Sometimes, a day at work here astonishes me. On one fateful day last week the wonderful people that called on the Lacor outpatient stretched my head and emotions in so many directions, by the end of the day I was wondering if it was some form of daydream. Out of the 30 patients seen that day, here’s a little bit about 10 of them.
1) Skin diseases are the bane of most doctors, especially inexperienced ones. If something’s wrong with the heart or lungs, I can manage. The skin on the other hand… What are these spots that were all over her body?
2) As soon as this 7 year old girl walked in, I had my heart in my mouth. I’d only ever seen Sydenham’s Chorea before on videos. Two weeks of strange, involuntary faux break dancing movements was enough to drive her mother spare. Luckily, her heart was OK and the involuntary movements will most likely gradually get better!
https://www.youtube.com/watch?v=Q9OClocKTjE – Here she is!
3) The next woman has “Foamy macrophages” in her spleen (apparently). Having no idea what this means, I picture a huge pink foamy sponge in the bath. Not helpful for the patient!
4) The lovely old woman smiled at me as she handed me her bone marrow sample result. Like many samples it definitely showed cancer, but couldn’t say whether it was Lymphoma or Leukemia. It was fair enough that she didn’t understand why the clever doctors couldn’t figure it out after sticking a massive needle into her bone. We’re going to send the sample to Italy where hopefully they can shed more light.
5) “Benign hepatoma” was the ultrasound result from a small hospital. It seemed a bit fishy so we took a sample from his liver – He came back today with the heartsinking result – “Hepatocellular Carinoma”, universally fatal here. Discussing terminal illness is hard enough in your mother tongue…
6) The next healthy looking girl came in dragging her right leg. Two days ago ago she suddenly developed a splitting headache and then gradually started losing movement in her right side. Amazingly she could find the 200,000 needed for a brain scan in the capital, so I shipped her out quicksmart. Some things even Lacor can’t handle!
7) Next was a lovely old man who had forgotten his insulin for a week. He was looking very well but his blood sugar was unrecordably high. After having a talk with him about the importance of not missing a week, we kept him in overnight to be safe.
8) Often tragedy is unexpected. One 25 year old guy had a few episodes of swelling in his face and legs over the last year or so. After testing his kidneys over a one month period, we now have to communicate that he is dying of kidney failure, Dialysis is impossible, transplant costs an unfathomable amount. He asks me how long he has got left. How do I answer that?
9) The next woman who came in had a heart trying far too hard hard – I could see it pumping from a mile away. I made the mistake of making her lie down at which point she went blue and nearly passed out.
10) The last patient of the day was a near case of Doctor error. There was nothing much wrong with the guy, seriously – he just had a dry cough for 3 weeks! I asked him to try and cough something up with us, and my awesome diagnosis of “likely benign cough” (facepalm), made way for Tuberculosis! Sometimes it does pay to be cautious – not my strongest suit it must be said.
Wow Nick, what a fascinating job you have. 🙂 Amazing to see such a variety of conditions over the course of 1 day. Keep up the great work.
Thanks Mum (and Dad :p)
Gosh, yes. What a day. Challenging and interesting and heart breaking and life affirming and all that doctor jazz. As I sit drinking latte and looking for spelling mistakes and ways people can polish up their stuff for sale, there you are, making a genuinely worthwhile difference. Hoorah for you Nick, you’re a really good egg 🙂
Haha cheers Louise, you’re a pretty good egg too :p. I hope you are not analysing these posts too carefully for spelling mistakes, your head might get into a spin 😀
Yes. Absolutely fascinating. You do such amazing work. These patients are super lucky that both of you are where you are. Love the way you obviously care so much about your patients and their families. Go you!
What an interesting day at the clinic, nick! Thanks for the video of sydenham’s chorea!
Cheers Emma! I would imagine you see it a bit in the north Island where they’ve been having all those problems with rheumatic fever. I notice you’ve been on Peds – nurses still love their snacks here but it is fried banana rather than chocolate cake:p