Day 5

Today a picture of Geronimo (the son of the daughter (MaryBetty) of the woman I am staying with (Betty))

I was going to write about breasts today, but then something new came up so maybe I will go on my breast rant tomorrow…
Today, I saw my first febrile seizure, not my first patient diagnosed with a febrile seizure, but my first patient still seizing from his fever. It is interesting to me that I haven’t ever seen this, only the post ictal state and maybe is a statement to how slow we move in medicine in the United States. Here, the mother jumps in the car, drives to the ED and walks right in, no triage, no hoops, just right in. The doctors start treating and send the mom out to register and pay, this hospital doesn’t necessarily take insurance, but it is adjusted to make things really affordable for patients…for example, I had a child get a full blood work up with stool and urine labs and it cost her a total of $3. Anyway, the doctor gave the child diazepam (the South American version anyway) and then put the febrile child right in the sink to cool him down. Once fully bathed, due to concern for meningitis, the doctor told the parents he was going to do a lumbar puncture and just did it. No waiting around for the parents to decide if they were going to give consent and the LP was done quickly – FYI, they don’t use stylets at all in the LP needles. Now, for me, I like the fact that we give EMLA and lidocaine to decrease pain to the child, but on the other hand this is very time effective medicine.
It is amazing to me how much this hospital can do with so little. I am constantly surprised by the smallest things that I never noticed were a luxury…for example the tiny individually packaged alcohol pads that we use constantly – here they have a bowl of cotton balls, sitting in alcohol…just as effective and a heck of a lot cheaper. Plus less trash.
Another thing, now that I understand that the internos are actually in their last year of medical school, they totally kick our medical students butts. They essentially are residents right now because the residents are still on strike and they are doing so much. They do a lot without a doctor present and just know what to do. I think part of it is a product of our medical system limiting what a medical student can do…seriously people, would it really hurt the system to let medical student notes count in the chart for something as long as they are co-signed by a doctor. I am getting more and more of the opinion that the insurance companies in the US run too much of our medicine and maybe it is time that we take some of our medicine back from the insurance companies.
On another hand, sometimes the fact that someone is always watching out for us to mess up so they can jump in helps improve patient care…I can see Andy in this place going crazy due to the lack of safety…but then again, in a hospital like this, I don’t know how some things could run any other way.
If nothing else, I will definitely come out of this month with a good knowledge of just how much we take for granted in the US.
Plus, I chatted the whole with home with my taxi driver and understand the whole conversation and he only had to repeat himself a couple times (mostly because I couldn’t hear him, not because I didn’t understand)!
More Spanish classes tonight and in less than 3 weeks Mike will be here!