It's nice to be back in the land of adult medicine. I feel like part of the team this month. In fact, last friday the clinic director specifically mentioned if I had any ideas on changes that may help their clinic, to please let him know. And then rounding today, when we were at the bedside of the guy with infective endocarditis, (and we were rounding with the microbiologists as well the other ID attendings/consultants) it turns out that just two of them have seen right sided endocarditis from IV drug use before. Now, a couple things to mention. The were still able to quote the current treatment guidelines, discuss the common pathogens, etc etc etc. I point this out because I find it impressive that these guys have seen a case in the past, long ago, but still know current treatment stuff. And secondly, it was odd because I've seen more of this than them. I was slightly jittery when they turned towards me. I had flashbacks to pedi land and was getting ready to brace myself for defending US practices... but rather it was such a pleasant adult conversation about what we do back home in these situations. There were also soooo interested in heroin use, methadone, and these patients back home. They just don't see these patients here. Kind of a cool experience.
I like my ID attending. I think we share a similar practical philosophy. Case in point. We were reviewing bacterial meningitis treatment and outcomes in journal club this afternoon. The attending pulled the articles on the use of steroids in treating bacterial meningitis, and outcomes. The mortality rate at Bara is about 55%. I just throw that out as an aside. So we're reviewing all data, which is somewhat mixed, and tough to interpret. You have to factor in HIV/AIDS. Delayed diagnosis and treatment. Etc etc etc. And whereas the literature may be indicating that the use of steroids does not reduce morbidity/mortality (and there are no harmful effects) my attending says:
". . .when you know that more than half the people are going to die it's tough to follow the advice of these articles and hold off on the steroids, I'l still give them. . ."
Ahhhh. Yes. Thank you. If I have bacterial meningitis (heaven forbid) I'll take the steroids too! We're on the same wave-length. He's a practical clinician.
And typhoid: There is a 14 y/o boy on the adult ward (which is what happens here), how has ben diagnosed w/ typhoid. Which isn't all that common. Was absolutely superb to be at the bedside and hear the ID and Micro attendings give a lecture, at the bedside, about typhoid. It was just superb teaching. And kind of a lucky event since they don't see that much typhoid..
Other stuff of note: One of our attending was the on-call attending yesterday, and did post-call rounds with his ward today. They admitted 135 (ONE HUNDRED AND THIRTY) patients yesterday. Their ward holds 130. It's not worth explaining the logistics. Interns are covering 35 patients.
That's it for now. I'm off to read about Typhoid.
Cheers
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Notes on my year at Baragwanath Hospital (Soweto, Johannesburg, South Africa) Posts here reflect my own views and opinions. Names and details may be changed to protect the privacy of patients and others.
