Today was another smallish size day for the Internal Medicine service here at Kibuye, so I thought I'd give another random sampling of patients. We had 7 total (i.e. one for each medical student. Yes, we have a lot of students. But they are good at learning from each other's cases…)
1. Jean-Phillipe (no real names) is a 32 year old guy with HIV who has been here 27 days. We've done some good things for him. We have successfully treated his tuberculosis, and corrected his HIV-med regimen (he was only taking them half the time…). We've tried to check his CD4 count, but they only send them once a month, and I guess there is a quota, and we missed out last month. But he still has nightmares and vomiting. And now he says he looses consciousness. I'm not sure he would know, because he is always alone. We've tried everything. The student suggested some HIV-related brain lesion, which is a good idea, but we can't test for it or treat it. I talked to Jason and he may get an endoscopy tomorrow.
2. Juvenal is 47, and is his neighbor in the isolation building. He doesn't have HIV, and is being treated for TB also. He's a bit better, but not enough, so now we're entertaining concomitant emphysema, given a long smoking history. He maintains a good spirit despite a long hospitalization.
3. Across the little hall is Luc, a 29 year old taxi-driver with severe malaria: blood in the urine and vomiting. He was treated with quinine at another hospital. We brought him in and gave him the exact same treatment, and he is getting better. I don't know why this happens. What goes on at those other places? Are they missing frequent doses? At any rate, he is looking better, but had a fever last night, and I can't figure out why. For now, we're hoping it doesn't come back tomorrow.
4. Rounding out the 4 beds in isolation (all mine for the time being) is Gloriose, a 70 year old lady who came in with dysentery, and sure enough, got better with appropriate treatment. It's nice to have something go smoothly. She's going home today with some Cipro.
5. Gilbert is a 35 year old guy who admits to being a vrai buveur (a real drinker), which might not have been so bad if he didn't also have Hepatitis B. He's in florid liver failure, and there is not much we can do. We gave him some diuretics, and drained 4L from his belly. But then Friday he slipped into a coma. Honestly, I'm surprised he's still alive. His coma is a bit lighter, and we're trying to treat everything we can, but he's very sick. He has a couple faithful friends with him that seem to appreciate that we care about him. We prayed with them on Saturday.
6. Marie is 70 years old, and showed up last week all confused. It seems to have been a bladder infection, and she is getting better with antibiotics. It's a good simple case for the students, because they can never believe that a bladder infection would do that. But then, there are only 2 neurologists in the country, and they are long overdue for their neurology course, so it's a little hard to blame them.
7. Our last girl is Goreth, a 23 year old high school student (due to financial problems, high school often goes until the mid-20s) who came in Saturday: difficulty breathing, semi-conscious, big swollen legs, and distended neck veins. Sure enough, we did an echo of her heart, and found severe heart failure. Why? I don't know, but I suspect bad valves, maybe rheumatic, based on her echo. She had a low blood pressure when she came in, and almost all such patients die here. However, she is still alive, and even looks a little better today. We keep praying that she can get through.
7 cases. 7 individual stories. We will see how they continue on. They bump into us. We bump into them. Life. Death. Healing. Scars.
A couple years ago, I wrote a song about Revelation 22 called The Leaves of the Trees. This vision of the heavenly city speaks of a Tree of Life. But that's not all. The leaves of that tree are for the healing of the nations.
And sometimes that idea makes me ache. Because it rings so true. Yes, we need life, and badly. Pure unspoiled and unthreatened life. But we are who we are, wounds and all, and the fact that God would take that in hand, and provide us with healing, in addition to life, strikes me as a beautiful salve. A key that fits the lock of our brokenness exactly. There is joy, and there is sadness. There are scars, and there are so very many moments in which all we do is just palliative. Maybe even every moment.
But at the end, there is a promise. There is life and healing for all our wounds. There is, simply, that which we need.
(to listen, click on the play button. Download for free.)
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