There’s no air conditioning. It’s 104 degrees Fahrenheit. I’m melting like cheese on a radiator. The Florida-trained General Surgeon says it was hot in her Florida summers growing up, but not this kind of hot. As therapeutic as my cappuccinos were back home, my bi-daily showers are here.
The walls are smeared with occasional orange or brown or…I don’t know what’s on there, but I’m not leaning back on the wall, or touching the beds, or opening the screen ward doors with my hands.
There are about a dozen steel framed beds with latex foam mattresses and fitted sheets for each patient.
Nurses and student nurses crowd in the 4×6 fanned room, sitting or standing, but as comfortably as they can under the only fan on the ward.
A sign on the wall shows a picture of a king, or a president, or a significant male character declaring: ” Tuberculosis is not a curse, there is a cure“.
On rounds with Patient #1…
He’s the really old fellow, thin and wiry, maybe 90 pounds that sits outside House #6. House #6 is where we’re served lunch and dinner. Generally healthy, but admitted for gastroenteritis or pneumonia. He sits with his skinny dog and sings songs. When he sees us he shouts, “Praise the Lord. Allelulia…” and he’s waiting for our “Amen“.
Jim puts the stethoscope in his ears and the man whips his shirt off. “You can leave it on,” Jim tells him, but he whips it off anyway. “He is well,” Jim tells the nurse. And the old fellow throws his shirt on and high fives me with “Amen, allelulia“. He knows who has healed him.
On rounds with patient #2…
A forty something year old man laying with his arms in the air. His face no longer a form that is familiar. A few days earlier he had spilled a boiling vat of oil onto his body. About 20 percent burns cover his face, his hands and arms and abdomen, and the tops of his feet.
The oil took a layer of his licorice skin off, so his abdomen looked like the colour of milk chocolate. His left hand was cherry red.
Jim gave him an IM of Ketamine before his dressing change. Just ketamine. Cause that’s all they had. Oh, and for his post-burn pain, Tylenol. Them there’s something that don’t happen in Canada.
He was frantically trying to explain something to me after he got his shot. Jim told me that he’d be more reactive, talkative.
The translator said, “He’s telling us to ask the guard to let his brother back into the hospital compound so he can gather supplies.” He’s worried about his brother.
Later, he’s to have a dressing change in the OR. The nurse is to let the OR know. Later on that night, he wants to ask why he didn’t go to the OR. Jim is perplexed; he should have. Off to the OR to ask; his name and procedure are written on the OR board, but the OR is quiet. Oops, someone didn’t look at the board, or forgot?
On rounds with patient #3
Jim asked me to open the sharps package. I couldn’t figure it out and I didn’t want to use my mouth to do it, so I asked the nurse. She easily opened it. Not like back home. There would be no way I could keep that sterile.
Jim took off the cap and cut it partways. Then one handed, he slipped the cut plastic sheathe over the needle, attached to an ample syringe. He had me hold the penlight at the back of a man’s throat as Jim attempted to insert the syringe into a growing peritonsillar abscess. Puss. White thick tongue. The trachea has been pushed toward his right side. He couldn’t be intubated if he had to be in the OR. Jim hoped to extract some of that puss into his needle.
In laymen’s terms, it means that he’s had an infection around his tonsil, unknown cause, and it is puffing up the left side of his face, all the way to his temple, all the way down to his neck.
Jim had done this before. He laid hands on both sides of his face and squeezed his left cheek. This action forced an uncomfortable wincing on the patient’s face. And these people don’t wince. They don’t moan. Rarely do they cry. They are made of tough stuff. And if this was in North America, this guy would be under sedation.
I wince at Jim’s compression of this guy’s cheek. I can see this man is in tremendous pain. Jim knows this has to be done, and the OR isn’t an option. I notice that the student nurse is laughing at me…because I’m wincing.
—Earlier, the American OB resident here says that women yelling during their labours are yelled at to stop yelling. Them there’s something that don’t happen in Canada. I asked about epidural usage. Mwahahaha.–
Jim had performed the attempt at releasing the fluid from this fellow’s abscess the day before. And he’d asked the nursing staff to continue applying pressure regularly so it would release. They didn’t.
We are reminded that we aren’t in control of what happens here, that we just came to share. Without the help of skilled, organized assistants, what should be done, doesn’t always. What could be done, may or may not get done. An old Ghanian proverb says, Naawuni yi kabigi a gbali, o ni wuhi a ni yen kpahi shem. In English words: “If God breaks your leg, He will teach you how to limp“. So I will pray that we do the best we can, and share what we have.