medical wards

Well, this is it. my final week! And it's a new ward this week: the medical wards.

Which means general medicine, and I happen to be on the female ward because that's the one that I found first this morning. This part of the hospital is undergoing renovation--so this ward has actually already been renovated. It reminds me ever so slightly of home, too! AKA it actually looks like a more modern ward. There is oxygen on the walls so tubes can be plugged into that. There's still no suction, but there are lights and outlets. There's even a cabinet installed between two of the sets of beds which creates a semi-private room at one end of the ward! Hallelujah! Still no decent sharps box, the blood still goes in a paper slip made envelope and in the box, and the medicines are now kept under the desk instead of in a cabinet.

Interestingly, there's also only fifteen beds. I don't know if this is because the other six beds are used for the psych ward, or because the medical doctors in charge of the wards are often going to consultations on other wards but when I'm used to 35-40 patients per ward, this is far easier to manage. Plus with the new renovations, these fifteen patients get the room they should have because the ward probably used to house 20-30 patients.

Regardless, the medicine is fabulously interesting.

I've had the distinctly memorable experience of seeing Steven's Johnson Syndrome (SJS) and actually also Toxic Epidermal Necrolysis (TEN), the worse cousin of SJS. Basically in SJS your skin only peels to about 30% of your body's surface area, while TEN it's more than 30%. As you can imagine, mortality is quite high. It's a terrible thing to see and watch and know that the patient is likely going to die no matter what you do. So imagine SJS in Jamaica. The dressings that we use in America would cost probably $5,000 a day. That is impossible here--I can't imagine any of them have even SEEN the dressings, let alone consider getting one in Mandeville if there is one in Jamaica at all. So we have to leave the skin in place as a biological dressing; a rather creative solution here but there is always the risk of secondary infection. It's also complicated in this patient by an AIDS diagnosis that the patient is in denial about and thus is not treating. It's a very interesting medical question of how/if the AIDS contributed to the immunologic reaction that is causing the SJS. From what I've seen, she's really not in terrible shape, but time will tell. We definitely need to get IV access on this woman also and while we would have already gotten a central line in America, there isn't even peripheral access here.

There was a woman who is questionably having seizures or tardive dyskinesia, and she's not faking it like some of the other doctors had assumed. When you lift her hand over her face, she lets it hit her in the face. Fakers don't let their hand hit them. She was interesting because she can clearly hear us, but she can't respond.

There's a woman with a herniated brainstem...which in America is steps from brain death if not actually there yet. But they're considering their options here and if she's getting any better--I found this exceptionally odd, in addition to the fact that she's not on any monitors. I have no idea if they do transplantation here, but she would likely be a good candidate.

I mentioned above--no monitors. I haven't seen a single working telemetry monitor in the whole flipping hospital. I've spotted one monitor, but it wasn't working. When you consider the prevalence in America, that would probably be a significant visual difference every healthcare worker would pick up on.

Otherwise, mostly normal stuff here. Diabetic nephropathy, aspiration pneumonia, avascular necrosis from sickle cell crisis...

And then the psych patients. One of whom was wandering the ward and told me I wasn't from the US, but from Canada. There are worse things to be called, eh?