Sunday, August 31, 2008

Brief note:

Only 2 months...
 
And I got sick while at work Friday, just achy, ill feeling, nothing more to write home about. Though am proud to say that it took 2 months, and that I didn't pick up something quicker. One of the other docs was sick too, as was Satkile, our abandoned kid. I think he was spreading nasty germs, and since we pick him up every free chance, I'm sure he's the culprit for spreading nasty disease...
 
Thankfully, I rebounded today, as this is moving day. I'll get pics out soon, but this room is HUGE, and I look out onto a garden.

Also, now that there is internet in the house, as well as a landline, I am looking at options to be more in phone contact with people. Am looking to set up a Skype acct where people can call me via a local number, and so that I can make calls out... More on this later.
 
Time to finish unpacking, and then head out and get some sun, and make up for part of the lost weekend..
 
 
 
 
 

 

Tuesday, August 26, 2008

Absurd

Absurd. Throughout the day, this seems to be the word that kept coming to mind when thinking about how the past 24, 30 hours had been. Our call yesterday was just absurd.
 
For the record, I came home from work, and went right to bed. That was at 5pm. I don't think I have ever gone to bed, by choice, at 5pm. When I woke up an hour ago, I decided I should take out my contacts and try to be slightly productive...
 
I don't even know where to start..
 
5 pediatric resuscitations. I know there were 5, because I counted them.
 
Let me tell you about #3 and #2.
 
#3: I'm walking past the bench that kids sit on when they are waiting to get admitted. The bench had been empty ALL morning long (the ominous sign), and then we got nailed, and moms kept walking in with relatively sick children. Resus kiddo #2 was stabilized, I'd just finished admission paperwork, and had grabbed the next kid to admit, and was walking into a room to grab an admission packet when I happened to look at this child being held by mom. And this child looked dead. He had that unnatural waxy skin look to him. So, I did the right thing, I kept walking pretending I had never seen the sick kiddo, let him be somebody else's problem! Kidding. So I stopped, and quickly listed for a heart beat, which was there, and was less than 60. 60 kind of being the magical number for if this kid was going to get chest compressions or not... I grabbed the kid from mom and headed to the resus room, and grabbed the other senior resident at the same time. Time for ABCs. She started to bag, I started compressions, and others arrived. One of the medical students started bagging, she prepared to intubate, and I grabbed the first needle I saw I and miraculously got the inter-osseous IV on the first attempt (slightly pissed this kid was sent for admission without IV access from the ED-but this anger was retrospective). After a fluid bolus and some bagging, the heart rate picked up, but kid refused to breathe effectively on his own so he got intubated and went on the last available ventilator. This is an issue... Not having vents, but having more sick babies means it's time to make decisions about who else will get vented, and also means it is time to start calling around and find out what hospitals in Jo'burg have vents and will accept kids..
 
#2: Somewhere around 8pm, I went to do an arterial gas on my kid who had been the second resus of the night. This child had been treated for meningococcal meningitis and discharged the week before, and came in severely acidotic and dehydrated. She got the full resus, but managed to escape the vent. So, I arrive at the bedside, and before jabbing her, glance at the monitor. And her hear rate is in the mid-70s, and her sat seems to be in the mid 70s as well. These are both bad numbers, being sick, her heart rate should be more than 110, even 120, and her sat should be well above 90.. What the hell is going on. I send for the other resident as I poke the kid for blood. As she arrives, the kid drops her hear rate to 20, and then NADA. Zip. Zero. Zilch. We momentarily stare in disbelief at the monitor thinking that this is a cruel joke, but as she listens, and I feel, the child really is not breathing and no heart beat. We start coding the kid. And here, I honestly wish I were back home where there are code teams so somebody else could do chest compressions while we tend to the other details. It really sucks to be powerless. We run the whole algorithm, debate all the possible causes and are pushing meds, I get the kid intubated and as I bag, bloody secretions are aerosolizing and covering the child face. The absurd thing, at one point there is a 3 or 4 year old child behind the glass window of the room behind us who smiles and waves as I glanced in his direction. The medical student wants to throw I the towel at the 10 minute mark ("But we've been doing this for 10 minutes" she tells us). We watched this kid code, he was bagged immediately, and has had effective chest compressions, I try to explain to her why we will continue-(but really I'm half tempted to jump over the bed and strangle her, though I know the other senior resident has first dibs). It's futile. And we call the code after almost 40 minutes. It's really frustrating. This is a child, whom we admitted hours previously (after a vigorous resuscitation correcting fluid and electrolyte abnormalities) who was being followed closely, and who fucking still died with us watching. Literally, with us watching.
 
