Hospital days

I completely skipped a whole day to write about and it was one of the most interesting learning days. On Thursday the1st I went to the male medical ward where ward roundwasgoingom with the consultant. There was about 12 interns and us going from bed to bed and talking about the patient and their case for learning purposes. I saw so much and learned how they go about treating things. I won't go into boreing details but here is a simple list of what I saw:

1) strokes

2) epilepsy patient with complications with urinating 

              Learned that the antibiodics for UTI lowers seizure threshold which is very important with a patient with epilepsy

3) ulcerative colitis 

4) ischemic stroke

     Patient could not talk so we know the hemmorage was in frontal lobe. 

5) stroke and chronic kidney failure

         Learned what must be checked before putting a patient on dialysis 

6) ischemic stroke

7) ascites- had to determine if it was due to liver, stomach, or kidneys. Patient history is 70% diagnosis 

8) jaundice 

9) anemia

10) malaria

11) this case was interesting. It was a 12 year old boy who since February had been vomiting and diarrhea and after tests decided he had anemia and was put on meds but after 2 weeks he got worse. They tested again and found tonsillitis. They tested for TB but it was negative. He was taken off meds for 3 days and got worse. He went to another clinic and chest X-ray showed TB. After meds he still was vomiting and became very weak like jelly. Under physical exam it was found a lump in stomach and enlarged liver. He was put on injections to stop vomiting. They were planning an endoscopy to be done. However what I came to learn later on was that the consultant knew exactly what the boy had but did not reveal it to the patient and his mother while all the interns were there. He kindly waited till after the round and the interns left to go discuss with the mother that the little boy had HIV. It is a terribly and sad diagnosis and I am so happy the consultant waited to tell mother until it was appropriate and not with 14 student doctors just hovering around her son like a spectacle. They planned to take tests from his family members to see where he got it from. This worries me because of how HIV is spread if a male in his family is positive for it it could mean that the boy had been sexually abused. It is very sad and such a terrible circumstance. 

After a tolling morning it was nice to relax and spend time with the girls.vus girls went down to the cafe and had milkshakes and then did a little shopping. It has been so fun learning about each other and the things we do where we are from. It's so funny to think how different things are in the same world. I thought coming here I would learn so much of the Kenyan culture but lo and behold I have learned so much about English and Australian culture as well. 

So now that I am kind of jumping days I will just do the hospital experience then do the weekend and non hospital stuff. On Tuesday last week before safari I went to minor theater because it was hard to find somewhere to watch things. When we got there we had a 55 year old man come in for an abscess drain. This man was so thin and frail it was unbelievable. He was in A wheel chair and transferring him to the gurney was a hard process. We watched as the consultant cleaned and numbed the area, which was the lo gets I had seen a doctor wait for the local to work. Most doctors don't wait for the local anesthetic to work and cut into patient before number, The consultant however waited longer than any I had seen but still not quite long enough. The abscess was drained and blood and pus came out. There was a great deal of material in the abscess and draining it took a while and after some time the patient started saying it was very painful inside. The thing was they weren't stopping and the patient started screaming for them to stop and he started kicking the assistant and punching at the doctor. They had to hold him down to finish the dressing. He was instructions to change dressing every 3 days and come back in 6 months. 

The day before I left for safari I went to main theater. Me and Anna were suppose to go see orthopedic surgery but they were not ready so we went into another surgery. This was a 3 month old boy with a grossly  distended abdomen and was suspected to have hirschsprungs. They prepared him and made an  incision and started taking the intestines out. They were very inflamed and full of gas. As they examined them they came to realize the whole colon was dialated which in hirschsprungs the colon should narrow but this boys was dialated all the way to the rectum. The surgeon made a call and then changed his plan. He started taking biopsies along the intestines to find the pathology. He concluded that the distension was idiopathic. So he took 5 biopsies along the intestines and the anus. The results will not come back for about 3 weeks. Until then the boys intestine was cut to make a colostomy. So the intestines were released of the gas and build of feces and then stitched to his side so he would have a colostomy bag for 6 months. If it is hirschsprungs then that area that the nerves have not developed to innervate in will be removed and shortened and he will be ok. However if it is more severe and not this then the boy may have something that will not be able to be fixed and will have a colostomy bag his whole life. Warning graphic pictures ahead.