3 Deaths.

This morning as I made a run for coffee, I saw the Cuban surgeon who evaluated the child who I thought may have had intussusception. And I asked him about how's the child was doing.

Dead.

Sadly, he did prove to have an intussusception, and in to the operating room, they found dead bowel. The child made it to the ICU, but they were unable to maintain a blood pressure for long. This is the third child to die, or we seem to be averaging about one a call.

I also realized that the child who was in liver failure from suspected Reye's syndrome, had also died.

A couple of days ago, I overheard they few of the pediatric residents talking about the number of deaths from last month, and I don't recall the exact number, but I do recall one of the residents saying "well, you're under 10%." As if 10% were of the upper limits of acceptability. And I hope to point out that this reflects not only to the limitations of services, but also the severity of illness that is seen at the hospital. I highly doubt that the child with intussusception would have survived back home, and he came to the hospital so late.

On Fridays, the head Professor of the pediatric department rounds with the team that is on call on Saturday. Which means that the prof rounded with us today. We made a run through the ward and reviewed some of the unique admissions. It was phenomenal teaching. I was slightly apprehensive that this was going to be another pimping session, and was afraid of coming up with blank answers, but instead it was more of a guided tutorial at the bedside. This is how teaching should be. So we rounded on about six or seven patients with the prof, and there was much to discuss. The depth of knowledge of the prof was fairly impressive.

I diuresed my patient list today.... both Baby S and baby T. were discharged. Fingers crossed, and that we continue to get some adequate nutrition and gain weight. Baby T. is moving out of the area, and I am actually a little afraid that his mom won't follow through on getting him care for his HIV status.

As for follow up, our boy to was admitted with bilharzia continues to have bloody urine, and has failed his first treatment course of which apparently is not usual.

A, my 2 1/2 year old who has right-sided heart failure from an obstructed airway... I spoke to the ENT doctor today and explained the story, and apparently they will see the child in clinic on Monday. He was at least interested in seeing the kid, and his initial thought was that he will have to schedule the child to have his tonsils and adenoids removed.

And the and shocker this morning was going through results and finding out that baby M is actually HIV negative. He is the child who is six months old and has failed to meet most of his developmental milestones, and came in with failure to thrive. It was assumed that his neurological status was due to his HIV disease. His mom was tested on admission, and she tested positive so he preliminarily was considered positive as well based on his clinical picture. (He had other stigmata of HIV disease). Ironically, when I admitted him, his hypertonia and overall condition let me to think that he probably had cerebral palsy. And now that he has ruled out for HIV with a negative PCR, he probably does have cerebral palsy. Thankfully, the occupational and physical and speech therapists have had time to work with the mom and have made a little bit of progress, as well as to get him set up for outpatient care.

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