It's approaching 10pm. The bench is still full. I'm hoping to head home soon, so have stopped admitting new patients and am drawing bloods, doing IVs, spinal taps, etc on the kids who will be admitted. I'm in the procedure room when I hear the door open, and immediately I hear really sick breathing coming from the infant being carried by the senior resident. I pass of the kid I was taking blood from, and we watch as this kid goes into a horrendous coughing fit. This is an easy diagnosis. This child has pertussis. I have a 4 week old with pertussis on the ward, who looks exactly like this kid. Well that's not true, this kid in front of us is in quite a bit more distressed. This night sucks, and isn't fun. I'm never going to get out of here, so I offer to admit the kid. This kid is "HIV exposed." Will we intubate him if needed. Again, no vents or ICU beds at our hospital...
 
There are still 4 waiting for admission, and it's 1130. I grab what should be a pretty simple admission. The pedi ED note basically says 3 week old female with vomiting. This is a slam-dunk admission. I can get a history, spinal tap, bloods, bladder tap, and IV, and write orders on this kid in 45 minutes if I am really lucky! But the history is more complex than simple vomiting. The exam shows mild respiratory distress, fairly unremarkable abdominal exam..  So I feed the kid  some clear rehydration solution in hopes of proving that this kid really isn't projectile vomiting. But of course, when the kid vomits (old milk from 3 hours ago, and no bile) all over the place, the mom shrugs, as if to say, I told you so... (there is more to this, but I want to be in bed in 10 minutes). My admission differential is vomiting due to pneumonia/uti/NNS, maybe due to abdominal pathology (possible pyloric stenosis but kid is young for it, obstruction)..
 
So I finally leave just before 1am... And arrive back at 5:30 this am..
 
#4: The child with pertussis got too tired breathing an hour or two before I got to work, and I walk in to find him intubated. And being placed on a stretcher headed for another hospital who have graciously accepted him for admission.
 
#5: 8:30, just as we start to round on the 23 admission from last night, one of the kids admitted for kwashiorkor has just coded. He doesn't make it.
 
Flash-forward to 3pm. It has been a marathon day. We admitted sick, sick kids last night. Have spent the better part of the day drawing blood, doing LPs, starting IVs, getting essential studies such as ultrasounds, EKGs etc done and trying to basically stabilize the ward before we leave for the afternoon. Nobody has left the ward to go eat all day. We have been so busy with the kids who were admitted that we won't discharge any of the old kids who could have gone home today, because we've basically run out of time to sit and do the paperwork to get them out the door. And we all just want to leave. We are pushing to get out at 4...
 
And at 3pm, my vomiting 3 week old comes back from ultrasound. And she has radiological proof of pyloric stenosis. It's a small mental victory. When I was tired and grumpy last night, I still managed to stick to the fundamentals of being a good clinician. I took a good history, included a broad differential, and made a plan to evaluate with that differential in mind. I was actually shocked it was PS, I had thought that is was going to be more infective etiology. It's an affirmation about being thorough and systematic.
 
Goodnight.
 
 
 

 

Sunday, August 24, 2008

Maropeng

On Saturday I organized an outting to Maropeng. The plan had been to have an afternoon picnic, but we were running late so we skipped the picnic part and even missed out on the Sterkfontein caves.. Here are some random pics. PS-this is a great museum for kids!

