Anything but boring around here.
Clinic day: ligated an umbilical granuloma, did a newborn check, discharged a couple of inpatients, saw a bunch of controlled diabetes and hypertension (it's pretty great when you get to just congratulate people on how well they are doing!), more abdominal pain with fever than you can shake a stick at (this would almost always result in an abdominal CT in any US emergency room- nearest CT scanner is 90 minutes away and costs way more than most of our patients can afford, so instead we rely on physical exam and history), and of course just as I got into bed...an ER patient with gunshot wounds to the face and hand, including one penetrating through the cheek. I feel bad calling our only surgeon in late at night, but in any other setting I would have called anesthesia, trauma surgeon, ENT, etc.- here that's all rolled into one person.
Deciding patients are sick enough to be admitted here is a funny thing. I admit to myself, so anyone I send home is someone I don't have to round on in the morning, but do have to see in clinic in a few days for follow-up. Anyone who I decide to admit is a captive patient- I don't have to worry about how they are doing at home, but there's an element of fatigue in my decisions...is your abdominal pain really worse than the last person's in some way? Am I really concerned this could be something bad? Will sending you home make me stay up at night worrying about you? Will admitting make my life more complicated in the morning?
As one of my California friends says, around here life is full with "jungle medicine and full gospel baby deliveries"!! Prize of the day was receiving a HUGE bag of oranges from a patient. Food is one of my favorite ways to be thanked/paid :)
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Clinic day: ligated an umbilical granuloma, did a newborn check, discharged a couple of inpatients, saw a bunch of controlled diabetes and hypertension (it's pretty great when you get to just congratulate people on how well they are doing!), more abdominal pain with fever than you can shake a stick at (this would almost always result in an abdominal CT in any US emergency room- nearest CT scanner is 90 minutes away and costs way more than most of our patients can afford, so instead we rely on physical exam and history), and of course just as I got into bed...an ER patient with gunshot wounds to the face and hand, including one penetrating through the cheek. I feel bad calling our only surgeon in late at night, but in any other setting I would have called anesthesia, trauma surgeon, ENT, etc.- here that's all rolled into one person.
Deciding patients are sick enough to be admitted here is a funny thing. I admit to myself, so anyone I send home is someone I don't have to round on in the morning, but do have to see in clinic in a few days for follow-up. Anyone who I decide to admit is a captive patient- I don't have to worry about how they are doing at home, but there's an element of fatigue in my decisions...is your abdominal pain really worse than the last person's in some way? Am I really concerned this could be something bad? Will sending you home make me stay up at night worrying about you? Will admitting make my life more complicated in the morning?
As one of my California friends says, around here life is full with "jungle medicine and full gospel baby deliveries"!! Prize of the day was receiving a HUGE bag of oranges from a patient. Food is one of my favorite ways to be thanked/paid :)
