Training wheels off...

So Justin is gone and it's just me now. Today was ok. We have grand rounds on Monday mornings and today there was a presentation by the Medicine Service which actually wasn't that bad. All of the departments are there with the medical students here and they gave a clinical presentation.  They even presented an orthopaedic case which no one quite knew what was going on with the patient so the guy asked me what I thought; it kinda put me on the spot in front of everyone, but I had an idea of what the patient's condition was, so I educated those in the room as to that particular clinical condition. Was pretty cool.  After the presentation, the meeting kinda got off track and they started debating some issues that were completely unrelated so I left and hustled over to the OR b/c I had 6 cases scheduled today.

Because the meeting went well over time, the OR got started late today so we were only able to get through 3 cases today-I wished we could have gotten to all of them, but the day was cut short.  Now we have to bump cases to Wednesday.  After surgery I got a call from the hospital general administrator that there was an emergent case that was transferred in that she needed me to go take care of.  This lady was involved in a car accident and suffered a severe spinal cord injury.  She dislocated one of her vertebra in the neck and was rendered paralyzed.  Sad situation.  Unfortunately there wasn't much that I could do for her here, b/c we don't even have a CT or MRI scan, let alone the capacity to do spinal surgery here.  I had to ship her off to Ghana by plane to get appropriate care.  It's not a good feeling to feel helpless like that when you're limited by your resources. 

I felt that helpless feeling today in the ER after I left surgery and saw the lady with the spinal cord injury.  One of transporters brought a guy into the trauma bay after being involved in some type of accident.  He wasn't responsive and was breathing rather labored.  He just dropped the patient off and left him there and no one in the ER was going to tend to him until he was 'registered.'  It was a bit disconcerting to say the least.  I noticed that the guy was not in stable condition so I ran over to assess him, cut his clothes off and tried to see what his injuries were.  One of his pupils was fixed and dilated and the other was constricted and nonresponsive.  He also had cerebrospinal fluid and blood leaking from his ear.  He wasn't oxygenating very well and was unresponsive.  I felt so helpless.  I was going to try to intubate him at least, but there is only one ventilator that they can use-and if the electricity goes out while he is on it then he's dead anyway...
I was told when I arrived that I would have to let people die right in front of me and just move on to the next patient.  That's hard to swallow when you train in a system with resources that can save people's lives.  It's not everyday that you feel 'helpless' in the states b/c of lack of resources.  I tried to use the patient as an opportunity to teach some of the nurses-they were focused on other minor patient issues and didn't seem to want to help get the patient stabilized.  You don't want to come across as being mean, but at the same time when you need all hands on deck, dammit you need all hands on deck!

When I finally got back to the dorm I was tired and a little discouraged to be honest.  But I'm over it now and back on track.  I had a nice burger tonite at one of the hotels down the street while I played a little solitaire on my laptop.  This blog thing is actually somewhat therapeutic for me.  I get to write out my thoughts and experiences and as I read and review them before I publish the post it has a soothing effect to it somehow-it makes me smile everytime I hit submit post.

I guess it's time to get some sleep now.  Tomorrow shouldn't be too bad-I hope.  I don't operate; just clinic.  The thing is...now everyone knows I'm in town...

Nite everybody