Message board at the end of the museum


The view from the top of the museum, where we just sat
and enjoyed the perfect saturday afternoon. On the levels below
there is a cocktail lounge, and a restaurant.

My 3 coworkers.

One week left on the pedi wards, then I'm off to the pedi HIV clinic for a month. Need to get some serious reading done to feel a bit more prepared for the HIV clinic.


Friday, August 22, 2008

Floating

I am not floating.
 
The thoughts in my head are.
 
I feel like it has been ages since I've made any significant mentions. Many things have floated through my mind today, like, oh gee, I should mention that, but then it kind of seems that the names may have changed, but the story is largely the same. Also, I think I've hit that comfort zone where things really don't phase me. For example, called to see a baby on the ward with bleeding in the mouth, show up to find the baby being coded (little momentary respiratory distress). A sodium value GREATER THAN 200!. Walking into cubicle 9 this am, which I think has all the trouble making toddlers in it, but are cute as can be, and finding to kids with taking their mercury thermometers and placing them in their mouths, and banging them on the cribs. These are the things that float through my mind as the day passes.
 
The mantra of today was 4pm.
 
It doesn't matter what the hell happens, 4 pm will arrive and then we are outta here! It's been a long week, and we're all tired and just thrilled to have a golden weekend, so at 8am this am we started the countdown until 4pm.
 
Now that my car is legal (and there is still a story to tell there, but I'm too superstitious to post it on the web, and there are many stories to tell about my car in general), I was thinking I'd get out of the country (just sounds cool to say that) this weekend, and hit Lesotho, or Swaziland, or Batswana. But in fact, I'm just too tired to think about driving somewhere, and decided to hold off until Sept to do more traveling on weekends. Am looking forward to a Mon-Fri schedule!
 
So that's about it. My lovely friends S&S have invited me out for dinner, so must get ready to head out and start the weekend off right, with a great steak and some wine and good friends.
 
 

Wednesday, August 20, 2008

Home Sweet Home

I'm moving at the end of the month (it really isn't cool to post the reasons on this site; there are many reasons I need out of this house). But, the great news is that the new place has a landline, and internet, which means access to phone calls and Skype. Unfortunately, all of the rooms are rented for December, so will have to work that out as time gets closer, but thankfully I have vacation then so will only need to find a place to stay for 2 weeks. Crazy, I know...
 
Anyway, speaking of home, check out this article from the NY Times on the Denver art scene
 
Cheers!

Tuesday, August 19, 2008

Weekend (and then some) Update

Friday finished work nice and early. Ran to the gym, the grocery store, the watch battery store, the bank. Headed up to S&S house (the gorgeous one I have written about earlier). When I had dinner w/ them last weekend I had mentioned how I would need a social outing when I finished this 14 day stretch on Friday, so they made plans. Basically told I would show up Friday and then head home saturday night. Friday night we had wine sitting outside in the perfect afternoon/evening light, catching up. Then we went out to dinner with some other friends, and then a smaller crowd of us went to meet up with Tim (US professor who is headed back to the US-actually lives in MA). Finally ended up home in the wee hours. Saturday woke up on and off to protests going on outside. Thought I was dreaming of anti-zimbabwe protestors outside, and when I finally got up, realized that the anti-Mugabe protests were starting in the lot across the road! Ended up going for a great brunch and then some walking around and shopping in the Parkhurst area, which rivals melville for having some outdoor seating, shopping, and good people watching. Went back to their house, spent a few hours in the afternoon drinking coffee, reading outside, and I fell asleep outside and took a nice nap! The we went for Sundowners-the art of sitting, enjoying friends and beverages, and watching the sunset. We went to the Westcliff (5 Stars) hotel and it was spectacular. I don't have pics, but S&S do and I will get them, for sure! We then headed out for a Braii, which was also a house-warming for a Norwegian friend of theirs who works at the UN. And what a fun party with so many interesting people!! Unfortunately, I didn't get home until 1 am, and then was up at 6:30 for work. And it was busy, so I ended up leaving work at almost midnight, and then up at 5 yesterday. Needless to say, the excess of work and pleasure have left me slightly wrecked. On rounds today, I started to count down the days left on general wards. The big improvement this month has been my working relationship with the 2 other Regs (Senior Residents) and being treated more like a peer, but the downside has been that while 2 of the other MOs are good, the other 2 are quite lacking, and the medical students are somewhat difficult to manage.
 
