As I go into my last day at Princess Marina Hospital tomorrow, scenes of patients suffering left and right stick out in my mind. I don't think I've been around so much suffering in one place before. And I've already felt my reaction to it change in the eight days I've worked here. Rounding in the male and female medical ward, there are multiple delirious and cachectic patients, gripped by the throes of illness after presumably years of not taking care of themselves. Pessimism floats in the air - how can any of these folks be saved? For example one of my patients admitted today came in with a week of confusion, after having weight loss, cough and night sweats for weeks. He's in his mid-20s and HIV+ and his brother described how he became non-responsive in the last few days. His chest x-ray came back a few hours later, and both lung fields were marked with what looked like small millet seeds, a cardinal sign of miliary, or disseminated tuberculosis infection. I watched as he writhed in bed, both arms strapped down to keep him from pulling out the IV lines he needed for his medication, his eyes floating around the room to nothing in particular, groaning and speaking insensible words. THe mortality rate of his infection is extremely high. Unfortunately his sight is a typical one.
Yet another one of my patients today actually reminded me why it doesn't have to be about hopelessness in these situations. He is also in his mid-20s, newly diagnosed with HIV. When he arrived on the ward earlier this week, his oxygen saturation was very low and whenever he took off his mask which gave him supplemental oxygen, he began to hyperventilate. He looked incredibly scared, surrounded by a team of concerned doctors, laying next to beds of patients much older and much sicker than him. He likely had PCP (pneumocystis pneumonia), an opportunistic infection often seen with a low CD4 count in HIV. I was scared for him. We started treating him unsure about what course he would take. The ICU is very small and rejected him when we requested he be transferred. And in a chaotic place like PMH, the nursing care leaves much to be desired, so someone like him with a lot of needs really needed a good response to his meds in order to do well.
Each day this week, he would call me over as I passed his bed in the hall. We talked about his work as a waiter, how he missed school, how much he loved his family. He felt like a little brother. And I told him he'd be okay, even though ultimately I wasn't sure what would happen. Luckily today he flashed a smile when we got to him on rounds. His oxygen sat stabilized, and he had minimal shortness of breath. He looked more energetic, more hopeful. He was also excited to introduce me to his mother when she arrived at his bedside. His cell phone would always ring in the morning while I was drawing blood on him, and the name "Mom" would flash on the screen. He explained to her that I was the guy poking him with needles every day.
I was encouraged by the fact that even at Princess Marina, where there are so many patients and so many health professionals, and the medical teams are big and the patients are very sick, one can still make a human connection. One can still give a patient fearing for his or her life some companionship, some understanding. I'm humbled by the difference one can make here. Everyday at 1pm families flood the wards for visiting hours. Watching them pray to God for mercy, and watching some of them weep at the bedside, you remember that this isn't just another number, but a father or a mother, a brother or a sister, a lover or a friend.
Despite how much illness resides here, the generosity and spirit of the medical officers and interns make the hospital run. But I know just how much the forces are stacked against them. In my short span working at this hospital, I have seen and learned so much about how important it is to not give up on patients, and to humanize them despite the dire picture they present. This is an incredible challenge in a resource poor setting, where there's only so much one do, and only so many tests one can order. I applaud the folks in the trenches every day; it is a pleasure to work with them.
Wonderful!
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