End of clinic week 3

I walked over to clinic 15 or 20 minutes early this morning, intending to check my email & make sure the slides for my afternoon journal club presentation were ready.....I suppose the "intending" part of that phrase makes it somewhat obvious that didn't happen.

Fridays are a slower day at the clinic, something like a half day because they start and end with weekly meetings (of the doctors in the morning and of all clinic staff in the afternoon, followed by journal club)....so the time to see patients really ends up being something like 4 hours.  This Friday, however, didn't start with a meeting for me....I was the first "doctor" to the clinic this morning and as I walked in a few of the other clinic workers (nurses, social workers, etc) who were already there came up & asked "doctor, can you come look at this patient in emergency?"  Though it will soon change, I pointed out that I wasn't a doctor who could write prescriptions (expecting it to be an early patient who needed to make it to school or work early).  They assured me that was fine - they just wanted someone to look at the baby that had been brought in to be sure she was somewhat stable. 

In the "emergency room" (the urgent care/procedure room normally) there was a 6 month old who was coughing & having trouble breathing normally (for at least 1 week and maybe up to 3 weeks).  She also was losing a little weight and not eating well.  It doesn't sound good - and it wasn't - but she really didn't look that bad overall, which was surprising.  The baby girl was not really fussing a whole lot - not quite lethargic but on her way there.  She was not overly dehydrated or malnourished, as are many of the sick little kids.  Signs of the trouble started with her nose (nostrils flaring a bit with each breath)....then she would cough a few small, weak coughs, take a few normal-ish breaths, & then almost seem to stop breathing/hold her breath for a few seconds.  When I tried to listen to her lungs, it was much of the same - listening for/finding lung sounds was difficult to impossible because she was breathing so irregularly.  Her heart rate wasn't astronomical for a sick infant, in the 150s perhaps, but once we got some oxygen on her so her breathing evened out a little, she had a respiration rate of 70+ (and oxygen sats that came up nicely from low 80s to 100%).  Luckily as my initial exam was finishing, one of the Baylor physicians was walking in to help make a plan & the emergency nurse arrived soon thereafter.  We will not know for a few days what the diagnosis will turn out to be, but we sent her to the hospital after a shot of rocephin. HIV positve with an unknown CD4 count - they will get an x-ray and treat her empirically at the hospital, but PCP and TB are both very feasible options.....and they may well be accompanied by a run of the mill pneumonia.  It will be interesting to see what they find in the hospital - hopefully when the Baylor docs go for rounds on Monday, she will be doing much better.

So, that was my adventure in "doctoring" today.  It really won't be so long now before it's the real thing (though not with kiddos), and to that end, this trip has been great experience for thinking "outside the book" even though oftentimes I don't totally agree with the approach that may be taken in the limited resource setting here.

The rest of the clinic day went pretty smoothly & the patients were of the typical nature (a few tb, a few med refills, and so forth).  I gave the journal club presentation on dehydration, fluids, & gastroenteritis associated mortality.....and now it's just a little downtime to catch up & organize for the weekend.  Mac will soon be by to whisk Carter & I off for another weekend adventure.....I believe Nancy has chocolate mousse (made with Toblerone) in store for dessert tonight.  Tomorrow morning, first thing, we will head for South Africa again to make a trip through Kruger park to see more animals and big game (crossing our fingers for elephants and giraffes and lions and leopards and everything else!)  No promises on getting those pictures up this week (it took hours for the last batch from my camera)....but maybe we'll try to pick a few winners & get those up. 

I hope everyone has had a good week back home - have a great weekend!