Day 5

I just love our medical students here.  The attendings and residents on the team change frequently, but the medical students are always there and really the best form of continuity for their patients.  They’re expected to know the patient better than the resident does, and also to make sure the patient gets the treatments they need since there are so few nurses available.

This morning we were starting rounds, and Anthony, one of the third year students (here medical school is 5 years) grabbed me and said “Dr Kacie – I’m worried about this patient over in the corner – I think she needs fluids”.  The patient wasn’t even his patient, he was just observant enough to notice someone in distress who wasn’t being attended to.  So I went over with him somewhat hurriedly to evaluate her. Since she wasn’t his patient he didn’t know what her primary problem was, and we didn’t have a time to look through her chart.  She was huddled under blankets and looked very ill.  I checked her pulse rate: 126.  I grabbed a blood pressure cuff and as I tried to uncover her I put my hand down in something warm and goopy … a pile of fresh yellow sputum.  She had been coughing up phlegm into the scarf she was covering up with.  After starting some fluids on her we took a quick peek at the chart – sure enough – her sputum was positive for Tuberculosis.  Thankfully it can’t travel through the skin, but I sure did douse myself in some chlorhexidine I found in one of the lab sinks!

And remember that CXR lecture we gave yesterday?  Every time we would pass a bed today that had a chest film on it, the med students would pick it up, huddle together and try and interpret it using the steps I taught them.  They all did a great job!  It made me proud watching them learn!

On rounds the students get asked questions frequently to test their knowledge base.  The other day we had an elderly female patient who was admitted for confusion.  This is a very bread-and-butter type of admission for the US, and generally the first thing a medicine resident would consider would be a urinary tract infection.  Well, the medical students got asked what they thought might be causing confusion in this nice lady, and they spouted off all kinds of answers like: Syphilis!  Cryptococcal Meningitis!  Toxoplasmosis!  It was humorous hearing their differential diagnosis, but it turns out that common things in America can also be common in Africa, and the lady just had a UTI.

And last but not least, and not related to medical students, it rained today!  Like Forrest Gump rain.  We woke up to the wonderful sound, and it really cooled things off quite nicely.  Unfortunately in the hospital the rain was coming down so hard the power went out – which again isn’t necessarily a strange thing – so we did rounds in the dark!  Gotta love it!