October 11, 2012

• Night Call

     It has been a long time since I have had a lot of night call.  Since 2007, I have been blessed with physician assistants (you know who you are!) who have taken most of the night calls.  So now, in Africa, I find that I am on 24 hour call all the time.  The other night, I was awakened by Tening, the nurse from here, whose wife is about to deliver.  Since her last child was born in the field, I thought that he wanted me for that.  But it turned out that the local shopkeeper, Botch, who had been recovering from malaria, thought he was dying.  So I trudged out in the middle of the night, with the African sky looming bright with stars and constellations, in the moonless night.  I didn’t have time to enjoy them, as I was wondering what sort of emergency that he was having.  When I got there, Botch was lying down and restless, moaning with left sided back and abdominal pain.  He was acting like someone with a kidney stone back in the states, so I got him to get me a urine, and trudged further in the dark down to the clinic.  But there was not a bit of blood in the urine sample, which makes a kidney stone a bit less likely.  But it still seemed like a kidney stone to me, so I trudged back to my house where I knew there were just a couple of Vicodin that would be good for this pain.  Then I trudged (hey, there is a lot of trudging, but that is what I call it when it is very dark and you are feeling the path with your feet) back to my house and got him 3 of them.  I told him to take 1 now, and 1 every 3 hours through the rest of the night.  Then back to bed, as the moon was just rising in the east.  Beautiful, but it took some time to get back to sleep. 

       The next day, after clinic, I went by his house to check on him, and asked how the pain was doing.  The answer was “i kaba” to my relief, which means it quit.  And he seemed to be very much alive, thank the Lord.  So I don’t know if my diagnosis was correct or not, but as long as he was better, that was the most important.  A couple of days later, Botch stopped by the house, and we were just chatting or “jumbai” as they call it.  After a while, he mentioned casually that “the medicine you gave me, it is very good” and that he would like to have some on hand in the future.  I explained that it was something that I had to save for emergency situations, like the middle of the night when someone is dying….perhaps. So I avoided my first long term patient on hydrocodone in Africa…

      Last night, earlier this time, I was called to the house of one of the church members to check a lady who had fallen off a bike.  When I got there, she had superficial facial wounds, and a bunged up knee, but she didn’t seem to be very responsive.  She didn’t speak Kiriol, but she wasn’t responding with any words at all.  Then I got a bit more history that she was driving very wobbly, not very fast when she fell.  There is no CT scanner in Guinea Bissau, so there is no way to check that, plus no way to get her to the hospital anyway.  So I checked her blood pressure, and found it to be 210/124..dangerously high, and a sign to me that perhaps she had a stroke first and then fell off the bicycle.  In America, the treatment would be a CT scan of the head, and if no bleeding, then give aspirin.  I decided with that kind of blood pressure, a bleed was just as likely as anything, so we treated her blood pressure and decided against aspirin.  I was not really hopeful for the patient, but in checking on her today, it seems she is marginally better.  I think she did have a stroke, but at least she is able to swallow okay…..

      There have been other calls in the middle of the night, but I think those were the only true emergencies so far…

  And now for “when the doctor is the patient” section.

      Today, I fried fish, which is abundant here, and very delicious.  And so as I was eating, I swallowed a bone, which lodged in my throat.  Oh, great, I thought, I am going to die of a perforated esophagus here in Africa due to swallowing a fish bone.  (I once had a patient who nearly died from such a scenario, you know.)   Your mind can work overtime when you are far from significant medical help.. So I ate bread, as I was taught.  No luck, still there.  I ate more fish..no luck.  I ate more food today than normal.  Still no luck.  But I am happy to report, sometime this evening, I suddenly realized the fish bone had gone on down to where it should be…and I shouldn’t get a perforated esophagus.  So thanks to the Lord for his preservation..you don’t know how often that happens…

  When the morning falls on the farthest hill

  I will sing his name, I will praise Him still

  When dark trials come and my heart is filled

  With the weight of doubt, I will praise Him still.

  For the Lord our God, He is strong to save

  From the arms of death, from the deepest cave,

  And He gave us life in His perfect will

  And by his good grace, I will praise Him still.

  Fernando Ortega.

     

  • 4:10 pm
  • 2 Comments