A Glimpse of My Patients Today

(from Eric)

Today, the Adult Medicine service, where I am working, has only seven patients.  This is not shocking, given that these patients (unlike the children under 5 and pregnant ladies) do not get subsidized care from the government, but as I like to say, we still have more than enough pathology to keep our medical students on their toes.

To give a glimpse of our work here, I thought I would describe these people.

1.  A 45 year old lady with diabetes that really needs insulin at home, as it is impossible to control with pills.  However, insulin injections are impossibly expensive requiring home monitoring and refrigeration (read: electricity that is reliable).  So we've been doing our best.  She is not well-controlled and will certainly have complications, but maxing out pills has at least brought her excessive urination down to a level where she can sleep better at night.
2. A new lady, about 40 years.  Her referral came with a concern of asthma.  Our initial note mentioned maybe meningitis.  Now we're thinking strep throat with difficulty swallowing.  Yeah, I guess we're a bit in the dark.  Thankfully she's breathing OK and I don't think she has meningitis, but it's a little hard to tell what to do for her.  So, we'll keep going another day and see if we make progress despite all that.
3. The male ward is especially dark when the power is out, most mornings recently, because there are no windows.  Like "hold up your cell phone flashlight to let me write a prescription" dark.  The first guy has bloody urine, fever, and anemia.  I agree with the diagnosis of complicated malaria, but his test is negative.  Well, it's not a perfect test.  Is he doing better with malaria treatment?  Somewhat?  We transfused him, but our blood count machine is currently unavailable due to lack of a voltage regulator.  Checking his kidney function is out for the same reason.  I would love to check his urine (which is still bloody), but we apparently don't have any more collection cups.  Nevertheless, he's maybe getting better, so we'll keep going.
4. A 45 year old man who came in dying from what Carlan noted to be an acutely failing heart valve.  He was initially sharing an oxygen concentrator with another guy, literally passing the mask back and forth.  I didn't think he would make it, but he has pulled through, becoming a chronic heart failure patient, now going home today on a couple meds.  We wanted a chest x-ray, which isn't working for us right now, so he will try to get one in town and come back with it to clinic next week.  We took a few moments to pray before leaving, thanking God that he is still with us, and asking for his healing to continue.
5. An 18 year old girl who was admitted from John's eye clinic last Friday.  She was fine 10 days ago and now is blind.  Her eye exam shows unmistakable signs of high pressure inside the skull, but from what?  We have no way to know, and thus our few possible interventions are more likely to hurt than help.  We gave her a few medicines over the weekend, but she's not doing any better.  The family wants to go home, and so we say OK, make a few decisions about what to do at home, and she will visit John next week.
6. A 50 year old lady who came in Saturday in a coma.  Test was positive for malaria, but she wasn't responding well, so we added antibiotics for bacterial meningitis.  She is now slowly waking up, so though her medicines are expensive, I think they saved her life.  She still has a fever.  It's getting better though, and I hope it's gone tomorrow.
7. A 35 year old lady who groans in pain constantly.  She arrived Friday in obvious signs of end-stage kidney failure.  She needs dialysis, but we can't even check her Creatinine or Potassium.  Full of fluid everywhere, we gave her meds to get her to urinate some more, but her symptoms are severe and months old.  Now we're shifting to comfort measures, but not really succeeding.  She is unhappy, and generally seems to think that we would help her more if we wanted to, which is pretty crushing for us.  Carlan came and ultra-sounded her belly, and found the problem.  After talking with Rachel, we've decided it's likely an ovarian cancer which has permanently blocked the urinary system.  She's too sick to operate on.  So maybe it's good to know, but I would trade that for a stronger pain medicine for her.

So, it's a mixed-bag, with some victories, even some very unanticipated ones.  And they come very much in spite of our insufficiencies.  But the difficulties can really make us feel like "what are we doing here?"

In Luke 7, there is a story where John the Baptist sent his followers to Jesus to ask "Are you the one who is to come, or shall we look for another?"  This is John's flagging confidence in the face of his own trials.  It's his weakness, but it's hard to blame the guy.

Jesus tells them to go back and tell John that they are seeing the blind see, the sick get well, lepers cleansed, the lame walk, and the poor have good news preached to them.  In other words, John, I know it's hard, but my kingdom is going forth even when it doesn't feel like it.  But if you look for it, I think you can see it.

And we can.  In fact, we see every last thing on that list, right down to the lepers.  Our systems are broken, our resources inadequate, and our abilities insufficient.  And through those things, newness comes.  In the darkness shines a light much brighter than that of a cell phone flashlight, and it will continue even if the electricity never comes back on.