Greetings from Guatemala #5
01/26/2008 04:47
Dearest ones
hello again from Guatemala. I just got off a 24
hour shift
and I am in meditation mode recovering. I know most of you love ER
stories so I will start there.
A 7 year old boy came in yesterday for a follow up visit. We have
diagnosed him with mycoplsma pneumonia and ereythema multifore (EM). This
child has a total body rash (EM) for the past four days and has been
itching like mad. His body is swollen and he is very uncomfortable. An
American pediatrician happened to be visiting the hospital so we got her
to consult with us. While she was talking away the little boy was going
crazy with itching, writhing all over the bed, rubbing his legs together
and crying.
When I witnessed this little boy suffering it came to me that sure I can
adjust his prednisone to help him in the long run but that moment was when
he needed to be healed. In the midst of all the people and commotion I
closed my eyes and put my hands on his legs and began silently repeating
the rescue/emergency prayer that I have learned. I prayed for the healing
power of God/Love to come through my hands and help this child to relax
and relieve his suffering. It took a few minutes but he started to let
go and eventually he was lying there calm under my hands. I didn’t tell
anyone what I was doing. I attached a picture of Irene the local
Guatemalan Doctor examining her patient in the same bed the little boy was
lying on.
Just about 5 o'clock a man came walking to the hospitalito who had been
hit by a Tuc Tuc. The Tuc Tuc is a little gas powered vehicle that is one
of the main modes transportation around here. It seems like there are
thousands of them and it like the autopia ride at disneyland. They are
red putt putts, racing around crazily and it seems like there are
thousands of them. The streets are narrow and I was advised to be careful
when walking because I might get killed by one, and I was also advised
while riding in them to be ready to jump out at all times because they are
reckless, driven by children and get in collisions all the time. It costs
$.60 to ride across town, almost no one has a car and its the way to go.
Initially this 60 year old man was complaining of pain in his right hand,
right cheek, left hip and lower abdomen. Pedestrian versus vehicle is a
red flag in ER talk even though the guy walked in on his own volition.
His abdominal pain was the fourth thing he listed and was most concerned
about his hand. My lovely Stanford med student Kirsten was kind of green
on the subject and focused on his hand. I taught her to be very
suspicious of anyone hit by a car and to go the whole nine yards with his
evaluation. After I examined him, sure he had some bruises but the only
thing that could kill him was this nagging abdominal pain. To make a long
story short with serial exams his pain went away at rest but remained with
palpation, then over the next hour his abdomen stared to distend. I
called Jerry in and he agreed the exam had changed. I almost called the
Doc on duty in my ER for a consult, but we decided to send him off to
Solola with the bomberos. We do not have a trauma surgeon at the
Hospitalito. Of course his family had to be called in to decide if they
would let him go. The bomberos arrived and were ready to go but the
family all had not gotten there so they keep waiting as his abdomen got
bigger and bigger and then it started hurting in the upper quadrants. I
finally told the nurse that I was freaking out that this is an emergency
and they guy has got to go! Eventually they let him get in the ambulance
and leave. We will call to find out what happened on Monday.
When I applied to work as a volunteer at the Hospitalito they had many
questions for me about my skills and comfort zone in practice. Since I am
a ER Physician Assistant and a midwife they wanted me and now I know why.
The ER and the Sala de Partos (delivery room) are connected and the person
on duty is responsible for both rooms at all times. They also asked me if
I was comfortable handling high risk births such as pre eclampsia and
pitocin inductions. I told them no, that my practice was to manage high
risk situations with a doctor present and that most of my experience is
with natural childbirth. Ok well that lasted one shift. Last night I had
a laboring woman come in with a blood pressure of 150/119. Panic time,
here we go again with pre eclampsia and risk of seizure. I called Jerry
the MD to come in and we gave her Mag Sulfate right off since we had a
seen a seizure a few days before and did not want to see that again in
this lifetime. We started a pitocin induction and then Jerry said OK she
is stable I am going home. I picked his brain to death on the whole
subject and let him go home. My goodness how soon I give up my scruples.
So I was up most of the night watching her like a hawk and increasing her
pitocin. I cannot believe I did it. The good news is that today around
noon she had her baby girl without a cesarean, or a seizure.
Thank you to all of my ER doctors for the years of training that have lead
up to this moment in time. Especially to Wanbli who ran me through
scenarios in the weeks before I came and for telling me I knew what to do
and had the knowledge within me. I think of you while I am working and it
carries me through. I am beginning to see how much ability I have rather
than to focus on my weaknesses.
