Not so normal Tuesday in the clinic...

Unlike most Tuesdays, today was hectic; many children at the gate and many ‘interruptions’. Here’s the run down…

0715 - Phone rings. A patient of mine that had surgery on the Africa Mercy has been discharged. The father wants to know if I need to see the child, or if they can go home to Kono. I tell him he can go home.

0750 – I arrive at the clinic.

0810 – I go to the gate to face the line of 60 children; time for triage. I see a girl who looks pale & weak; I’ll see her first. I am asked to talk to 2 other patients; they have tumors. I need to discuss the possibility of surgery on the ship.

0820 – The patients are inside. My first patient is 4 years old, febrile, pale and breathing fast. I take her to the lab to do the history & examination while the lab tech draws blood. We wait for the results.

0845 – Her Hb is 6.7 g/dL. Her blood smear is full of malaria parasites. I send her to the referral center with a letter, hoping they have bed space.

0920 – By this time I have just seen a 2 month old boy with a persistent cough & fast breathing. He is struggling; he needs oxygen. A referral letter is written, a taxi is chartered, and off he goes.

1000 – I see a couple of ‘regular’ patients.

1030 – One of my follow-ups arrives. He’s 5 months old and I’ve been treating him for 2 weeks. He was pretty sick yesterday, today he looks a little better, except for a respiration of 80 per minute! I arrange for a chest X-ray elsewhere. He’s on his way.

1100 – A nurse asks me to see a patient; a 2 year old I saw last week (malnourished, breathing fast, poor condition) that I referred to the TB doctor. He is now on anti-TB drugs and looks a little better; he has a long way to go.

1245 – I have another follow-up case. Usually follow-ups come in the afternoon but I was concerned about this one yesterday and wanted him to come earlier. I diagnosed him with malaria & anemia (Hb 5.6 g/dL =low) and started him on anti-malarials. Today he’s eating & playing. I send him to the lab again.

1250 – I have a 5 minute lunch break while waiting for this child’s results.

1255 – Oh no, his hemoglobin is falling. It’s now 5.3 with the centrifuge and 3.9 with the hemocue. Yikes! I call the referral center; no beds left. The child is stable so I send him home with clear instructions, in case he gets worse. I will see him again on Wednesday. I say a quick prayer.

1300 – I continue seeing patients. There are at least 30 still to be seen. At least there’s another doctor now.

1600 – Children that were in line at 8 am have been seen. It’s now time for the 10+ scheduled follow-up cases. Some are better; some need to go back to the lab, some need other meds.

1630 – The boy I sent for an x-ray at 1030 is back. The x-ray was fine. I’m puzzled by the case; he is again on antibiotics and will be followed-up again.

1700 – The father of the 2 month old I saw earlier today shows up at the gate because his wife & son did not return home. I call the referral center to check if the boy was admitted – he was (so was the 4 year old girl). I tell the father. He seems disappointed that we didn’t give medicine; he is concerned. I explain that the child needed oxygen and stronger medicine. In the end he seems to understand and leaves for the referral center.

1800 – We’re all waiting for the last lab results so that we can send the last few patients home; almost done.

1830 – I’m on my way home.

Of course the craziness didn’t end there. I got home to find out there was no water in my bathroom and so washed my hair under the stand pipe outside, and finished with a bucket shower. I then realized that I missed my laundry slot. Then I went to a movie night at a local restaurant, to watch a great movie that unfortunately finished before it was really over. Then when I got home I had to finish up the October statistics for the clinic. It’s been quite the day!