Heather Armstrong, Dooce, 07-07-06
"Tomorrow is the most important thing in life. Comes into us at midnight very clean. It's perfect when it arrives and it puts itself in our hands. It hopes we've learned something from yesterday."
John WayneUS movie actor & director (1907 - 1979)
I love that title picture by Dr.Massaud. It is going to stay up for a few days.
Today I continued to see progress. It is progress that is small and subtle, but added together through time will equal big changes. Forinstance, the inpatient ward did not smell as bad as it normally does, doctors were doing wound care with gloves on, and nurses were changing bed sheets.
I visted with the Physical Therapist for a while today. I wanted to let him know that I considered him one of the most important people in the hospital. Most of the inpatients are Orthopedic patients that are recovering from amputated limbs and serious fractures. I told him that it is essential that he gets out of his 1st floor office and work with the inpatients upstairs. Despite having brand new equipment, such as treadmills and stationary bikes, he still insited that he needed new equipment. He pointed to his old cervical and lumbar traction devices. They look like mideval torture devices. I told him that this equipment is not important for the work that he needs to be doing. I informed him that in the states all a Physical Therapist that works in a hospital needs is a belt around their waist. I told him that the most important thing he should be doing is getting the patients up and moving. Here is the cervical traction machine.
Seeing pictures from the last VCR trip to the K.O.O. inspired me to try and get some artificial limbs for some of our patients with amputations. It turns out that we already have a contract in place with the K.O.O. and we were just not taking advantage of it. I would like to see at least one patients get a new prostetic device before the end of my deployment. I have arranged to have one of the patients seen this weekend. Ultimately, I would like to establish a regular scheduled visit to the K.O.O., like a shuttle service that runs there every 2 weeks. I will keep you posted.
I had a long debate/discussion with the ER doctor. He was giving an IV to a lady that was 12 weeks pregnant (by the way, just getting him to use an OB wheel to determine how far along she was was a challange in itself). He said that she came in with a note from an outside doctor that said she had abdominal pain which was the result of having kidney stones. I asked him if he did a urine test to check for a urinary tract infection. He answered, "No," because she was already diagnosed and that the doctor just ordered for her to get IV fluids. I tried to get across the concept of covering one's diarer. There are no malpractice attorneys in Kabul so doctors are not exactely concerned about getting sued. I tried to teach him that you should never trust what someone tells you. To always have a jaundiced eye to what others are telling you. Always verify for yourself just to be sure. I finally was able to convince him to get a urine study. The patient ended up not having a urinary tract infection but the ER doctor did say, "She has an abnormal lab! She had a hemoglobin of 8." Normal is >12. I said, "Good job. What did you do with her?" He replied, "I sent her to OB." That was not exactly the answer I was looking for.
We then had a 5 minute debate about how best to improve her anemia. He wanted to give her iron dextran which comes as a shot that you give in the arm. Aside from being very painful, it could also be very dangerous for the mom and the baby because you can potentially get a very serious reaction from it.
While I was in the ER I saw that they had 2 of the eye charts that I brought in the other day hanging on the wall. I asked the assistant if he knew how far away a patient had to stand to do a proper visual acuity check. He incorrectly answered 30 feet. I asked him how he planned to measure out the distance and he said that since he owns an apple orchard he is very good at judging distance. The distance will be the same distance between 2 apple trees. We both laughed. So I guess a patient should have 2 apple tree by 2 apple tree length vision. Works for me.
Thanks for reading.