More on the food and shopping later. Love to all Lynn
and I am in meditation mode recovering. I know most of you love ER
stories so I will start there.
A 7 year old boy came in yesterday for a follow up visit. We have
diagnosed him with mycoplsma pneumonia and ereythema multifore (EM). This
child has a total body rash (EM) for the past four days and has been
itching like mad. His body is swollen and he is very uncomfortable. An
American pediatrician happened to be visiting the hospital so we got her
to consult with us. While she was talking away the little boy was going
crazy with itching, writhing all over the bed, rubbing his legs together
and crying.
When I witnessed this little boy suffering it came to me that sure I can
adjust his prednisone to help him in the long run but that moment was when
he needed to be healed. In the midst of all the people and commotion I
closed my eyes and put my hands on his legs and began silently repeating
the rescue/emergency prayer that I have learned. I prayed for the healing
power of God/Love to come through my hands and help this child to relax
and relieve his suffering. It took a few minutes but he started to let
go and eventually he was lying there calm under my hands. I didn’t tell
anyone what I was doing. I attached a picture of Irene the local
Guatemalan Doctor examining her patient in the same bed the little boy was
lying on.
Just about 5 o'clock a man came walking to the hospitalito who had been
hit by a Tuc Tuc. The Tuc Tuc is a little gas powered vehicle that is one
of the main modes transportation around here. It seems like there are
thousands of them and it like the autopia ride at disneyland. They are
red putt putts, racing around crazily and it seems like there are
thousands of them. The streets are narrow and I was advised to be careful
when walking because I might get killed by one, and I was also advised
while riding in them to be ready to jump out at all times because they are
reckless, driven by children and get in collisions all the time. It costs
$.60 to ride across town, almost no one has a car and its the way to go.
Initially this 60 year old man was complaining of pain in his right hand,
right cheek, left hip and lower abdomen. Pedestrian versus vehicle is a
red flag in ER talk even though the guy walked in on his own volition.
His abdominal pain was the fourth thing he listed and was most concerned
about his hand. My lovely Stanford med student Kirsten was kind of green
on the subject and focused on his hand. I taught her to be very
suspicious of anyone hit by a car and to go the whole nine yards with his
evaluation. After I examined him, sure he had some bruises but the only
thing that could kill him was this nagging abdominal pain. To make a long
story short with serial exams his pain went away at rest but remained with
palpation, then over the next hour his abdomen stared to distend. I
called Jerry in and he agreed the exam had changed. I almost called the
Doc on duty in my ER for a consult, but we decided to send him off to
Solola with the bomberos. We do not have a trauma surgeon at the
Hospitalito. Of course his family had to be called in to decide if they
would let him go. The bomberos arrived and were ready to go but the
family all had not gotten there so they keep waiting as his abdomen got
bigger and bigger and then it started hurting in the upper quadrants. I
finally told the nurse that I was freaking out that this is an emergency
and they guy has got to go! Eventually they let him get in the ambulance
and leave. We will call to find out what happened on Monday.
When I applied to work as a volunteer at the Hospitalito they had many
questions for me about my skills and comfort zone in practice. Since I am
a ER Physician Assistant and a midwife they wanted me and now I know why.
The ER and the Sala de Partos (delivery room) are connected and the person
on duty is responsible for both rooms at all times. They also asked me if
I was comfortable handling high risk births such as pre eclampsia and
pitocin inductions. I told them no, that my practice was to manage high
risk situations with a doctor present and that most of my experience is
with natural childbirth. Ok well that lasted one shift. Last night I had
a laboring woman come in with a blood pressure of 150/119. Panic time,
here we go again with pre eclampsia and risk of seizure. I called Jerry
the MD to come in and we gave her Mag Sulfate right off since we had a
seen a seizure a few days before and did not want to see that again in
this lifetime. We started a pitocin induction and then Jerry said OK she
is stable I am going home. I picked his brain to death on the whole
subject and let him go home. My goodness how soon I give up my scruples.
So I was up most of the night watching her like a hawk and increasing her
pitocin. I cannot believe I did it. The good news is that today around
noon she had her baby girl without a cesarean, or a seizure.
Thank you to all of my ER doctors for the years of training that have lead
up to this moment in time. Especially to Wanbli who ran me through
scenarios in the weeks before I came and for telling me I knew what to do
and had the knowledge within me. I think of you while I am working and it
carries me through. I am beginning to see how much ability I have rather
than to focus on my weaknesses.
More on the food and shopping later. Love to all Lynn