WARNING: THIS AND THE REST OF MY ENTRIES MIGHT NOT BE FOR THE FAINT OF STOMACH.
I was in the medical unit today, which is mostly long-temrm or paliative care for peple with HIV. I say mostly, and for the duration of this trip I think you should assume that patients have HIV less I say otherwise, it's so common in the hostpial. Endera was working wtih me, through somewhat reluctatnly. She had been working on this unit the day before, and had lost several patients during the day. We started the day just looking over the unit. There were only two nurses for the unit, which consisted of two rooms: one for women and one for men. The staff don't wear TB masks, though we do, which is a bone of contention between us (but I'm not going without it, even thorugh the windows are open). The rooms each ahve ten beds in them, and the men's side was full though the women had only three patianets. Of those three, only one was fully conscious. In the men's side, the look of the patient's was striking. At least five of the patient's were nothing but skin and bones (from AIDS related wasting or chexia), one was unconsious, one was both, and the man in the far corner was...well, he looked from a distance like he was completetly grey colored. When we got over to him, we saw that what we had thorugh was skin coloring was coming from the fact that every surface on his body was peeling. His entire body was sloughing off, and it was on the bed sheets and floor around him. One patient was delious to the point of having halluincations of pills that he mimed putting in a drawer, and thinking he was in a hotel and wanted to leave.
We started with one of the unconsious women, a patient that Endera had taken care of the day befoere. She had had a stroke while they were with her. Her pupils were unresponcive, and her NG tube was draining "coffee grounds" which indicates taht she had a bleed in ther GI tract, and Dr. Schivone was worried that her stroke was really a bleed into her brain. We talked to the DR about it and they also seemed slightly concerned. They said that they wanted to talk to the family to get a more complete history, and the nurse on the ward stated that "there is no family". The dr moved on after ordering an x-ray, and we were going to move on two when a man and a woman walked onto the unit. "Are you relatives of this woman?" Dr. schivone asked. Turns out it was her sister and brother, and they said that she had come to the hostpial several times for severe headaches. She'd been taking lots of pain medicine, and I wondered outloud if it might be an asprin type substance that she was taking. Dr. schivone as very proud that I had asked, but we didn't fine out (though we had the South African name of the drug, so we can look it up).
As Endera worked with this patient, Dr. Schivone and I moved to the other unconscious patient, who was having some drool issues. As I cleaned her up, DR. Schvone (hereby known as Deb, it's too hard to type her whole name), told me about her case (HepB, fluid in her abdomen, she'd be unconscious all day the day before). She ahd me paplate her abdomen to find her liver, but as I did so the woman's arms started mvoing down to protect her belly. Dr. schivone tried to keep them out of the way, but she got more and more agetated and finally openned her eyes. W tried to reassure her (and I stopped poking her) but it was actually kind of a good thing since she hadn't been awake for a while and now was speaking, even if we didn't understand her.
As we were telling the nurse about that patient, the nurse mentioned that she had found a pressure ulcer on the men's side, and asked if we would like to dress it. We were really excited, since this was a chance to do a proceedure that we'd be prepared for for a while, and headed over. The patient, David, had some paralysis and wasn't able ot help us move himself much (his ulcer was on the left side) when we got ready to move him, we saw that the sheets were soiled. Deb ran to get more, and endera and I talked to him a bit. We asked his name, his age, and I checked that he had uninated (and it wasn't drainage or stoll as well). He said yes, and that he was sorry. WE both told him not to be osrry, he was in hostpial, and I guess he was getting to like us because he started saying "it hurts" and showed us a penile ucler that looked painful. Just as Enera and I were showing that we had no idea what to do with that, Deb came and we told her about it. We cleaned him up, and rolled him over to the ulcer (it was stage three, and the skin was sheering off arund it where hte nurses would pull the sheet to mve him). WE told David that we would be back, moved him off that side, and took our info to the nurse. The nurse (a guy we didn't like very much) said that David never says when he needs his sheets changed, he just sits there without complaining. I wondered how ambarassed he must be that he needs that kind of help. They didn't know about the penile sore (he'd never shared it with them). I felt like, even in a short time, we'd made a different with this one patietn. Endera put a dressing on it, and he seemed more comfortable while we were there.
The last patient that I really took care of was the man with no skin. WE went over to check on him and found him shaking like a leaf, enough so his whole bedframe was moving. I got a termometer (glass) and put it under his arm, while the nurse covered him in blankets. His temp was 38.4 C, which is high, and we went to the nurse to get him a a\tylanol. As DR. shivone wehn to get it, I talked with him a little. I can't imagine how scary that must be, even DR. Shcivone ddn't know for sure what was going on. His chart stated that he had come in for an URI, and absolutly no mention was made in the nursing notes to the fact that all of his skin was falling off. It was abserd, the fact that this huge thing was happening to him and as far as the chart was concerned he was "bathed and comfortable". Finally, we got him some drugs, and he stopped shaking, but two hours later his temperature was still 38.8. We were leaving at that point, so I just reported off to the nurse. This was during visiting hours, so a woman was sitting with him. Several of the pts had felame visiters, and I looked at these womn and wondred if they were sisters, girlfriends, or wifes, and if when they looked at these men they saw where they wouldbe in some small amount of time.
My last adventure invovled taking a patient downt o x-ray. Th trip itself wasn't that exicing, except being able to talk ato the male nurse, and Benny (a priest in traiing who ehlps out in the wards) who are nice guys, and the x-ray tech, who was "so impressed' that i'd been able to say "hello" Zulu, but the patient when we moved him was nothing but skin and bone. It was so strange, like moving a man made of paper mache. I was afriad that his bones would come through his skin every time I touched him.
At the end of this long day, I had spent half of it "holding up the walls" as magie would ahve aid and the other half changing beds and doing other little things. I felt a little like I had been too hestitant, again, to interact with the patients, but Deb cought me on the way out and said that I ad done and good job and jumped right in. It was a great feeling to hear her say that, and made me excited to go back next week.
TOmorrow: SAFARI!
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