Day 11

I woke up early today because I wanted to go for a morning run but I lost my iphone somehow in our mess of our room and it took me 40 minutes to find. Anyone who knows me at this point knows that I can lose anything BUT my iphone. It comes as a first priority at this point. I found it under Celine’s backpack/clothing. Not sure how it flew in a projectile manner off my top bunk into the middle of the room, but I was never good at physics. I blame it on ninjas.

Today I would be working with Dr. Puspa, one of the Nepalese physcians and Celine. Our day started off with a bang. We had a young woman come in with an altered mental status after a week long history of nausea, vomiting, fever and headache. She presented with postitive meningeal signs on exam, so it was a red flag that this was meningitis or an infectious encephalitis. My mask was glued to my face. We gave her Ceftriaxone, started an IV and gave IV Vancomycin whie waiting for transportation to be set up to go to the ER. She began seizing after the IV Vanco, and we proceeded to get her stable before transporting her. It’ll be interesting to see how her case proceeded. We’ll get the reports most likely tomorrow. The ALS-like patient got her CT scan back, and which showed a small hypodensity which looked to be localized in the parietal region. Maybe a stroke, but it could also be some sort of lesion. Her presentation didn’t seem stroke-like so again, it’ll be interesting to see how the Filipino physicians at the hospital proceed.

Working with Dr. Puspa was great. He works at a very fast pace, asking for my input and letting me doing parts of the physical exam. Celine went to work in another room since we were short Dan for a while. We saw a few intersting cases in the afternoon, such as a 21 year old male with TB adenitis that presented with a large mass to his right neck with abscess like lesions to the area. Another patient definitely presented with postitive TB (MASK ON TIME!), with a year long history of weight loss, fatigue, chest pain, cough, and hemoptysis. We referred him to the TB clinic for sputum cultures. I gave a few shots to some patients, and an IV injection to a patient with chlaymidia. Never a dull moment.

 We had mangos for lunch! Stop it right now….but don’t. We haven’t had mangos in a while, like 3 days and I am having withdrawal. I even bought my own bananas in Sorsogon yesterday because there hadn’t been any at breakfast, and I really couldn’t have that happen again. Yes, I’m addicted. Afternoon I was paired with Puspa again and we knocked out a few more cases. I didn’t have my stethescope for the afternoon, because I’m a total idiot and forgot it after lunch. And let me tell you nothing is like your own stethescope. Daniella let me borrow hers, which is a Littman Cardiology III like mine and it just resonates heart and lung sounds beautifully. I tried another one and it was just NOT the same. I contemplated going back to the dorm to get mine but I really didn’t need it. Clinic ended early around 4pm. Puspa asked me to do an abdominal exam on a older women complaining of pain. Upon palpation she had RUQ pain with a positive Murphy’s sign, which I reported back as possible cholecystitis. Her ultrasound results which she brought back to us showed exactly what I had suspected. Multiple gallstones suggestive of cholecystitis! BOOM! I love when a good physical exam just sings to you the diagnosis. Unfortunately however, a symptomatic patient with gallstones is in need of surgery to remove her gallbladder, and those are funds that our clinic does not have. Therefore she would have to come up with the expenses on her own or wait until next year when we have the clinic again. We have been sponsoring many sick patients in need of surgeries and are coming up short on funding. Again, any help is always appreciated.  We had a lot of asthmatics today that I had to set up neb treatments for. The great thing about this experience is how I have gotten so comfortable distinguishing between normal and abnormal results on a physical exam. I hear murmurs and heart defects right away, and can differentiate between wheezing, crackles and rhonchi from normal. I can’t say how much I love doing this. It’s like being a detective, and once you put all the pieces together you can solve the mystery.

After clinic we went for a walk down to the small town just to get some exercise. Children were on the side of the road playing with their machetes. It puts the whole “Gun Control” issue in America into perspective. The children here play with machetes and yet the level of violence is negligable. Upon our return we ate another wonderful dinner before starting off the Friday night festivities. Gathering around the dining table, we played a game called “Heads up” on Sean’s iphone that is similar to charades. Mix in a little more of the Phillipine’s finest beer and liquor with that and we looked pretty ridiculous as the night went on and we progressively got worse at the game. I even stayed up until past midnight! Tomorrow we go on an excursion….Barbie out!