Wednesday, July 8, 2009

Tuesday and wednesday

Tuesday the 7th came around and i dragged myself out of bed to get ready for my first hospital consultant ward round at 8 am. I got there on time, not the case for the other members of the team who were vital to the ward round. We waited for everyone to arrive and finally commenced at 9.30 am. Dr UE introduced me to the team, we then proceeded to our first patient.

Patient A was a schizophrenic who had a myriad of problems that i couldn't quite grasp. The consultant spoke to his mom for a few minutes and ignored them for the rest of the time we were there as he quizzed the residents and house officers about the case. The patient lay asleep on the bed, noticeable on his ankles were bruises from being tied down the last time he was in a hospital. I didn't know that such crude methods were still being used to restrain psychiatric patients. We moved on from patient A to Patient W. Patient W is a patient with HIV that has progressed to AIDS. His CD 4 count was 5! (normal range is 500-1600). He looked really sick and cachexic (thin and emaciated) . Worse still he had a bed sore from lying in bed all day. Dr UE called me around to take a look at the sore. Suffice it to say that it was one of the more disturnbing things i'd ever seen and i've seen quite a number of disturbing things. I am beginning to see that HIV is indeed endemic in Africa.

What was heart warming though about this patient was that his wife was always by his side and attended to him all the time. I was touched that despite the depths of his awful illness his wife was still loyal to him. We moved on from the AIDS patient to a man with heart failure on a background history of dilated cardiomyopathy. He was recovering well and wanting to go home. The senior registrar directed to come back and take a history from him as well as examine him.

On to the female ward we went to see a lady who had lupus. This was quite suprising as i was under the impression that Lupus (SLE) was a disease that predominantly affected caucasians. She wasn't doing well and was unresponsive to the treatment regime the team had prescribed. The only treatment that was left was a new and revolutionary drug. In medicine, new and revolutionary usually equals expensive. The drug rituximab cost something like $800 for a course, ouch did i hear you say! i hope she's able to afford it and that it works for her. It will be quite an expensive flop if it doesn't work. From lupus we moved to a young lady with sickle disease. She was unresponsive but not in a coma and had a high grade fever. Her Neuro imaging showed cerebral atrophyand several strokes in her brain from her blood vessels being occluded by the sickled red cells. Her mom was very involoved in her care and gave a few suggestions to the doctors on how best to manage her daughter. I was impresssed with this and thought it was something that should happen more often. The issue that arose with her was trying to get a vein to bleed her of large amounts of her own sickled blood and then infuse her with normal blood. This is called an EBT (exchange blood transfer) The haematology team promised to do what they could to achieve this.

The ward round was full of jokes and laughs, it was quite interesting and fun to walk around with the team led by the two consultants who looked on the lighter side of things. The last patient that was seen was a lady with resistant hypertension. She was on so many drugs yet het blood pressure was still high. The doctors were at a loss as to the reason for this. All the tests for possible explanations for this phenomenom had come up negative. The round ended in A & E with our HIV patient who was suspected to have meningo-encephalitis. After rounds i went back to the heart failure patient to speak to him. On getting there I discovered to my dismay that he didn't speak english, neither did his brother. We got a nurse to interprete for us. Didn't help our communication much and caused me to end the interview early as i didn't feel much head way was being made. I examined him and could see his heart pulsate from a mile away. His heart sounds were abnormal, suggested that he'd sooner rather than later need a valve replacement. Good luck to him.

I thanked him, washed my hands and left for home soon afterwards. Was a long day and i needed to get some fresh air and rest.

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