More Medicine

I forgot to write about one other loss-- transporting the patient in their bed.  Apparently, that did not go over well because the corridors are relatively small and it is hard to move the beds through doors. Also, the beds are heavy relative to stretchers and since there aren't working elevators (there are ramps between floors), it is TOUGH moving those guys between units.

We did have one interesting pulmonary intermezzo, when one of the physiotherapists (there aren't any respiratory care practitioners in the country) asked me about an X-ray. The film (yes, still a film) showed a horrendously scarred left lung consistent with old TB. The old man was admitted to the hospital in respiratory failure, was treated, and was now going home. Did I have any suggestions?  He was still coughing up tons of sputum. A CT scan had been done of his chest as well, confirming my initial guess of bronchiectasis.  I suggested that the family continue to do chest PT at home. Another HVO doc and I demonstrated, and then I had the man's daughter practice on her dad:

A six year old child died in the ICU. The day prior she had been struck by a car and sustained a massive head injury.  One of the volunteers is a pediatric ER fellow; she's quite good and we worked together on resuscitation, the trauma survey, and getting her up into the unit. Unfortunately, her injuries would have caused her death at a US Level I trauma center. Nonetheless, it was difficult to see the child die, and the distraught parents. I couldn't console them, because they did not speak English. Since I am a registered physician in Bhutan, I signed the death certificate. The staff wrapped the child in a blanket, put her on a stretcher, and put her out in the hall so the parents could spend time with the child before it was taken away.

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