Last week, while in the grocery store, I stopped in the coffee section, and analyzed a few products. I know, I know, I have issues with coffee.
Let me also take a minute to say, that I have been spending way too much time in grocery stores. I could write volumes about my fascination with grocery stores abroad. I like finding things that I didn't think were consumed (chicken hearts), in the meat section, as well as all other sort of new things (digestives: a type of biscuits). I actually, still remember when I was visiting Ireland, and walked into the grocery store there and walked around (thinking to myself, I can live here, at least they have food). I have to add my absolute delight of finding an Irish section in the grocery store in Massachusetts. For god's sake they have Aero Bars, Golden Pouring Syrup, Kerry Gold butter, and digestives (among other things)
Anyway, grocery shopping, hasn't been the targeted run in and out shopping trips that they usually are back home. I have a list, but then wander the aisles looking at assorted spices, snack foods etc.
So last week I literally got stuck in the coffee section. Not the coffee bean section, which happens to be very paltry at this store. I tend to do most of my shopping in the non-affluent mall. It's closer. However, I will add that the other day I stumbled upon another grocery store, in predominantly white suburb, and the coffee selection there was exciting!
So, there I was. Looking at coffee makers and travel mugs. You know you're a connoisseur or addict when you predict which travel mug will spill, and which coffee maker is the best value. Also, having learned once before, just because a place (or country) sells coffee makers, doesn't mean they have coffee filters.. And so once again, I held a mental debate about sticking with instant, or buying a coffee maker. There's a financial aspect (coffee maker, or half a tank of gas, or a night in a B&B, or crayons for the kids on the wards.. that money can be spent better ways), the addict aspect (why do I need so much coffee), and the reality of that fact that I'm here a year, and I'm tired of accumulating material possessions So, I decided to fight on, and not give in to the addict raging inside of me.
Surprise #1: A care package showed up with, among other goodies, 5 or 6 pounds of Starbucks coffee. Hello heaven. Decision made. Ironically, when picking up the care package at the post office, I stumbled on what may be a coffee shop of the hang out and ready/study type. So this evening, I made my way back to the aisle where I spent an excess amount of time last week and bought myself a coffee maker, and a travel mug.
Tomorrow morning, when I head out for my overnight trip, I'm going to have Starbucks coffee in the car with me! Now that is a pleasant surprise..
I admitted 5 kids on call yesterday.
One was a kid with panhypopit who was coming in with headaches, and was for rule out meningitis/sepsis. Of course, I neglected to think outside of my USA box, and when we admitted the kid didn't really consider TB as a cause, as in TB meningitis. (Though really, the kid looks too good and his pain is sooo minor wouldn't be mentionable except that this kids is not physiologically normal and at risk for infections).
I admitted a 9 y/o boy who has juvenile dematomyositis, but also has TB of the right knee, and has had oesteomyelitis (MRSA-our friend back in MA who is hardly seen here) numerous times. He came in with worsening pain/swelling to the same knee (is still on TB treatment). And was admitted with a differential of osteomyelitis (again), septic arthritis, abscess, DVT. He actually went to surgery last night where they drained the knee. Organisms not yet identified.
I admitted a cute cute cute 3 month old who was in pretty moderate respiratory distress. Her sats were 82% on room air (again, should be >90-92.). Her chest xray was hyperinflated, some patchiness, maybe a soft call of right upper lobe PNA, but really more viral bronchiolitic looking. Until we rounded with the attending this am, who thought she's likely TB. Again, diagnosis of TB based on clinical suspicion.
I admitted an almost 6 year old male who is somewhat psychotic... I'm just going to leave it at that.
And then, just before leaving, I admitted a 9 day old infant. The presenting complaint was irritability. If that's enough for admission, I'd have been admitted by then as well. Seriously, though, this child was sleeping in mom's arms. That being said, the doc at the local health clinic and the docs in the pedi ER (equivalent) had thought the kid was irritable. And really, at 9 days old, that's enough to justify looking for infection. She was marginally irritable during the exam, but consolable with a bottle.
Infection presents weird in this age. Irritability is a common sign. But also, this mom had the "my baby is just not herself today" complaint, which I think has a very high predictive value for a problem with the baby.
