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A Day in the Life

sunny 85 °F

This past weekend, we took off Friday and went out to the beautiful island of Roatan to snorkel and relax. We also met up with Mariel's dad there and had a really great time. We will post some photos on Facebook once we get it together a little. But this blog entry isn't really about the weekend (though it was wonderful). I thought that instead I'd give you a synopsis of a day in the life of a med student down here.

It can be a little deceiving and seem like we're really taking it easy when we say that we have clinic only from about 8am to 2 or 3 in the afternoon most days (because all the patients try to catch the last bus back home, which runs at 3:00). We also take call every 4th or 5th day with one of the physicians here overseeing us, and jump in wherever else help is needed or something interesting is going on. So here it is, a day in the life...

Wednesday, 6:30 am - wake up, decide I'm too tired to go for a run and snooze for another 20 minutes. Eventually drag myself out of bed and get ready.

8:00 am - I get to the hospital and survey the waiting room. Lots of people today. Uh oh. Before heading to my clinic office, I go to the ward to check on the patients I'm responsible for. Today I just have one, a woman one day post-op after a hysterectomy, and she's doing well so I chat with her and then write a quick note with orders to advance her diet and encourage her to walk.

8:20 - Head back over to clinic, by way of the ER to make sure there's nobody there I need to see, since I'm on call. I start seeing patients and am delighted to see that my first one is a return patient who is here to get his sutures removed. I had put them in a week or so before after he cut his hand with a machete. It healed up well, so I sent him on his way. Afterward I swing by Ben's office, where he is rechecking the woman whose leg he sutured up last week after she was clawed by an anteater that was fighting with her dog (she won the fight in the end and killed it with a machete). Looks like she's a bit infected, so he keeps her on antibiotics.

9:00 - Head back to my office to find more charts have appeared. I quickly see another return patient, a young woman I admitted a week or so prior with respiratory distress who is finally doing better. Next I see a few older patients with diabetes/hypertension/pain complaints, with a few sick kids slipped in between.

About mid morning we hear about a case going on in the OR: a one year old boy is here to have a giant Wilms tumor on his kidney removed. It's happening now because an anesthesiologist is here for the week. He clearly has some other problems, though, including developmental delay and a general floppiness. Everyone keeps this baby in mind as they continue with clinic patients.

12:00 - There's a lul in clinic as I'm waiting for labs on several patients, so I sneak off to lunch quickly and feel relieved that it's not a 3:00 lunch day, which we've been having too many of lately.

1:00 - Return from lunch ready to go again, and find plenty of patients also ready. I spend a lot of time with an older man with lots of complaints, including prostate problems, out of control hypertension, prior strokes, athletes foot, and an unsightly growth on his face (a seborrheic keratosis, for my med student friends). I deal with him and a few other people and manage to sort out all of his problems and even lop off the seb K in time to get him on the 3:00 bus.

3:00 - Now that I've finished with clinic, I stop by to say hello to my hospitalized patient again and swing by the OR to see what's going on with the baby. He is out of surgery but hasn't come out of anesthesia well and isn't breathing on his own. I settle in and start rotating in to help him breathe with a manual bag venitilator, since there is no automatic ventilator here. We start to notice that his temperature is quite high and seems to be rising. At 104 degrees we start getting ice packs to put on his little body and we feel helpless as his temp rises to a max of 106 degrees despite all of the ice packs on him. I find more and more ice to put in the wet towels we have on him and the anesthesiologist administers dantrolene, presuming malignant hyperthermia, a very rare but potentially lethal complication of anesthesia. After a few hours of this, his temp finally starts to drop.

6:00 - The baby is looking more stable and his temp is still down, but his blood pressure is acting funny. He still isn't breathing on his own and we're having a hard time keeping his CO2 level down. I continue rotating in to help him breathe. His parents come in to say goodbye for the night, kissing him and talking to him in baby Spanish.

