Wednesday, July 7, 2010

“Just since yesterday…”

7 July 2010
“Just since yesterday…”
This is the phrase that you hear in disbelief over and over again here. So many patients present to Kijabe Hospital with advanced stages of disease with the story that it only was noticeable to them “just since yesterday.” I just returned from Casualty where Samuel, the OPD clinical officer, and I were evaluating a 58 year old man with acute renal failure, lower extremity edema, constipation and scrotal edema. Listening to his story, you’d think this all started in the last 24 hours but simply examining his abdomen revealed a 25 cm mass arising out of the pelvis up past his navel. The mass is firm and fixed – not a good prognosis but we’ll admit him tonight, get an ultrasound and try to figure out if he will have any chance with surgery before he completely obstructs his ureters and his bowel.
Lying next to this patient was a 60-ish year old woman who was obtunded with a hematocrit of 4.5% (normal being 36-45). I did think that was compatible with life. She is getting transfused right now with a possible diagnosis of pernicious anemia though I suspect there is more to it than that causing this profound anemia.

I was introduced to my service of patients today and here is the general rundown:
- 3 patients with last stage AIDS – one who has had a remarkable turnaround from his TB and PCP pneumonia in the past 3 days. He initially came in with oxygen levels at 41% (also not compatible with life it would seem), but today he is saturating up to 90% after 3 days of treatment with Septra and steroids (and TB treatment, of course). One of the other patients has cryptococcal meningitis and was obtunded yesterday but by adding steroids he improved dramatically overnight.
- 2 patients with metastatic cancer – both pending biopsies to confirm the type
- 4 ortho consultations for management of high blood pressure and diabetes
- 2 patients with diabetic ulcers (one with his second amputation being done today).
- 1 with an upper GI bleed
- 2 patient with a resolving abdominal abscess with hypertension
Anyway, a good re-introduction to the way things are here. I have run into a number of staff from the past years I have been here – a lot of warm hugs today! I am always surprised they remember me since there is a steady flow of volunteers here throughout the year. It is reassuring to see the longevity of the staff here – jobs offers from other hospitals are out there, and the pay is often higher now in the government hospitals due to efforts to reduce the brain drain in Kenya. Fortunately for the patients here, many of the staff stay on despite the other opportunities.

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