Salome Patients - Taking Stock

One of the many questions we as resident doctors ask when signing up to go to Kijabe is what type of medical problems will I be seeing? Will I be prepared? I am cleaning out my notebook today and thought I'd take stock. I have a wide variety of patients on the Women's (Salome) Ward ages 20's to mid 80's. Most are from many miles away and have traveled days to get to Kijabe. As for the preparedness, I say yes, thank you to all my attendings and senior residents at Swedish, though it would be nice to have a cardiologist, nephrologist and gastroenterologist.....to consult with. :)

Yes, some patients are in the hallway, it's so crowded.

My currently admitted patients are struggling with:
Diabetic foot awaiting amputation x2
Class IV Heart Failure and End Stage Renal Disease with refractory volume overload
TB Meningitis with history of stroke
Community Acquired Pneumonia
Pneumonia with Pancytopenia
Delirium of unknown origin
Tuberculosis of the spine "Pots Disease"
Intrahepatic Cholestasis most likely due to toxin
Pneumonia with Lung Collapse history of TB/fibrothorax (see chest x-ray)
TB Meningitis
Uremia due to Acute Renal Failure (attempting transfer for hemodialysis)
Metastatic Cancer x2

Discharged:
Pneumonia x3

Stroke x2

Heart Attack

Acute Renal Failure

Hyperosmolar Hyperglycemia State

Cryptococcal Meningitis

Pancytopenia

Prolong heavy vaginal bleeding due to cervical tumor

Bacterial Meningitis

Congestive Heart Failure

Metastatic Cancer x3

New HIV diagnosis

Excessive Salivation

Anemia

Pyelonephritis

Consultation service:
All maternity/gynecology patients with hypertension
Postpartum hyperthyroidism
Surgical Clearance
Pneumonia in Pregnancy
Postpartum rule out pulmonary TB

Deceased:
Victim of assault with head trauma
Methotrexate Overdose

This last case was a tragedy. A young 34yo woman with a presumed diagnosis from an outside hospital of scleroderma and rheumatoid arthritis was prescribed toxic doses of methotrexate (I assume an innocent mistake) 20mg daily instead of weekly? This seems like a high dose for even weekly. She came in with severe pancytopenia, interstitial pneumonitis, stomatitis and renal failure. The antidote leucovorin would have saved her life if they had come in when her first symptoms first came on, but unfortunately she made it to us a week later, very ill but still really with it and fighting for her life. Her family were able to get leucovorin from Nairobi but it was to late to rescue her. She was transferred to the ICU the next day and attempts were made to get her to Nairobi for hemodialysis (to wash out her blood) but it was too late. She passed away within 3 days of entering our doors.

The above cases are only a glimpse of the tragic stories this women have. The patient with uremia due to acute renal failure is one week postpartum after a still birth. Her pregnancy was complicated by pre-eclampsia (high blood pressure in pregnancy to put it lightly) and then following delivery she developed endometritis but became so sick she was admitted to us with "puerperal sepsis," a creatinine of 10 (normal is less than 1) and hallucinating. She needed urgent dialysis which means transferring to a hospital one hour away. After being disconnected seven times trying to get a hold of the renal unit by phone I was told she'd have to go through the ER "casualty" anyway. After all that....time stood still....her family had to come in and accept the transfer...wow, you've got to be kidding me!

My heart breaks everyday. Thankfully some do get better and go home. Kijabe can be a beautiful place, patients surrounded by 10 family members singing and praying, each taking their turn to feed the patient or tend to the needs of the patient as nursing care can be a little too slim. Bad news is broken with prayer and hope of God's presence and strength during this time of suffering and unknown prognosis. I don't know if it this element or the fact that I am surrounded by my patients and their families all day long as I do my work that I feel more connected to my patients here than I do at home. I cannot simply check on a lab or vital sign without passing family and giving updates to each and everyone of them. At home I feel like we are always running off to our outpatient clinics, teaching sessions, our patients are scattered all over the hospital and discussions with family are over the phone. I am pondering ways to bring this home with me. Maybe more bedside rounds....
---Katy