More soon...
 
 

Thursday, August 14, 2008

A Day of Joy & Taking Steps

I've shown up to work the past 2 mornings with unrealistic demands. Basically have regressed to where I was when I arrived, and find myself getting all bent out of shape that things don't get done as ordered. No neb treatments all night long. No oxygen sat readings. Wrong volume feeds being given to my 8 week old kid with new heart failure. Getting frustrated and all bent out of shape doesn't change anything, except to make me grumpy.
 
We had a great day. We only had 11 admissions yesterday to our ward (4 to other wards), and a pretty light work load...
 
One of the things that has been bothering me since I got here is how un-inspiring the ward can be at times. Little stimulation for the children. Like I mentioned before, one coloring book.
 
And then today, a bag of donated toys appeared. It was like Christmas (or like all the kids had a birthday on the say day, don't want to force Christian holidays on anybody). Of course, "S" got first dibs! Today really felt like what a children's ward should be. (I may have a pic from today, but it's not going up now). At one point, in Cubicle 9, KM, a 3 y/o was on the floor, playing with 2 other kids, and they were eating oranges all at the same time! Smiling. Laughing. Pretending to shoot each other with toy guns (ok, not that the toy gun thing makes me happy, but what the hell)...
 
Today was joyous for other reasons..
 
Step 1:
We have a 9 year old girl on the ward who has cerebellitis (infection of the cerebellum, portion of the brain which controls fine motor) after having had Hep A. Rare, but has been reported before. And she's had really poor coordination (cerebellum-portion of the brain which takes a hit with alcohol, so you can guess how she walks, and in fact, I completely plan on walking that way in 24 hours from now). Today she was actually outside with the PT/OT group (nice sunny day) and was making small progress and taking some steps.
 
Step 2:
We have a 10 y/o boy who was admitted with pneumococcal meningitis and septicemia. I remember when we did a spinal tap on this kid last week, he didn't even flinch. At one point I looked at home to make sure he was actually still breathing. He was basically comatose for a few days. But he has slowly woken up. Here's a plug for crunchy parents, if you don't want to vaccinate your kid, and they get pneumococcal meningitis, they are in for a bad, bad time.  (Where's that damn soap box...) Oh, so anyway, he's actually made a bit of progress. (I thought it was a bit cruel that for the past 2 days it's just been him and the 2 y/o with TB meningitis-who is basically left in a vegetative state. Anyway, the 10 y/o sat up in bed yesterday, and with the help of holding on to 2 PT assistants, took some steps.
 
Step 3:
I know I go on and on about S. But seriously, this kid wakes up happy, smiles, laughs, giggles, and is such a ball of joy to have in the ward. He is SPOILED, Rotten. But, after a week or two of neglect in the ward, when we realized that he is never going to get placed (we joke that in 12 years he'll get transferred to the adult ward), we've set some goals. Basically, get him walking and talking. I don't think he is really developmentally delayed, but rather hasn't had enough stimulation and will catch up nicely. And today, with much coaxing, the other Reg and I got him to take 2 steps!! Woo-Hoo.

The most amazing thing about today is that we were post-call and didn't have the normal crazed post-intake madness that usually keeps us from goofing around and having fun. It was really a joyous day.
 
 

Tuesday, August 12, 2008

Safety Net

The hospital is suppose to be the safety net of the system. To be there to provide medical care for all in the community. And if people don't have access to a regular medical practitioner, then the ER becomes the ultimate safety net. But I don't understand, yet, how the safety net here fails to catch people. Are there holes in the net, or are people (kids) just too far out of reach of the net?

