First a little background- several days ago I saw some patients out in Pinge (an hour from Soroti with practically no medical resources)and one patient just seemed like he had something big going on. His liver was huge and tender and he had multiple vague symptoms but he was only 28 years old. I recommended he come into town and have some blood work done. He wasn’t convinced he needed to do that so I told him to call me if he changed his mind and wanted my help. Well, this morning he came into town and I met him at the hospital. He looked way worse. I went into the consultation with him and the doctor agreed that something clearly wasn’t right. Pt was tachy, and short of breath, had pitting edema in his legs, his spleen edge could be found two finger widths above his iliac crest, also had a huge liver with slight ascites, and nausea. (But no fever or any other symptoms) We agreed on a bunch of blood tests. I left to see other patients but came back in an hour just as all his results were coming back. The first doctor wasn’t around but another one grabbed his chart and brought us back into the exam room. She started reading bits of it to me “Well, he has Hep B which explains the large liver….. but white count is critical low….” I got up to read over her shoulder. I couldn’t help but say out loud “look at his ALT and AST, I’ve never seen numbers so high! And his BUN and creat- I don’t think his kidneys are functioning at all.” Her response? “And look at these platelets (essentially none), we probably shouldn’t send him home.” Meanwhile, I’m thinking: cardiac, check, kidneys, check, liver, check. Yep, multisystem organ failure. Are you kidding me?! Then I pointed out to her his Hbg was 3.5. (Reference: 11-18 is normal. In the states less than seven gets you a transfusion. He was half that.) The doctor told me that they couldn't transfuse there and he needed "further studies" anyway so we packed up and headed off to my favorite place in Soroti, the regional referral hospital. (Note- not actually my favorite place.)
And now here it is four hours later and I almost have him admitted. I think I should be happier with that than I actually am. There were more than 200 people in the OPD waiting with their referral letters. A portion of those were children with an adult so possibly I could assume only half were waiting to be seen. But there were two doctors on. And at a minimum of 10 minutes apiece…. We had more than eight hours to wait. So I got assertive. I grabbed a nurse I recognized and begged her to “introduce” me to a doctor. I gave him a 30 second rundown on the patient and he grabbed the lab result I was trying to show him and scribbled me a completely illegible note on the back that I took to be an admission order. Richard was still in the waiting area trying to catch his breath from the walk from my truck. The doctor never even saw him. I feel just a bit bad for jumping in line but at least I only took one minute and who needs an assessment or vitals anyway? So I grabbed a wheelchair and took the patient over to the male medical ward where he joined the line behind five other men waiting to get beds and nursing orders. The doctors were doing rounds so it was going to be awhile. I left him there and went to go collect some of the things he was going to need to spend the night in the hospital like sheets, a jerry can of water, food, etc… as home was more than two hours round trip away. I’ll head back shortly to see if we can’t get some blood in him before sundown.