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.
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