We had a monthly review meeting yesterday. A review of the stats from the previous month. This review is only for the 4 general pediatric ward teams. The stats don't reflect newborns/NICU/hemeatology-oncology/pedi ED, pedi surgery or the metabolic/refeading units.
 
In July there were 507 admissions, and 37 deaths. Each team reviewed the overall picture of the kids who had died. And it was quite interesting to note that more than a few of these kids died the same day they were admitted, or even within a few hours of coming into the hospital. What is keeping these kids from showing up earlier, and therefore, maybe having a better chance of making it?
 
Certainly, many of these kids had gone to local healers (aka sangoma) as a first option. This is culturally related. But also there is a delay because as far as I understand, one must go to the local clinic first to be seen (likely a wait there) and then be referred to the pedi ED (more wait) and then eventually seen, and eventually admitted.
 
Some of these deaths were not completely unexpected. A few, well-known, kids with chronic medical conditions died during the month, having exhausted medical therapy. But it seemed that so many of the deaths were related to poor nutrition and living standards. It's always been one thing to read statistics of child mortality and know that diarrheal diseases and respiratory infections are big offenders, but there has always been a disconnect in reading this information. But having seen these kids the past few weeks, it's really, really appalling to know that many of these deaths have been preventable!
 
I was kind of tuning out thinking about how many preventable deaths occur over the year when something caught my attention.
 
"Baby S, and 8 month old discharged from ward 18 2 week prior. . ."   And so now I'm really curious to know who this kid is. . .  "had been admitted initially w/ dehydration and severe malnutrition. . ." This is beginning to sound familiar. . . "Was readmitted for -blank- and died the next day."
 
-blank-
-blank-
 
Blank isn't some mysterious medical condition or something that I'm too worried to share, but blank is exactly what happened in my mind as I realized who this kids was.
 
My Baby S! The one I wrote about last month.
 
Shit!
 
And I think this sucks. He had follow up in place, but somehow something happened, and he either fell through the safety net, or missed it completely on his way down.

Monday, August 11, 2008

Address Change

Hi-

If you have my current address in South Africa, please hold off on sending me anything for the time being, as my address may be changing.
 
Cheers



Thursday, August 7, 2008

Caca

Me: Grandma, how is the baby's caca?
 
Caca is the appropriate term for it. I've seen more variation in Caca than I ever thought was possible. I've seen the classically pasty white stools of biliary atresia. The malnourished kids have liquid yellow caca (which kind of reminds me of egg drop soup). So, asking about caca is routine. It's routine elsewhere too, here is really no different. In fact, I remember being told once, when you need time to think about what other questions to ask, as about bowel movements as a stall tactic.
 
Grandma: Oh Doctor! The caca is very, very nice.
 
That's it. Nice caca. Now I've heard it all. Grandma loves this boy. So much that even his caca is great. It's almost like she is describing a place I should visit. Oh Doctor! Clarens is very, very nice. Or a bottle of wine. Or a cheese. But caca...
 
This saying has been playing over and over in my head. Last night as I was running on the treadmill I laughed as I thought about me asking her that question in the admission ward. Oh Doctor! The caca is very, very nice.
 
I headed in a bit earlier than usual today, looking forward to getting out maybe a bit early and enjoying an afternoon run.
 
Today, was caca. And there was nothing nice about it.
 
I walked into the ward, looked into cubicle 10 to see if the 2 year old had made it through the night. His bed was empty, but with ward shuffle, there could be a chance he was still alive, though it would be a miracle, but not necessarily a good one. As I sat down to check labs, one of the nurses came over to me.

Sister: Doctor, there is a resus going on.
Me: Where?
Sister: In the resus room. (Which seems like a good place to do it).
 
I had walked past the room on the way into the ward, the door was closed, so I didn't think anything of it.  This is also our procedure (blood draw, IV, spinal tap) room. So I head to the room. And of course, I put 2 and 2 together, and wonder why the 2 y/o is in the resuscitation room, certainly his file clearly indicated he was "not for" active resuscitation.
 
And as I step into the room, I see an exasperated pedi registrar (senior resident), and 4 month old infant. Caca. Not nice caca.
 
