnostic puzzle. After making a plan for his care we headed home to make dinner. I got called back mid-preparation to evaluate a patient who was scheduled for a C-section next week but seemed to be in labor. She was, but was early enough that I had time to go home, eat the dinner that Liz had made, and think about going to bed.
We got called around 9:30pm because the patient who was being induced was 'complete' according to the nurse. A tarantula scared us coming out of my house.
The patient was only 7cm so we headed back up the hill. About an hour later, another call. Now she was actually complete.
While she was pushing, an ER patient came in. We saw him in between delivering this lovely girl and evaluating the other laboring patient.
The evening concluded around 1:30am with a successful VBAC and seeing a gecko eating a moth run up my front door. Just another ordinary day.
