Liberia #8
I awoke at 6AM with a bursting bladder. realizing I had hardly drank any
water during the day and sweat profusely with all the protective gear on
in the OR and also in the outpatient department, I had lost a lot. so in
the evening I loaded up eating and drinking about three liters of water.
After I was up i had my daily devotions and went into the hospital
devotion. After a reading and singing and prayer, the medical director
admonished everyone to always be vigilant about ebola and that in some
areas near Sierra Leone the rate was increasing. he also admonished
everyone to verify that there were minimal people in the hospital and to
make family members stay outside- other than one person taking care of
the patient. A little reality check! He also mentioned that if they
planned on leaving work and starting to work for an ebola treatment unit,
please inform the administration. apparently staff at an ebola unit make
10 times more than the locally paid staff. So the 3 PA?s and many
nurses, haven?t turned a resignation. If they do it is the day before
leaving, but many just leave and never say anything. This leaves one
nurse and an aid for the 10-40 patents. And these people are working a
lot.
I made rounds starting at one end again, this time making it through
three group rooms before meeting the patients that Gillian had already
rounded on. the prostatectomy patient from yesterday is doing well.
The urine coming out is clear with out blood, wonderful! the guy with
the second and third degree burns had stayed NPO so we could take him to
the operating room and decide wether to debreed and skin graft or not.
the guy with an infection around his lung (empyema) is still draining a
lot of pus out of the chest tube, but the amount is lessening and seems
to be less viscous too. the baby that was delivered by C-section still
had not drank any breast milk. I asked the mom if she had milk and she
said yes, pulling up her shirt and squeezing her breast to show me the
nipple with a little dot of milk coming out as she did it. I am in
Africa! here, like in most third world countries, breasts are a
functional body part only. Another guy had a distended abdomen that I
was worried about, but after consulting with Gillian, who admitted him,
he was apparently much better, so we will continue to monitor him. He
has sickle cell and malaria. Next another patient with abdominal pain.
And more. the abdominal pain is difficult to assess. We have only
ultrasound as a means of evaluating the abdomen, other than physical
exam. so much treatment is done based on suspicion. the possibilities
are many, and we try to narrow the possibilities some by physical exam,
history of the disease, and area of the abdominal pain. And also look
for the local common reasons of typhoid and malaria. I redrained a guy
with cirrhosis and ascites. That means- taking a iv cannula and IV
tubing and sticking the cannula into the abdomen, and running the tubing
down into a collection bowl. later when it stopped draining the nurse
removed it. Only about a liter today.
We took the burn patient to the operating room to decreed and possibly
skin graft him. Fortunately i was able to buy some dermatome blades just
before coming, that fit their machine, otherwise a large skin graft
wouldn?t be possible. The patient waddled down to the operating room.
Upper thighs and both arms are burnt from about shoulders to wrists, and
neck and face. So it?s painful for him to move. I gave the anesthetic
ketamine. Because of the areas he was burned, and already having had his
feet poked many times, we were unsuccessful at getting an IV. So I gave
it to him in his muscle. In about 10 minutes he started going to sleep,
and was relatively calm till the end. Ketamine can make one hallucinate
and move a lot, salivate, and sometimes thrash around. He was still most
of the time. after taking off all the dead tissue, it did not appear
that a skin graft would be needed, so we redressed all his burns with
honey, and wrapped them in gauze. gillian mentioned that on her burn
rotation, they had started using slices of raw potato on burns with
similar antibacterial effects. I guess potato are not real cheap here,
unless sweet potatoes.
After that I went to the outpatient area and saw about 7 remaining
people. Children and adults with pains, fever, cough, anemia
At about
6PM, i saw the hospital driver Robert. I asked him where the nearest
store was, and he decided to take me. Just after i changed cloths, they
called me to see another patient in a car out front. i looked in on a
woman 60 year old woman who had spilt boiling water on herself 5 days
ago. Because of her rural location she couldn?t come in till her sister
here in the ?city? heard about it and went to get her. she?s burned on
her left arm, and left leg- hip to ankle, and right thigh. They appear
to be pretty deep, but it is sometimes misleading until after debredement
or a few days time. After asking questions about the different symptoms
of ebola and other burn related questions, i admitted her and went to the
store. It was a mini supermarket. They had quite a variety of stuff,
all priced in US dollars. I guess in most major stores here, things can
be purchased in US dollars or Liberian dollars. I bought some bread,
peanut butter, jam, toilet paper, ramen noodles.
After finishing and bringing my stuff back, I went into the hosptial. A
10 year old girl who was breathing rapidly with cerebral malaria had just
died. So I filled out the death certificate. Another near by was
unconscious with malaria and vomiting rice and breathing poorly. We
tried to get a suction to work quickly, but after about 15 minutes go it
to function. He was breathing better then, but Im not surprised if he
aspirated a lot. We will know if he becomes more short of breath. No
chest x-ray- so all auscultation and coughing to tell.
I came back to my room and fixed PB and jelly and ramen. then I realized
I was almost out of water. So I?ve been boiling batch after batch to
make it safe to drink. Hopefully Ill get some in the fridge, for some
cool liquid tomorrow.
i was able to Skype with Audrey yesterday, which was awesome, today it
wasn?t possible as the internet wasn?t working at that time. i think Ill
dunk my scrubs in bleach water and hand wash some tonight, before i run
out of clean ones. please continue to pray for the safety of all the
hospital workers.
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