Me: What's the story?
Her: low sugar, can't get an IV. dehydration.
Me: who is this kid? (I can't figure out why he is in here, though he looks familiar)
Her: it's your ward, do you know this kid?
Me: (grabbing the chart) yes.. (we'd reviewed him at 4pm, he was in with pneumonia, went back on oxygen in the afternoon, but was fine otherwise).
Her: Is he for active resuscitation?
Me: (I hesitate to say yes, because in my mind some days all these kids are still for active resuscitation). Yes, he's negative (HIV), he was getting better, and was likely going home in a day or two.
Her: This is the fourth resuscitation of the night.
Me: damn, that's not good.
Her: On this ward.
 
Oh caca. Really, really not nice caca.
 
We fumble for an IV. It's getting drastic, this kid is literally crashing before our eyes, and we don't have an IV. We tackle from opposite ends. There is still an airway, there is still breathing, there is still circulation (barely) but there isn't glucose, and there isn't enough fluid in the system. She's trying for a femoral line, and I'm going for an intraosseous (needle into the shin bone). And we both are striking out. So we literally switch sides. I'm working on the central line, she on the intraosseous. I ask the nurse to find some glucagon (like this kid is going to have any glycogen in the liver...). Glucagon doesn't ring any bells to the staff... I ask her to call to casualty and find some. Also, asking to drop an NG and give the kid some oral until we get an IV.
 
His breathing is slowing down.
 
Caca.
 
Time to make the decision.
Me: It's time to intubate.
Her: he is definitely for ventilation
Me: yes.
Her: Ok, can you grab a tube?
 
So I reach to the emergency trolley. And that's when I see the failed third resus attempt. I'm caught off guard. Apparently, that kid had just died when they literally whisked this kid into the resus room, and literally there wasn't time to do anything but move the body off to the side.
 
[I hesitate to write that part. But to me the reason to mention is that this hospital is amazing. You have incredibly sick kids being take care of by a staff-both nurses and doctors, who work against such tremendous odds at times, and when the shit hits the fan sometimes you are literally moving from desperate situation to desperate situation, and there wasn't even time to remove the body from the resuscitation room].
 
There is a trend here to nasally intubate kids and confirm placement/finish placement with forceps using the laryngoscope. I don't understand this method. To me it just takes longer. It's a tough intubation.
 
I offer to try, and she agrees. I haven't intubated an infant in a long time. But as I insert the laryngoscope, the cords drop into view and I get the tube it. I'm so surprised that I actually got the tube on the first try that I damn near inserted the thing the whole way.
 
We start bagging the kid. By this time, others should be around, and she gets on the phone and calls for back up. Who arrive.
 
We start full CPR. Get IV access (finally an IO), but it's really too late.
 
By the time we decided to stop, the entire team, is in this room. It's sinking in that in addition to the kid who we knew was going to die, that 3 others died as well. One of those wasn't too unexpected. But 4 deaths overnight takes a toll on morale. I absolutely must point out here that these kids were sick. All of them would have been in the pediatric ICU back home, or at least would have been moved there well before demise. There isn't any sense of wrong doing or negligence at all, but rather a sense of defeat by the level of poverty, the disease burden, and the lack of ability of the system to fix these kids.
 
The day ends when I discharge the child with the nice caca. I see the grandma walking out, carrying her grandson on her back, as is custom here, and I think about the nice caca and laugh to myself. Thank god this day is over.
 

Wednesday, August 6, 2008

Ward 18 Mascot

This is a pic from the day we took S on our tea break. He came in having gotten into organophosphates (an effective, cheap pesticide, which is bad to ingest). He's been abandoned. He's always got this smile and happy-go-lucky persona. Though, we were reminded that he screamed and cried for the first 2 days on the ward, back in early July. He's 13 or 14 months, and there's been a slight rally around him recently, now that it seems he may be on the ward for many months. We've come up with the goal of getting him talking and walking. He's mostly developmentally appropriate, though maybe slight language delay. This morning he was crawling down the hall as we were in the first cubicle on rounds, and I grabbed him and carried him on rounds until I got too tired and had to set him free.