7:00 - The nurse on call comes into the recovery room to tell me that there is a patient in the ER ready to be seen and another who just arrived. I abandon all hopes of dinner anytime soon. A young woman about 7 weeks pregnant is here complaining of abdominal pain and passing blood clots. Her vital signs are stable, so after talking with her for a while I go see what the other patient has going on. He is laying on the other side of the curtain with blood covering his lower leg. He tells me the story: he was outside working with some kind of machinery cutting something, and he accidentally cut a piece of old wire which the machine threw into his leg. Sure enough, there is an old rusty-looking wire poking out from his shin. After his tetanus shot, we clean up the area as best we can and get ready to try and pull the wire out. The labs and X-ray techs don't work at night, so we can't get an X-ray to see how long this wire is and where it is, but we figure it's best to try to get it out and hopefully send him on his way. Despite the lidocaine to numb him, the man yells out and writhes in pain as we pull with all our might on the wire, which doesn't budge. We decide he should be admitted so that we can give him pain Meds and antibiotics through the night and check an X-ray in the morning. Later that night, I add a few words to my vocabulary and discover that he'd told me he was using a weed wacker and accidentally whacked some old fencing wire, which may or may not have been barbed wire. Spoiler alert: it was definitely barbed wire, and he was lucky enough to get the barb itself embedded in his muscle.

8:00 - We ultrasound the pregnant woman and send her on her way, and I get the weed wacker man admitted to the ward. I head back to the recovery room where the baby is still being cared for. The nurses are making a schedule for the night for bagging the baby and i notice my name under the 3am to 6 am shift. My body suddenly feels more tired, and more hungry. It looks like the baby is doing about the same though his temperature has come down significantly. He fails an attempt to breathe on his own and we adjust our bagging to make up for the deficit just created by this trial. As he becomes more stable again, we go over the schedule, the 9:00 bagger arrives, and I decide to go get some dinner and sleep before my shift is up, or until someone else comes in to the ER.

9:00 - As I round the corner of the hallway out of the hospital, my radio cries out, "Code blue, code blue, recovery! We need help!" I spin on my heels and run back to the recovery room where the tube has fallen out of the baby's mouth. The anesthesiologist is quickly trying to re-intubate the baby and I help hold his tiny mouth open. The tube goes in and we relax, only to watch the tube slip out yet again. After a few more moments battling, the tube is back in place and we give him more breaths through it after sticking it down with a whole lot of tape. Once he is stable, I grab my bag and walk the half mile home in the dark to find Ben has made me a great dinner. We go to bed early, anticipating our shifts later that night. I put my radio close to my head and pray it won't wake me until 3:00.

12:30am - Knock, knock, knock! We both start awake and look around thoroughly confused. Ben opens our door and we hear the anesthesiologist's voice, "Hey, you guys don't need to come in for your shifts anymore." Oh good, I think, he's breathing now. "The little boy died." he finishes. "Oh, no," mutters Ben. The anesthesiologist turns and walks away to his room, obviously upset. Ben closes the door and comes back to bed. We sit quietly in the dark. "What the hell happened?" I ask eventually. Ben shakes his head. We lay back down but I can't turn my brain off.

1:00 - My radio goes off: "HR3HOT, Dra. Mariel me escucha?" the nurse calls. I jump and answer, "Si, adelante" expecting a patient in the ER. The nurse starts to tell me about the baby and also says we don't need to come in, and when I ask "que pasó?" Renee takes the radio and tells the story. The baby just had more and more trouble breathing and his blood pressure wouldn't stay up. The anesthesiologist thought it was probably a metabolic disturbance, a profound acidosis resulting from the malignant hyperthermia, that was to blame, but we can't do the required tests to say for sure here. They said the mother wailed for hours. I get up and read for awhile after this news before I can fall asleep.

4:55 am - "HR3HOT, Dra. Mariel me escucha?" the radio calls out. I shuffle to the next room and answer. There's a patient in the ER, a man with excruciating flank pain radiating to his testicles. Kidney stones, I think, as I get my scrubs on and walk over in the pre-dawn dark. Sure enough, his story fits well with this disease so I admit him and start pain Meds and fluids. We'll have to wait for morning to get an abdominal X-ray to confirm the diagnosis.

6:00 - I shuffle back over to our apartment, now disoriented in the light of the day. I fit in another hour or so of sleep before I can no longer ignore the alarm clock.

At 8:30, I'm back in the hospital ward talking with my three patients before a full day of clinic.

Posted by vagabundos 19:03 Archived in Honduras

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