Day 3

Yesterday was Friday.  After morning lecture and post-take rounds, there were regular rounds.  Wards are broken up into male and female, and each ward is just a big open room with beds on each side of the room.  One side is called road (closest to the road) and the other river (closest to the river).  I was on river side, and the most exciting part of rounds was a physical exam finding I had never experienced.  While writing in the chart, Amir asked me to listen to a patient’s heart sounds as he wasn’t sure what he heard.  I put my stethoscope on her chest and I heard, “squeak squeak squeak”.  I kind of half smiled to Amir and then after enjoying the three different sounds kind of like bare feet walking in the sand, I told Amir it was a pericardial friction rub.  Cool!  That means there is something in the sack around the heart, and when the heart beats it rubs against that substance and makes a squeaking sound.  New physical exam findings make me feel a little weird, because I first get really excited about it and then sad because it generally means something bad for the patient to me to hear/see/feel something new.  This patient has HIV and lumps on her belly, for which a biopsy was concerning for lymphoma.  So it may be cancer cells causing that squeaking in her heart.

After rounds we had a quick lunch, and then I walked back up to the wards to do an optional make-shift chest X-ray talk with the medical students.  I got there right on time, and to my surprise the room was packed – despite everyone usually being late on “Uganda time”.  Fortunately I have saved some interesting chest X-rays throughout residency and put them in a PowerPoint file.  I had all the students gather round my laptop while I went through the methods of interpreting normal chest x-rays, then had them interpret abnormal ones for me.  They did so well!  AND no one fell asleep after an hour in a stuffy room!  That was probably the best compliment of all.

After that lecture it was time to head home with a giant box of files to pour over for my research project.  I have two projects going on currently, so let’s just call this project #1.  Last year when I was here, Amir and I co-wrote up this project with the help of my research mentor, Chris.  Here’s the basic premise: lots of people come to this hospital very sick with sepsis (infection).  The % of people who die within 30-days of their hospitalization for sepsis is about 60%, based off my research project #2.  There are very limited resources as you can imagine, and sometimes it’s hard to tell if you’ve treated someone well enough as you can’t necessarily re-check labs or even take vital signs very frequently.  So we have a hand-held machine that checks something called lactic acid.  This is made when your tissues don’t get enough blood flow/oxygen, which happens in sepsis.  We are trying to see if patients who decrease their lactic acid concentration in 6 hours go on to have lower mortality rates.  If so, the theory would be that once someone’s lactate decreases then you know it’s safe to send them from the emergency room (closer monitoring) to the regular ward (basically no monitoring).

Today I woke up, and after mopping up the flood in my apartment from last night’s rain, I started going through the 120 files of patients that have already been enrolled in the study.   At this point I am checking the already entered data for accuracy.  As I go through it’s almost like a book or movie, that I see how old the patient is, where they’re from, etc.  Then what their complaints are, what their vitals and labs are, and then I start to get nervous because as I flip the next page I find out whether they died or not.  The amount that die is shocking.  Just as I was starting to get a little depressed, Amir called me that there was a patient who was willing to be enrolled in our study at the hospital.  So I ran across the street and worked with Amir to enroll her and then ship her over to the emergency ward.  I’ll be back in 6 hours to see what that follow-up lactic acid is.  It’s kind of a neat process!

After that I decided to go for a little jog.  It was tough!  It’s really humid with the rainy season and there are a lot of hills around.  I’d also like to blame altitude but I’m not sure Mbarara is really much higher than C’ville.  After cooling off and showering I’m back to my files now, and then planning on making some swiss chard I bought from a guy named John on a motorcycle!!  Pretty excited about that.