Wednesday, January 21, 2009

Lessons Learned

Castom meresin (custom medicine) might cause outrageously precipitous labors, but it also causes shithouse APGARS and neonates who seize at 8hrs of life.

(Almost) No pap smears in a population with epidemic HPV infection pretty much equals outrageously high rates of cervical cancer. I've spent a couple of days observing scary, scary colposcopies which will have me getting my pap smears religiously for the rest of my life.

No fewer than 4 women aged under 40 lost their uteri in the last few DAYS here. Here's hoping that is all they lose. I'm officially on board with the Gardasil vaccine. I wish we could be giving girls HERE that vaccine.

I hazard to guess also that docs in the US very rarely see cases of metastatic gestational trophoblastic disease. She's 32 and a mother of 4. Aside from also losing her uterus, there is little else to treat the metastases in her lungs, liver and spleen (and they're just the ones we can see without a PET scanner). All of which could have been prevented with a little methotrexate back when her molar pregnancy began.

And finally, sometimes after a normal pregnancy and an uncomplicated birth, you end up with a cute as a button kid who struggles, who just looks off from the word go. I cared for him during his first two hours yesterday, and then this morning was shocked to find him gasping in an isolette on 10l of 02 in the head box, cyanosis like I've never seen, O2 Sats in the teens. The peds worked on him, finally got him satting in the 60's (high 90's on room air is the goal), and set about trying to figure out if he had a fistula, or a diaphagmatic hernia, or most ominously a massive congenital heart defect (ToF was debated at length). Portable X-ray came by twice to take films of his tiny retracting chest, and even to my completely untrained eye, the large whitish shadow on the left side of his chest looked too much like a heart that is just way too big. I ran the films up to the consultant surgeon who confirmed what we all feared. That heart completely fills his left chest. We have no way of finding out exactly what congenital defect we're looking at as we don't have any of the equipment to run any of the tests. All we know is that a kid can't live with a heart that big and there isn't a pediatric cardiologist in the country. He's blue now, and working so hard. Soon, probably tonight, maybe tomorrow, or even the next his huge heart will fail.

I went back, relayed the information quietly to the staff, washed my hands, and gave him a little love stroking his cheek and his tummy before again encouraging his mother and father, who've been standing next to that isolette all day, praying on and off to love on him with their hands as well. I hope like crazy that someone will see to it that he's in his mother's arms when he finally flies away.

They have a shrug here which I've not seen before. It's the shrug that goes with horrible realities like this one. It's a shrug that says "there's nothing we can do". I saw it when that tiny baby was left on the resucitaire to expire, and again today from the surgeon. I'd really like to not see it again this trip.


Unknown said...

I'm sorry to hear about your bad day. I wish I could make it better some way for the people of the Island.

Miss you lots and had a great time with you when I was there.

Unknown said...

I am sorry for what you're heart-learning.

I am very grateful for what we have here.

Katrina said...

I am loving reading your blog. It is just incredible to "see" how different other countries are.
Thanks for sharing,
I'll be thinking of you there!
Katrina :)