First day in the hospital

5-30-08 – Esmeraldas, Ecuador

It’s now lunch on my first real day of work at the hospital – I’m home for the Netherlands girls’ big send-off feast. Technically I’ve got .5 days under my belt, but the five hours feel like five years. This morning started with the neo-natal floor. The director turned out to be much more receptive than when we first met – we worked together for an hour, rounding on babies, discussing different illnesses and the effects of “anti-cuerpos” (antibodies). The latter became important when we got to a newborn whose mother tested HIV+. With that diagnosis she shouldn’t be breast-feeding, but if she’s not breast-feeding, the kid won’t get his mom’s IgA - without which he’s at a greater risk to become ill. At the moment he’s on prophylactic anti-retrovirals for the potential HIV and antibiotics as a precautionary step following the Caesarian section. I intended to keep track of these drug names but someone on the bus stole my pen – and the hospital doesn’t have any extras so I’m without the notes.

After an hour he turned me over to the emergency room. Half-hour later I was seeing patients. Half-hour after that I was giving injections. This afternoon I’m told I’ll be learning to suture.

Some time mid-morning an old man came in with respiratory distress. He was poor and ill – so emaciated that his clothes were falling off. The skull beneath his face seemed only a prop to keep his skin from losing shape. A discrepancy arose over his pulse – some thought his heart was beating 64 times a minute, others up in the 80’s. The problem was that the arteries in his wrists were too weak to be palpated for more than five or six seconds at a time. When asked to weigh in I went right to the source – foregoing the wrists and putting my stethoscope directly over the patient’s heart. We are taught in medical school to maintain the seal between the stethoscope’s diaphragm and the patient’s skin – but I never learned anything about how to deal with emaciated patients whose chests suck in on themselves between the ribs. So I did the best I could, putting the stethoscope down as a bridge between two ribs and counted the sounds coming through his bones. In spite of government-subsidized free treatment, he later asked to go home and die. I think his family talked him out of it, but I’m not sure because I then left the room for the next patient.

The rest of the day went a little something like this:

33 year-old man with sudden onset of wobbly stance, slurred babbling incomprehensible speech, light-sensitivity (feels pain when he opens his eyes in a room with the lights on). Assessment: intoxication due to drug overdose.

63 year-old diabetic woman whose low blood sugar dropped her into unconsciousness. Veins no good. Started IV dextrose on her finger, given hard and fast to raise her blood glucose.

7 yo boy presenting with machete laceration to the knee whose parents waited 22 hours to see if it would get better on its own. They did not notice that the knife went through his muscles.
(At this point the Emergency Room ran out of running water)

26 yom with dangling flesh from ankle secondary to bicycle accident.

7 yom who fell from a playground, presenting with what appears to be a wrist in the middle of his forearm. Treatment: pull the arm back in place. Lots of crying. An injection of lidocaine was given as a local analgesic, but it seemed to make little difference.

9 yom with a snake bite

23 yom friend of a friend from high school (small world) with puncture wound to shin from walking along the street and falling in a hole.

-BH-