Day 4

So those of you who know me well are aware that I have sweat glands the size of my home state, so you may be wondering, "How's she doing in that hot/humid climate?" I had not been working for very long on my shift yesterday when Jean, my favorite interpreter, said to me, "You are already sweating." I responded, "Oui, toujours." The heat is pretty intense on the day shift, by 11 am, I'm basically soaked. It's disgusting. Today I went over to round on hospital patients at St. Lucs. The internists on our team were doing teaching rounds with the New Haitian docs that have been hired to cover the hospital and nights in the ER/ICU. I came in late and could only stay for about two patients. The fans were not turned on and no air was moving. The patient we were discussing was interesting: mumps and possible TB. But I was so distracted by my sweating I could not stand it. I kept on staring at these Hatian docs and thinking "Not a drop of sweat, how is that possible? Why did I have to inherit my father's sweat glands?"

I rounded with the docs in the ER/ICU this morning. I found myself repeatedly asking, "so what's the plan for this patient?" I have noticed that many of these patients have been here several days which puzzles me. The ER/ICU in my experience is the place where a patient is stabilized, once that happens they are transferred to the next appropriate setting. As the morning progressed, I noticed that some of our plans were at a standstill. So I started harassing the Haitian doc to write some orders, specifically a CT scan and chest x-ray for two different patients.

The CT scan of the head was for a patient who we knew had a stroke, we just needed to confirm it. During rounds I was asking a lot of questions about the patient. She is an 86-year-old who has hemiplegia and is basically nonresponsive. I was asking about the treatment plans for this patient. Dr. Crevecoeur said in Haiti there is no such thing as DNR/DNI. The expectation is for the docs to do everything to "cure" the patient. And there is really no such thing as palliative care. I asked if there would be a meeting with her family to determine how much intervention they want. He said it would happen at some point and likely this patient will be dying in the ICU or at St. Luc's.

Another patient who is in her 80s was found to have complete white out of her left lung on chest x-ray. We are not sure if it's fluid or infection. She's on good antibiotics for an aspiration pneumonia. For the past two days there has been discussion as to whether or not the fluid should be tapped. I'm thinking let's make a plan and follow the plan. ;)

A psychiatric patient came in the afternoon. She was a young woman about 6 days postpartum. It looked like a postpartum psychosis. She received 4mg of Haldol and 1 mg of Ativan. I could tell the meds were taking effect and she was starting to relax when the nurse arrived with a foley. Apparently they wanted to give her lasix for her lower extremity edema and therefore wanted the foley. Um, really? Do we need to diurese her now when she is floridly psychotic? She needs to sleep. Of course she's puffy, she just had a baby. I let the Haitian doc know my opinion...that the foley would only succeed in agitating her more and I don't think it's necessary right now. I left to check on other patients, but I could hear her screaming from the next room. I don't think they were successful. When I walked by later..she was sleeping with no foley. I wish I could have fought a little harder to prevent her from having to experience that but I don't want to burn any bridges.

Well we need to get working on some education sessions for the nurses. I'm going to the orphanage tomorrow...I'm looking forward to playing with the kiddos.