Sunday, May 30, 2010
Saturday, May 15, 2010
Thoughts to share
This past month has been filled with some significant "firsts" for me and I wanted to share them with you, as these experiences have impacted me quite a bit, not only on a personal level but also on a professional level.
* My first house call - I made my first house call to check up on a newborn with jaundice. Over here, newborns and moms remain at home for the first 30 days. For the newborn, their first visit to the doctor may not be until the first set of immunizations are given, which would be at a few months of age. In fact, there is not much emphasis on routine well-child checks over here, so a child is usually seen only when he/she is sick or in need of immunizations. Because of this, all of our residents have very little experience with caring for a newborn, the newborn exam, and common newborn findings/concerns. Moms must also remain at home for the first 30 days. Family members often come to visit and help out during that time. Some traditions I've been told that moms must follow during this time - eating only certain foods, not bathing, and staying in bed. But back to my patient - she did indeed have jaundice and ended up being hospitalized, treated with phototherapy and antibiotics, and had a full recovery. Both baby and mom are doing well now. I really enjoyed making these housecalls because 1) I love caring for newborns, and 2) I got to see my patient and her family in their home setting. It was nice to meet all members of the family, and observe them in their home and their interactions with one another. My patient is blessed with a wonderful family who already love and care for her immensely!
* My first patient death - I returned from Yushu to find out that my patient whom I had been following for the past 4 months at a local orphanage had passed away. Before I left for Yushu, there was active discussion between me and the orphanage about getting a blood transfusion for my patient because she was severely anemic. While a blood transfusion may sound like a simple process, it can be quite complicated for an orphan. Many factors have to be considered - transportation, timing, availability of caretakers, cost, etc. While these factors were being considered, my patient passed away. I'm not sure what the exact cause of death was (no autopsy was done), but it sounds like she was bleeding at the time of her death, and most likely died from that. This loss has been extremely hard for me. As a resident, I cared for patients who died despite all that we did for them. And that's the difference - we did all that we could for them and we used all our resources available. One thing that I have noticed here, and have attempted to understand, is that there are resources available to help our patients but they are often not utilized. Why? I don't know. I have some ideas but, ultimately, it comes down to the fact that I just don't fully understand this new culture I'm in. I keep asking myself, "Did I do all that I could for this patient? Could I have done more as a consultant beside making the same recommendations time after time? Would a blood transfusion have made a difference? Could we have prevented her death??" Losing a patient is difficult. Losing a patient because resources were not used is not only difficult, but also frustrating...and makes closure so much harder. It's times like these that I remember I do also believe in a God who is good. Though I may not understand why things happen, He can be trusted in all things and He is greater than anything I am able or unable to do.
* My first hospital encounter - One of my patients was admitted to the hospital this past week for hyponatremia (extremely low sodium levels in the body) and seizure. We think the hyponatremia most likely caused the seizing. She was seen at one of the best hospitals in this city and, as her PCP, I got to see a little of how hospitals work over here. Here are some of my observations:
Patients pay for everything up front - medications, IV supplies, IV solutions, labwork, imaging studies, etc. The doctor will write an order for labs or medications, and it is up to the patient to get this done. If it is labwork, the patient must track down a nurse to draw the blood, then take the blood over to the laboratory, and pay for the test to be done. If it is medications, the patient takes the prescription to the pharmacy and purchases the necessary medication. If the medications needs to be given through an IV, the patient must find a nurse to place an IV (or go to the IV station) and have the medicine hooked up for them. If patients are admitted, they must stand in line to get a room, and once assigned, must pay up front for the first night. If they are unable to pay, they lose the room and cannot be admitted. My patient was admitted to a regular floor and the cost is about 20Y/night. An ICU admission costs about 1000-2000Y/night and the cost includes around the clock nursing care as well as any labs/tests or medications needed during that time. For this particular hospital, the ER cannot do a lumbar puncture (spinal tap) or intubate if the patient stops breathing. These procedures can only be done in the ICU. Treating with IV management is extremely popular over here (in fact, there are many businesses that specialize in making and selling IV chairs), and this hospital was no exception. Each time my patient lost her IV, which was quite often, we had to take her to the IV station to get a new one placed. The nurses were too busy to come and place an IV at bedside, so we had to go to the station. And the station, of course, was packed with families everywhere getting IVs for their children, without any order or visible lines. Throughout the hospital, you would see families carrying sticks (no fancy IV poles here!) with an IV bag at one end connected to their child - they all looked like they were going fishing. Interesting, huh?
And on the lighter side...
* My first bike - and hopefully, only bike! There is a pretty high rate of bike theft over here. I was told to buy an old, used bike to avoid it getting stolen. But I think that's how the seller got the bike in the first place... Oh, and my bike helmet cost more than my bike. Go figure. Picture to come soon!
* My first house call - I made my first house call to check up on a newborn with jaundice. Over here, newborns and moms remain at home for the first 30 days. For the newborn, their first visit to the doctor may not be until the first set of immunizations are given, which would be at a few months of age. In fact, there is not much emphasis on routine well-child checks over here, so a child is usually seen only when he/she is sick or in need of immunizations. Because of this, all of our residents have very little experience with caring for a newborn, the newborn exam, and common newborn findings/concerns. Moms must also remain at home for the first 30 days. Family members often come to visit and help out during that time. Some traditions I've been told that moms must follow during this time - eating only certain foods, not bathing, and staying in bed. But back to my patient - she did indeed have jaundice and ended up being hospitalized, treated with phototherapy and antibiotics, and had a full recovery. Both baby and mom are doing well now. I really enjoyed making these housecalls because 1) I love caring for newborns, and 2) I got to see my patient and her family in their home setting. It was nice to meet all members of the family, and observe them in their home and their interactions with one another. My patient is blessed with a wonderful family who already love and care for her immensely!
