Some thoughts

I got to the wards this morning early since I was on the admitting team and discovered a new patient, a 17 year old boy with a very puffy face. Turns out he was transferred from another hospital after being treated for several weeks for "generalized body swelling" and then suddenly lost consciousness yesterday and was sent to our hospital. He clearly had nephrotic syndrome from the look of him, plus he had a potassium of 7.1, sodium of 116, and creatinine of 12. He urgently needed dialysis. Remember that photo I posted yesterday of the consult form with the varying degrees of urgency -- very urgent being "within 1 week." Well that appears to sometimes be true, but luckily for this fellow our registrar was on top of it and did all she could to arrange for dialysis by this afternoon. Cross my fingers he gets it. There are many roadblocks, the first being that the hospital does not have catheters, instead the relatives have to go to town to buy them and bring them back so that he can get the dialysis. My registrar said she had a similar case in the past except that the boy came in on a Sunday and since the shops in town were closed, he could't get a catheter and he passed. Wow.

Also, as I mentioned before we see a lot of interesting diagnostic cases, many of which we can't work up fully like in the states. For example, I think one of my patients now has a protein-losing enteropathy but the stool test that we would do at home they can't do here, not to mention all the specific tests to figure out which type. In fact, they can't even do PFTs. Which makes me wonder how many patients they call COPD who in fact have something completely different, but because they have a smoking history are labeled COPD. This means they may be treated incorrectly, but it also means that we may have little idea what the actual diseases that are common here are. We say that things like inflammatory bowel disease, Whipple disease, alpha anti-trypsin deficiency, for example, are more common in northern Europeans (and in developed countries), however, how much of this is just because these are the people (and the places) that we are more likely and able to look for these diseases in. If we looked here I bet we would find much more than we think!

Today was the first day I encountered a consultant (aka attending) on our team (they usually come twice a week but for some reason mine didn't come last week). He was pretty great!