The contrasts on the ward are extreme.

This afternoon three of us spent the better part of an hour trying to "drip" a kid (aka get an IV). This kid doesn't need an IV though. What he really needs is some pain control, and to be held. He will be dead by morning.

This morning, I was debating (in my head), whether I should test my 13 day old kid for HIV. Which means test the mom (who has told me she is negative, but doesn't have a copy of her results), or do a PCR on the kid (expensive). And I decided not to. Why, because I trust this mom. Which is silly, because the newborn is my patient, not the mom.

After an hour, and multiple, multiple stabs, I got an IV. Luck. This kid is 2. He's smaller than S. He was past the point of flinching with IV stabs. And he didn't bleed from them, but oozed serous fluid from where the IV cannulas pierced the skin.

What is remarkable, is that this is his first visit to the hospital. This kid has never walked. Can't feed himself. And is wasted. We tried to figure out where to lay the blame. How could this kid, who will die tonight from HIV, TB, malnutrition, end up in this state?!?? This is more a rhetorical question, as this is a complex problem, and blame won't bring about change.

And then I thought back to my 13 day old baby. And realized the answer to my debate from earlier. Yes. Of course, the kid should be tested. Any chance to diagnose a kid with HIV, and get them appropriate medical care for their status, and hopefully prevent them from dying in the hospital at age 2, should be jumped on.

Reality needs to trump Trust.

To end this on a lighter note, S shit on me yesterday. But we're still pals, I just check diapers regularly now.

Monday, August 4, 2008

Cleaning House

I theoretically could have had no patients when I get to work in the morning. But one will be left (who will be bounced back to his ward tomorrow). Once you're admitted to a ward at Bara, pediatrics, you basically go back to that ward until you're 14, if you are re-admitted.
 
I discharged the 8 y/o with TB (pulmonary and abdominal), HIV, Anemia, Depression, severe malnutrition. The palliative medicine physician scored major bonus points with me and was so concerned about this girl that she found a placement within 4 days! So she's off to hospice to get some better rehab care before going home. She was actually beginning to perk up a bit too!

I also discharged the kiddo who came in with status seizure last week. Amazing what the human brain can endure, this kiddo seems to be back to her normal self.
 
There was also an silence on the ward this morning. M, our 3 year old who suffered a head injury and has lived on the ward for months was finally placed. I don't know the full story, but think there is suspected child abuse, and she was kind of abandoned, or they couldn't figure out to whom to release her, but she is now gone. She was cute, usually walking around the ward (nekked), smiling and holding the lone coloring book of Ward 18. She didn't have much verbal skill, but she always had a smile!

That leaves S. Our currently orphaned 13 month old, as the sole Mascot for Ward 18. "Are you sure you don't want to adopt him?" A question I've been asked numerous times. He's such a ham! We've taken him to the break room with us, and last week he was spotted in the cafeteria with one of the staff.

We're on call tomorrow.
g'night.

Saturday, August 2, 2008

New Family

Our new niece, held by Uncle Kevin

Friday, August 1, 2008

Missing Out...

Tomorrow I'm missing a wedding.
 
There will be many things I miss in the next 11 months. When I started to plan this a year ago, I didn't take into consideration the events I would miss out on. I knew there would be things that happen that I'd like to witness. Both things planned, and unexpected.
 
This is the second wedding that I'll miss while in South Africa. The first was in 2003, when my little brother got married. This time, one of my dearest friends is getting married in San Francisco. Ona introduced me to my favorite coffee in the world, has hosted me numerous times when I needed to hang out and needed an escape. She was one of the people I clubbed with regularly, many, many years ago. If I were able to make it to her wedding, I would take Mint Aero Bars as a wedding gift, because when she visited in Dublin we ate Aero Bars and made outrageous jokes one night...
 
Tomorrow night, I'll have a silent toast and some mint aero bars to celebrate from afar.