An Interesting Sunday Call
So a couple of Sunday’s ago, I (John) had a fairly eventful
day on call. I saw 6 patients throughout the day/evening/morning and here are
their stories – the most interesting one is the last:
Patient #1: She was riding in the back of a dump truck, like
many people here do including us at times, and across the top in the middle is
a large log that had been tied on in order to keep your balance or tie a tarp
onto. Many people were holding onto this log and when it suddenly broke, coming
down and hitting her forcefully on the head. She said that after about 20
minutes of being unconscious, she woke up and after five hours of continued
headache came to our hospital for evaluation. Thankfully, our CT scanner just
arrived and has been operational for about 2 weeks. After a negative CT scan of
her head with no signs of bleeding, I sent her home with meds for her headache.
Patient #2: He was an 8 year-old who came in with his
parents with pain in his arm. He apparently fell with his hand behind his back.
An x-ray showed that he had fractured both his ulna and radius and would likely
need surgery to have it repaired. We don’t have an orthopedic surgeon, so he
was referred onto Abancay after a splint was placed. My primary concern was
that the story didn’t seem consistent with the fracture. I’m not an expert of
fractures, but I didn’t ask the father anymore in hope that in Abancay they
will find out the whole truth about how the fracture really happened (a beating?).
Any thoughts based on this x-ray and the story of falling with his hand behind
his back?
Patient #3: A 28 year-old woman who came in with 3 days of
cough and pain in her lungs. The chest x-ray showed a pneumonia. She followed up
in 3 days and was greatly improved with antibiotics!
On the x-ray you can see a faint line in the patient's right lung between the middle and lower lobes.
Patient #4: A ~75 year-old woman came with history of liver
masses from a recent ultrasound in Cusco as well as labs and ascitic fluid
being taken out of her abdomen and sent for analysis. When she arrived, her
oxygen saturation was 75% (normal is 90% or higher). She was very dehydrated
and looked terrible. I admitted her and in the morning ordered an ultrasound
and labs. They showed that she had an 8-cm mass in her pancreas, cirrhosis of
the liver and was in the beginnings of renal failure. Her chest x-ray showed
what looked to be possible metastasis in her lungs. I talked with the family
and told them of the poor prognosis and said that the only place to treat her
cancer would be in Lima. I recommended that due to the severity of her disease
and the extremely poor prognosis that she not get chemotherapy, radiation or
surgery that would severely decrease her quality of life. Instead I recommended
that she go home with pain medications. I then prayed with them that the Lord
would be with her in these final days and that He would give her peace in Him.
After a couple of days she was sent home feeling better, but also knowing that
these would be her last days on earth.
On the x-ray there are some questionable nodule behind the heart concerning for metastases.
Patient #5: This was a 50 year old woman who came with three
days of pain her belly. An ultrasound showed that she had an infected
gallbladder and she was admitted with antibiotics and will have surgery to take
out her gallbladder.
Patient #6: This is likely the most interesting case of the
day. He was an ~80 year-old man who lives high in the Andes mountains with his
wife. Over the last 3-4 months he’s had more and more troubles with swallowing
and eventually it got so bad that he could hardly get anything down for the
last 3 weeks. His daughter came to visit him and his wife 3 weeks ago (with her
1 year-old son) and realized how sick he was and immediately took him to the
health post in Cusco. They checked a couple of labs and gave him some medicine
for pain and sent him home. He wasn’t improving so she took him back and they
checked his urine and gave him some medicine for a urinary tract infection (UTI)
and sent him home. He still wasn’t better and so upon the recommendation of a
friend, brought him to see me at Diospi Suyana. Looking at him, he looked like
one of those people you see in Africa that is starving to death or dying from
AIDS. Just looking at him, I knew it was more than a UTI. His mouth was so dry
that there was some dried mucous attaching his tongue and palate that he
couldn’t remove because it had dried that way. He also had spots of blood under
his mucosa throughout his mouth and throat. I gave him some fluids and unlocked
the lab and ran a lab test finding that his platelets were only 29,000 (Normal
150,000-450,000). He also had signs of infection. I admitted him and did some
tests in the morning finding that his kidneys were quite stressed from the
dehydration and that his lungs looked terrible! See the picture below. The
following day, Dr. Klaus John did an endoscopy and found that he had thrush
from his mouth to the bottom of his esophagus and found tuberculosis in
aspirates of his gastric fluid like we expected based on the x-ray. Even after
just one day of fluids, he already looked SO much better and he and his family
were extremely thankful for the treatment that he’d received. After a few days
of care by Dr. Martina John (She saw all of my patients for a few days while I was
stuck in bed sick) he was sent to the local health post now with a diagnosis of
tuberculosis which they typically treat very well. We pray that he will not
only find physically healing through this process, but also spiritual healing
as well!
Thanks for your continued prayer for our family as well as
all of the people that we are coming into contact with! God is working in their
hearts and lives and every day we have more and more people coming saying that
they know that they will get healing here because this is where God is working! We know that we may not be able to find physically healing for everyone that comes, but we do know that God is offering spiritual healing to everyone of them through Jesus Christ if they are willing to accept it. This is the most important healing that anyone can receive!
