First Do No Harm

"Smoking is one of the leading causes of statistics."
-Fletcher Knebel

"Quitting smoking is easy, I've done it thousands of times."
-Mark TwainUS humorist, novelist, short story author, & wit (1835 - 1910)

The story behind how I got the pictures for the slide show is kind of funny. A father of a deployed service member found my site and then he emailed his son who is also at Camp Eggers to tell him about it. It turns out that I was the driver of a car that the son was ridding in when we went on one of the VCR trips. He sent me an email and asked me to teach him all about milblogging. I was more then happy to show him the ropes. I will post a link to his blog when he gets it up and running. He was kind enough to let me have some of his pictures. I still do not know how they live in those tents with this weather.

We had a very productive day at the clinic. I attended their Morning Report. They basically went over how many patients were seen overnight. I let them know that in the future it would be a good idea to go into more details about some of the cases or to discuss different medical topics. It can get very interesting when you have a number of doctors in a room all discussing a patient's case. The real purpose of a Morning Report is not just to discuss who was seen, it also should be an oppertunity to learn new information. I think that it would be neat if I taught the ER doc how to do a case presentation using Power Point. If we have an interesting patient tomorrow then I will see if we can work on it together.

Change tends to happen very slowly in the hospital and it is not because of lack of motivation. Obstacles get placed in people's way which tend to slow down progress. It is especially difficult when you are female. You are sort of the low person on the totem pole. I have been trying to get the OB department to fix up their room in order to get it ready for their 2 deliveries that should happen this week. They have not been able to make any progress because they have not been allowed to access the necessary supplies. I had to do a little convincing to get the head nurse to release some of his supplies. The OB department now looks pretty good. They now have 2 delivery beds, 2 hospital beds, and 2 bassinets with clean sheets and blankets and all of the supplies to support a normal delivery. We still do not have all of the fancy monitors and baby warmers but they will come with time.

I visited the inpatient ward and it was obvious that someone had been smoking. I knew which patient it was so I approached him to give him a hard time. It was a patient that is paralyzed from the waist down. He adamantly denied that he had been smoking. I picked up a pack of cigarettes that was on his bedside table and I asked him what they were doing there. Little did I know he actually was holding a lit cigarette under his blanket. What can you do?

I had a long discussion with the surgeon regarding a patient that I was concerned about. The patient should really have been in an ICU. He had been transferred from a U.S. facility after having had multiple gunshot wounds to his abdomen. A large portion of his bowl had been resected and he had drains coming from his 2 ureters, bladder and he also had a colostomy bag. The father was providing all of his nursing care. The patient was having uncontrollable nausea and vomiting. The patient and the father were both crying when I was talking to the surgeon about his case. One of the tubes that drained the left ureter had fallen out. The surgeon grabbed the catheter with his bare hands, grabbing hold of the tip, explaining to me what he thought was wrong.

We went down to X-ray where he showed me a film that showed how the catheter used to be in its proper position within the ureter. He asked me if he should reinsert it. It is somewhat of a complicated question because in the states we would have labs, ultrasounds, and specialists to help you make tough decisions. The surgeon may end up making things worse attempting to perform a procedure that he is not familiar with and which he probably does not have supplies for. I told him if he knew how to do it and had all of the supplies then he should probably do it. I also told him that he should use his best judgement and do what is best for the patient and not just act because I am raising the issue. I also tried to give some suggestions on fluids and nutrition. I will be sure to check on him tomorrow.

Thanks for reading.