So, this child was going to get the full septic work up. Blood. Urine. Spinal Tap. Chest Xray.
For 9 days, she could squirm! But I felt the needle pop it, and looked for the spinal fluid to drain out.
Surprise #2: Turbid! Mom was right. Don't even need to see this under the microscope, this baby has meningitis. And given that we're in South Africa where mom's aren't tested for Group B Strep before delivery, this is likely Group B strep meningitis..
So, I arrive at work this am and start my day. I decided to just start in cubicle one, and work my way through each cubicle. The patient shuffle (see previous post) has been done to accommodate the 21 new admissions and there is no tracking system. So I just walk into a room, look for familiar faces. I know that back in MA, I tend to prioritize the list of seeing patients (sickest first, most pain the ass last-really, that's how it happens, unless the family is the pain in the ass, then see them first before the family is there). But here, I just take one of the many leaps of faith and assume that if a baby is sick, the universe will inform me.
I'm on kiddo numero 3 or 4 to see when one of the other Docs (who was on overnight call) comes into the cubicle where I'm seeing a kid.
S: "Hey, your baby died last night."
Surprise #3: My synapses don't seem to really be connecting that information. But I make a mental note to buy a coffee maker today so I can take coffee with me to work which will allow me to think more clearly at work.
I'm not really sure how the fuck that baby could have died. "Meningitis???," I think to myself. Baby looked ok. Exam not too impressive. Vitals were ok. Jesus, was there something else as well that was totally overlooked.
Me: "What?!"
S: "Your baby died last night."
I say "what", because to me it's obvious that there is something terribly wrong here, and "what" means clarify who, when, why, where, or more to the point: WHAT THE FUCK HAPPENED?!?! But, I see this is a lingo barrier, and I need to be more specific.
Me: "Meningitis baby?"-I hate using a disease term to identify a person, but honestly the names are still pretty foreign to me, and often I mispronounce them.
S: "No," she looks at me like I have 3 heads. "KR"
Surprise #4:
I can't really describe what happens inside my brain next. There are about 5 simultaneous thoughts.
#1-he was 4 and a half, and wasn't a baby.
#2-that explains how I got to cubicle 5 and hadn't seen him yet.
#3-why didn't I look for him first thing this morning.
#4-and I told his family he would get better.
#5-What the fuck!?!?
I hate writing about/thinking about/acknowledging feelings. It's easier to be cold and cynical and numb. But I was really disappointed to hear this. Look at his picture again from my post a few days ago. If this kid needed a home, I would have adopted him. This kid is #7. More to the the point, this is the second kid I've had die in a week. I'm not use to that. At all. Unlike KP who looked so bad and wasn't likely to make it, (I rooted for KP because he was such an underdog!) I thought KR would make it. His level of malfunction, if you will, was treatable. And curable?
I make a mental note to think about this more (which I have done throughout the day). It's a busy morning, and there are 4 more kids to see before we round.
During rounds, I see KR's family walk into the ward. It dawns on me that I have no clue what happens in these circumstances, and with poor phone lines, using cell phones as primary contact numbers, I get concerned that they may not even know he is dead. I quickly ask, and am told that they "should know." As his family (Dad, Aunt, 2 grandma's and a few others) walk back into the hallway, I can't make eye contact with them. I don't feel responsible for his death, but I do absolutely regret telling them he would get better.
We move into the next cubicle on rounds. I was presenting while his family was walking in and out, and know that I need to do the right thing and go see them myself and talk to them. I fear, most, that they will be upset and angry. Which would be normal, but I fear they will be upset that I told them he would be ok, and now he is dead.
As I walk out of the cubicle, the two grandma's meet me. Both are women who looks to be in the 70s (but are more likely in their 60s-their life experiences have aged them). The are so humble looking. The smile and extend their hands as when they get closer. I feel a sense of warmth from them, there is no indication of anger.
Grandma: "Doctor, thank you so much for taking care of K."
Me: Nodding, "I am very sorry he died, I thought he would get better."
They just nod. There are no tears. The have a level of understanding which I don't have after such a short time here. I wonder if there is acceptance on their part because they hoped he would live, but maybe expected he would die.
Whereas, I expected he would live.
