Hospital Day 1

Today began just like any other day in a hospital…with worship music and an encouraging message during fellowship with other believers…wait. In a world where a typical morning for a resident involves frantic note-writing, lab interpretation, and abbreviated physicals with little time for meaningful patient interaction, it was so refreshing to hear a message this morning about having faith and depending on the strength of the Lord even in the toughest of situations, and singing about how mighty and able our Lord is.

After our chapel service, we started the day on wards. One patient had unexpectedly passed in the night. Another was decompensating with an unrecordable blood pressure, respiratory distress and no response to pain. Her body is slowly succumbing to her HIV, TB, meningitis, candidiasis, and who knows what else. Unfortunately, because she is a DNR, and there are only 6 ICU beds in the hospital (for both adults and children), she was not a candidate for ICU care. We also do not have the luxury of ABG’s or stat labs (most take at least 24 hours). We moved her to the step down unit and attempted to start appropriate therapy.

After getting her stabilized, we started rounds with our team of a consultant (attending), medical officer intern (MD intern equivalent), clinical officer (PA equivalent), and clinical officer intern. We saw about 20 patients with diagnoses varying from diabetes and congestive heart failure to HIV and TB meningitis. I was surprised at the amount of similarity between our patient population in Greenville on our medicine service and our medicine patients here. For example, one is being treated for a UTI, but she can’t go home because her INR from the Coumadin she is on for chronic DVT is supratherapeutic, and we can’t get her to a facility to have it checked as an outpatient. Another was a consult from ortho for diabetes and hypertension management. The issues are also similar: How do we get this patient follow up? How do we get their chronic medicines paid for? How do we arrange outpatient oxygen for this lady with CHF and pulmonary hypertension?

 This afternoon we admitted an 80 year old lady with sepsis from a necrotic diabetic foot infection who also has acute coronary syndrome and severe hyperglycemia. Her family informed us that she had a stroke several months ago and does not talk, walk, or feed herself at baseline. This raised the question: is putting her through an amputation worth the risk, suffering, or financial burden to her family? In my one day of limited experience, I have already seen that Kenyans understand the nature of the world and God’s hand in it much more than Americans. After learning that the woman and her daughters are believers, we prayed with the family and they calmly told us that they are leaving her in God’s hands. “You do the treating and God will do the healing,” one daughter told me. Healthcare here seems to be more humane in a way because there is not opportunity for futile care.

I know this is only a snapshot of what the month will hold, but if I learn as much as I did today each day that I am here, I will come back a new doctor. I am excited to see what my time here will hold!