Passages

8/3/07
Our medicine team has dwindled as we head toward our call weekend where we anticipate that we’ll double the size of our inpatient team to over twenty again. We have had several deaths on our service this past two days. The first was our 53 y.o. with a massive tumor load in his liver who died about 10 hours after we told him the pathology report that showed he had adenocarcinoma, and the second was one woman with AIDS and PCP pneumonia. Fortunately, we were able to send some people home who have recovered from their acute illnesses rapidly. Two patients with congestive heart failure went home this week – one young but with severe mitral regurgitation, and one who was older with cardiomyopathy due to hypertension. On rounds today we went to see a diabetic patient who was having cardiac ischemia just laying there in her bed who had pain for several hours already. Off to the ICU for her, as we treated what looked like an acute infarct when we first got her on a cardiac monitor. On arrival, she became lethargic from a low blood sugar since she had received her insulin but was too ill to eat from her chest pain. The pace of these crises is handled quite differently here – a bit like herding cats.
One great moment this past week was when I gave one of our AIDS patients (M.) a toothbrush that was donated by one of my patients back home to hand out here. She is wasted and quite ill, on treatment for TB and PCP pneumonia and not eating well at all. She had teeth that have been stained by her iron supplementation and had no toothbrush to clean them. She lay gaunt in bed with sunken eyes as we started on examination of her. When we were done, I asked her if she would like a toothbrush and toothpaste to clean her teeth. I gave her the package and had to open the brush packet as she was too weak to do so herself. She looked at our team with a huge smile. Now for the past two days, her smile has graced us each day on rounds as her teeth are getting whiter by the day. Thanks, Mr. and Mrs. Walker, for the gift you gave to M. and many others here. I am not sure if she will survive but she has known compassion and caring from strangers in a far away land. If she can pull through and get on HIV treatment, she may live a long life, but we must get her through this critical illness first. Only God knows if that will happen but we are determined to give it our best effort.