Insanity Insanity Insanity

Totally beat. We have had by far the busiest week of the time I’ve been here. Last monday we saw 74 patients, followed by 68, 59, 64 and 57. Then Saturday was slow, only about 25, then on Monday of this week we had 91! That puts us well over 400 in that seven day period, and Monday was one of the craziest days of my life. Viola was sick, so were short staffed. Normally if we get over 50 patients Irene will see patients as well as Viola or James, but with Viola out sick, Irene was the only nurse. She had delivered two babies on her way to work, so was tired to begin with. I spent most of the day moving back and forth between working with Irene doing the physical exams of the patients while she was speaking with them or their mothers, and helping Rogers in Station 4. It wasn’t just that we had so many patients, but the first 10 took us almost 2 hours to get through. I was pussed on, peed on, seized on and sprayed in the face with Diclofenac by a faulty syringe, all before 11 AM. We had a boy who has a seizure caused by fever, another boy in acute respiratory distress, and a girl with on of the most disgusting and absurd infections I’ve ever seen. This next part is going to be kind of gross, so if you’re squeamish skip a few lines. This girl had an infected, like, pus bubble on her head, that was huge. Imagine if someone had half a mango on their head, it was about that size. Anyway, Irene touched it, to see whether it was ready to be drained, and it straight up just POPPED. There is no other word for it. So the girl (who was maybe….6 or 7?) starts screaming, there is pus, like oozing everywhere, so I’m running through the clinic, carrying this child, trying to keep the pus from dripping on my skin (I think Alice burned the pair of scrubs I was wearing that day. Rightfully so). We had to Incise & Drain it, which the kid hated, and she was thrashing around so much that Rogers almost cut his finger open with the surgical blade. We had to get Muse Wilson in to help us hold onto this girl, and even then, I got kicked twice and he took a shot straight to the groin. It was actually kinda funny, he shrugged it off and said “I am old, I don’t need these anymore”. Rogers and I went through about seven pairs of gloves, and this kids head leaked for a solid 15 minutes. It was soooooo gross, but I’m not gonna lie, I was into it in that weird way you can be into gross things like that. Not like the pus and stuff, just the experience of it. The diclofenac spray came after we tried to give it to the boy who had had a seizure while waiting on the porch. Diclo is a fever-reducer. Anyway, we were injecting it into the kids rear, and the syringe was faulty, so when Irene pushed the injector down it sprayed straight backwards instead. She was giving the shot and I was helping to hold the kid, and we both got it in the face. Much worse things to get sprayed in the face with that diclofenac, but it was still absurd. This was from the same kid who peed on us, which was totally my fault. He was post-ictal following the seizure, and I was doing a quick exam of him since we’d not seen him at all prior to the beginning of his convulsions. I did a babinski test on him, since determining neurological status with an infant is a lot harder than with an adult, and immediately after his response to the babinski he started peeing on me. I don’t think urination is a typical response to a babinski, but given his state, I’m guessing that the surprise and the reflex from the test caused him to lose whatever bladder control he had. I felt way ahead of the game with the kid in respiratory distress, as we were treating him with albuterol given in one of those inhaler chamber tubes that I used when I was a kid. We were so worried about him that we had him on one of our two cots and I spent a solid half hour just sitting with him and monitoring his breathing. He normalized somewhat after about 3 doses of albuterol and some dexo, but we were worried for awhile.Wednesday was very exciting for me, I did a surgical debridement on my own. Not to get into overly disgusting detail but that is where you cut infected tissue out of a wound so as to be able to clean it. We have lots of surgical blades at the clinic, though none of the handles or traditional scalpels, so it’s kind of like using a loose razor blade. The boy was maybe 5 years old. I had actually seen him the day before. Robert and I were walking home from work and his grandmother stopped us and asked us to look at her grandson’s wound (from a bike accident). It was a terrible cut, maybe 3” x 3’, taking up most of the outside of his foot between the ankle and the heel. It was badly infected, and had been uncovered and untreated for almost a week, and the boy was sporting a fever. I told the grandmother there was nothing I could do at that moment, but we were only a few minutes from my house so I ran back to get supplies to bring back to her. When I returned 5 or so minutes later they had gone. Obviously there is nothing to do at that point, but suffice it to say I was very relieved when they came into the clinic a little after 10 this morning. The procedure was brutal for the boy. We have a small supply of local anesthetics and pain relievers, but we have to use them very sparingly, and wound care generally doesn’t qualify as needing it. I really wanted to use some, but Irene kept telling me that the cut wasn’t bad enough, so we gave the kid a rag to bite and something to squeeze and he toughed it out. It took a little over five minutes, and the kid was screaming in pain most of that time. His grandmother was very grateful, but I’m pretty sure he will hate me forever. And I don’t really blame him. That said, I was very pleased with my work, medically speaking, as I’d never done a surgical debridement before and got it all in one go with a loose surgical blade on an un-anesthetized five year old screaming at me by myself. It was kind of exhausting though, I have new respect for surgeons who spend 10 hours operating. We also had a patient come in last week who was suffering from injury-induced petallar-femoral syndrome, which is the healable rather than chronic version of the knee problem I have, so I told Viola, “Girl, you know I got this one” and gave the guy a probably 20 minute PT routine he could do at home.

Here is something fun, I figured out how to find (kind of) the clinic on google maps.If you search for Bulobi Primary School, Bududa Ring, Bududa, Uganda, you will find a school that I run past when I exercise in the mornings. My house is just up the road (called the Bududa ring on google maps) from that school, 1/3 of a a KM at most. You can actually see my house in the satellite image, it’s the second house on the left in the small cluster of house on the main due north of the maps flag for Bulobi Primary.If you put in Beatrice Tierney Clinic, Bududa, Eastern Region, Uganda, you can see where the clinic itself is. Bushiyi (one of my three favorite place name shere. It’s pronounced BOO-SHE-EEEEEeee, with the eeeee drawn way out. My other two are Bumwalukani (Boom-WAH-loo-ka-knee) and Sakusaku (sa-coo-sa-coo)) health center is shown on the map nearby, that is a lie, it doesn’t exist. K. Time for me to go Sasa (pee). Sorry for going nuts with the writing

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4 Responses to Insanity Insanity Insanity

  1. Ethan Cohen says:

    Dag.

  2. Kathy Tate-Bradish says:

    Ick. And – cool!

  3. What does “Dag” mean?

  4. Matt Cohen says:

    Nate- I think you will be ready for a surgical rotation when you come back. Sounds incredible.

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