Walking with the Washburns

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!