I'm tired. It's late. I have a good bit of work to finish before bed. But as I was driving home from my new late night bookstore (a SA B&N equivalent), I was thinking about today, and the guys who I am rounding on in the hospital.
They are all in their 30s. In fact, I am older than all of them. I though one of them was in his 40s, based on how aged he looked, but yesterday I realized he is 32. Right now I'm not really sure what their individual prognoses are. Only one of them seems to really have a diagnosis, and that's Doctor. He definitely has non-Hodgkin's lymphoma. The other one GT remains a bit of a mystery. I think I'm starting to favor a diagnosis of lymphoma in his brain. He's waiting for an MRI. And JC, is likely to be lymphoma or some other nasty cancer in this abdomen.
None of them look well. None of them could walk to the end of the corridor without having to stop and rest. IN fact, GT can't walk period. There is no sense of vitality, at all.
But, back to JC. I'm at the bedside, with two of the consultants. One is Dr JT, who saw JC on Jan 22nd, and did the initial work up. She's a little miffed that an ultrasound was done to, among other things, evaluate the mass that you can feel, and about which there is NO comment on the ultrasound report, and the other is the head of our unit, Dr AK. We review the notes, and the likely diagnoses, and what needs to happen, and happen fast. Dr AK takes some ownership, and decides that we'll go ahead and arrange for some of the work up, we'll book the CT scan that needs to get done, and we'll add one some labs. There isn't time to waste anymore, the clinic already wasted 6 months of this guys life, and the team who has admitted him are post-call and swamped today, so we'll help them in getting the ball rolling.
While the 2 consultants get into a discussion about something else, JC and I talk a bit. I'm slowly piecing his story together. He lives with his wife and 5 y/o child. He is from Zim, and is quick to point out that he has refugee status. I tell him what he plan is. He'll have a CT scan. A bone marrow biopsy. An scope down this esophagus into the stomach, as likely have one of those large lymph nodes taken out. It's going to be busy, and unpleasant. He wasn't to know what he'll get for pain control for the bone marrow. I hope they give him something, but I am unsure. He remarks how he is glad he ended up at Bara, and that something is finally being done to help him. He explains to me how after a while he thought maybe there wasn't anything wrong with him like the clinic doctors were telling him, and that maybe it was all "in his mind" like they said. And that he would get better with the HIV treatment. My attending catches a bit of this conversation and shakes his head.
We talk about it as we're walking to CT scan, to plead our case and hopefully get an urgent CT for JC. Dr AK re-iterates the reason why he doesn't like to down-refer patients to the outlying clinics. (Down referral-basically transferring care to the community clinics which can manage HIV treatment). Even though there are more than 4,000 patients on treatment in our clinic, and even though there are 3 vacant doctor posts at our clinic, and even though sometimes the clinic doesn't finish until 5 or even 6, and even though sometimes the clinic sees well in excess of 200 patients a day, it's still better to keep the patients where we can make sure they are getting the correct care. It's not about work load, it's about good patient care...
BPB