* My first patient death - I returned from Yushu to find out that my patient whom I had been following for the past 4 months at a local orphanage had passed away. Before I left for Yushu, there was active discussion between me and the orphanage about getting a blood transfusion for my patient because she was severely anemic. While a blood transfusion may sound like a simple process, it can be quite complicated for an orphan. Many factors have to be considered - transportation, timing, availability of caretakers, cost, etc. While these factors were being considered, my patient passed away. I'm not sure what the exact cause of death was (no autopsy was done), but it sounds like she was bleeding at the time of her death, and most likely died from that. This loss has been extremely hard for me. As a resident, I cared for patients who died despite all that we did for them. And that's the difference - we did all that we could for them and we used all our resources available. One thing that I have noticed here, and have attempted to understand, is that there are resources available to help our patients but they are often not utilized. Why? I don't know. I have some ideas but, ultimately, it comes down to the fact that I just don't fully understand this new culture I'm in. I keep asking myself, "Did I do all that I could for this patient? Could I have done more as a consultant beside making the same recommendations time after time? Would a blood transfusion have made a difference? Could we have prevented her death??" Losing a patient is difficult. Losing a patient because resources were not used is not only difficult, but also frustrating...and makes closure so much harder. It's times like these that I remember I do also believe in a God who is good. Though I may not understand why things happen, He can be trusted in all things and He is greater than anything I am able or unable to do.
* My first hospital encounter - One of my patients was admitted to the hospital this past week for hyponatremia (extremely low sodium levels in the body) and seizure. We think the hyponatremia most likely caused the seizing. She was seen at one of the best hospitals in this city and, as her PCP, I got to see a little of how hospitals work over here. Here are some of my observations:
Patients pay for everything up front - medications, IV supplies, IV solutions, labwork, imaging studies, etc. The doctor will write an order for labs or medications, and it is up to the patient to get this done. If it is labwork, the patient must track down a nurse to draw the blood, then take the blood over to the laboratory, and pay for the test to be done. If it is medications, the patient takes the prescription to the pharmacy and purchases the necessary medication. If the medications needs to be given through an IV, the patient must find a nurse to place an IV (or go to the IV station) and have the medicine hooked up for them. If patients are admitted, they must stand in line to get a room, and once assigned, must pay up front for the first night. If they are unable to pay, they lose the room and cannot be admitted. My patient was admitted to a regular floor and the cost is about 20Y/night. An ICU admission costs about 1000-2000Y/night and the cost includes around the clock nursing care as well as any labs/tests or medications needed during that time. For this particular hospital, the ER cannot do a lumbar puncture (spinal tap) or intubate if the patient stops breathing. These procedures can only be done in the ICU. Treating with IV management is extremely popular over here (in fact, there are many businesses that specialize in making and selling IV chairs), and this hospital was no exception. Each time my patient lost her IV, which was quite often, we had to take her to the IV station to get a new one placed. The nurses were too busy to come and place an IV at bedside, so we had to go to the station. And the station, of course, was packed with families everywhere getting IVs for their children, without any order or visible lines. Throughout the hospital, you would see families carrying sticks (no fancy IV poles here!) with an IV bag at one end connected to their child - they all looked like they were going fishing. Interesting, huh?
And on the lighter side...
* My first bike - and hopefully, only bike! There is a pretty high rate of bike theft over here. I was told to buy an old, used bike to avoid it getting stolen. But I think that's how the seller got the bike in the first place... Oh, and my bike helmet cost more than my bike. Go figure. Picture to come soon!
Sunday, May 9, 2010
Around the neighborhood
Do you see the man sitting on top of the cargo? All you can see is his head. A pretty common sight over here.
Below are a few pictures of the marketplace in my neighborhood. It's a few blocks long and filled with stands selling fresh fruits and vegetables, fresh cuts of meat (chicken, beef, lamb, pork), grains, and all sorts of other tasty items.
My friend with her vegetable stand.
Meat stands like this one are scattered throughout the marketplace. You can buy the meat in one piece or ask them to cut, slice, or grind it for you. I think they will even trim the fat for you, if you ask.
Freshwater fish!
Shellfish of all kinds - mussels, clams, oysters, etc.
Playing cards in the marketplace.
Signs like these are posted along the street throughout the city, each with a different message, but all relating to traffic safety. I don't know if you can read this message, but it says, "Loving your wife, your children and your family, amounts to nothing if ignoring traffic laws and regulations."
Children playing a game in the courtyard below my apartment. I think it's a version of dodgeball with a much smaller ball.
Many of the ups and downs of childhood remain the same over here...such as losing your baby teeth!
The pineapple man in front of my apartment complex.
I'm not sure what the logic is behind this, but the city has been uprooting their trees, so you see empty pits like this lining the sidewalks of the city.
Dogs are pretty well taken care of here in the city.
Finally!
Spring is here! We're about a month late and the "April showers" are now May showers instead...but it doesn't matter because spring is finally here. It is so refreshing to the soul to see the trees blossoming and flowers starting to peek out from the ground. The city seems to be coming alive with this warmer and brighter weather - vendors fill the street selling food and household goods, parks are filled with families flying kites and having picnics, neighbors are sitting outside their homes and chatting, kids are running around and playing games throughout the neighborhoods, and there's the sound of music from birds chirping in the trees. Ok, so maybe not the last part.
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