A Long Day

Well, yesterday was a long one for everyone as we went into our rotations in the morning and then as two pairs we visited the ER and Labor and Delivery at night, so today is a special blog.

Pete-Yesterday in the NICU I walked in to find that instead of 3 patients there were now 6. I arrived and looked over a few of the charts so I would know what we was being discussed at rounds in the morning. It was unreal to read the charts as one child is suffering from Chagas' disease, which is a disease caused by a protozoan and effects the nervous system of the digestive system. Other new patients included a patient with brain trauma, a new baby with a hole in its heart, and a malnourished child. At the end of the day I was told I would be presenting the 4 month old Patricia who is malnourished and was recently admitted to NICU yesterday. She is a 2.7 kg little girl with thick black hair. It's hard to believe that I will be presenting at rounds on patient who weighs nearly 6 pounds. Hopefully, it goes well and my Spanish carries me through the questioning of Dr. Montoy.

Cory - Yesterday I met with Sumaya, a nurse from Australia, and we worked on going through a few years of charts from patients of the burn center. We organized them according to age in order to better allow us to analyze the information appropriately. There are records from a few years back numbering more than 300. The age disparity of those burned was astounding, with victims coming in from less than a month old to over 70 years old. Mostly, though, burns seem to strike children under 10 the absolute most. The burns come from numerous sources: hot water, hot soup, alcohol and gasoline explosions, etc.

Pete and Cory's Night - Last night Pete and I went to the emergency pediatrics unit overnight. When we walked through the front doors, we were greeted with the sounds of an unhappy baby or two. We introduced ourselves to a few of the interns. Soon after, Dr. Jose Antonio Areo came in, the father of one of the doctors who works in the burn clinic. A mother came in a little later with a young boy who had cerebral palsy. Dr. Areo had an x-ray taken and grilled us a bit on our anatomy. For the most part in the hospitals down here, the doctors do not employ radiologists to interpret their x-rays before they see them. They check the x-rays themselves and diagnose the patient. After we'd seen a few patients downstairs with Dr. Areo, he invited us to follow him on his rounds of the pediatrics departments at Hospital Viedma. Making our way upstairs, Dr. Areo showed us patients with an array of conditions. One 3-year old boy had a carcinoma in his lung taking up almost the entire right side of his thoracic cavity. Another child, 8 days shy of being 2 months old, was suffering from brain damage stemming from "Shaken Baby Syndrome". The poor baby's heart rate would shoot up to extremely high levels, drop down to low levels, and then repeat the cycle. Another little boy, complaining of pain in his abdomen, was suffering from Guillian Barret syndrome (a degenerative nerve disease). One last little patient was in the pediatric ICU battling dysentery. This is relatively rare in the US, but the doctor told us that it is much more common in Bolivia. Our experience was amazing.

Mark - Like Peter said earlier, yesterday was a pretty long one for all of us. I started the morning out in the pediatric emergency room. It was a pretty busy morning as we had many really sick kids come through. There were two babies with pneumonia as well as an epileptic child that ended up being admitted to the hospital. I got some hands on experience during the morning by helping with physical exams.

Craig - Yesterday morning I spent in the burn clinic. It was a great time, I helped wake up the kids and serve them breakfast, and also got to see little Bianca, the 2 year old I ran into in the pediatric emergency room last week when she arrived with burns on her chest and neck. She seems to be healing well and will not require skin grafts. I also played some board games with Jhoselin and Juan and I lost pretty badly. Its amazing how happy these little kids are, even with all the pain they are in constantly. Around 10 am I went back into the OR with Dr. Ramero. I observed the cleaning and debriding of a little girl with 15 day old burns, and also another little girl with bad burns on both hands from grabbing hold on an electric cable. The last case of the morning was an 18 year old girl with burns over the majority of her body and face from a house fire. She was back for a checkup of an infected skin graft site on her thigh. It appears that she will be able to have it re-sutured closed in the near future.

Mark and Craig's night - At 8pm, we headed back to the hospital for our night shift. We had the great opportunity to spend the night in the labor and delivery area. During the first four hours there were not any births and We spent our time learning to count contractions, and helping and observing the residents perform ultrasounds to hear the baby's heartbeat. All the Doctors and residents were very nice and took the time to talk with us and show us patients charts. We met a 5th year student named Wendy who taught us a lot of Spanish in return for brief english lessons. Around midnight, the activity started picking up and from 12-3am we saw 2 cesarean sections and 3 natural births. It was an amazing experience to see new lives enter the world and to observe the skill of all the staff who made it happen. At around 3 am we thanked Dr. Turica (the OB/GYN in charge) and headed home with an experience we won't forget.