Thursday

Today was a fairly slow day in the hospital, but I stayed busy. This morning as I was getting ready the nurse called because my patient with the burns wasn’t doing very well. He was spiking fevers all night, was tachycardic, and his blood pressure was 65/40! I’m wondering why they don’t call Dr. Gamero, since he’s the physician. Anyway, I was wondering what’s going on with him. He’s got to be septic, but his white count is normal and his urine is clean. I thought maybe I wasn’t giving him enough fluids, but I’ve been giving him a lot lately. Anyway, I did some labs, bolused him some more fluid, and increased his maintenance fluid. The labs were all normal except one. Only his protein was a bit low which is another reason his pressure could be low and him having swelling in his legs, but it wasn’t that low so I doubt it. I consulted with Dr. Manzanero, who is the internist who sees patients in the hospital when the doctors need him. He didn’t really change much except an antibiotic, and he’s getting a chest x-ray tomorrow. I hope we can get this figured out because I’m really worried about this kid.
I worked with Dr. Sierra, the pediatrician, all morning. The funny thing is he sees all ages of patients because the doctors here have to. He was pretty busy this morning so he just handed me a bunch of charts and I took Dr. Lazo’s office and saw them. He’s great because he gives me a lot of freedom. It got a little wild was when Dr. Sierra left. He was only working a half day this morning so he left at noon. Dr. Gamero had to leave yesterday, even though he was on call, and I covered the ER for him even though nobody really came in. He was supposed to return at noon, but never showed up. It’s kind of crazy that a doctor can just not show up who is supposed to see patients and be on call. He got held up for some reason. Well, I just started seeing all the afternoon patients out of necessity. They were all pretty simple cases. Things went well and I also had an ER patient that had smashed his hand and broke the end of his finger. Finally, Dr. Gamero shows up at 5:30 pm after all the work had been done. After I checked on the burn victim I decided to call it a day. Tomorrow I’m taking the day off and heading to the Caracol ruins and taking the whole weekend for that matter. I’ve been working a lot lately so I’m more than excited to finally be able to get out and see some things. Dr. Lazo got back tonight anyway, so my fun days doing a lot in the hospital are probably over, since he and his wife seem to be anti-student. I’m going to try and just stay with Sierra and Gamero for my last two weeks so it’s not totally lame as I finish up my experience here.
One crazy case was this Mennonite girl who came in during the morning and saw Dr. Sierra. She had aplastic anemia which had been initially diagnosed and treated in Guatemala. She was feeling fatigued and looked as pale as a ghost. Dr. Sierra did a CBC and her hemoglobin was like 4!! Normal is 12 and you should transfuse blood at 7 or 8. Even worse, her platelet count was 5! Normal is >200. Platelets clot your blood and sever bleeding usually will occur at <20!>5. Dr. Sierra admitted her of course. She needed platelets very badly so I asked Dr. Sierra about it. He said they didn’t have platelets. I wondered why don’t transfer her to a hospital in Belize that had platelets. He tells me there isn’t one! I said, “You got to be kidding me, there isn’t one hospital in Belize that has platelets?” Nope. I still can’t believe that, maybe there was a miscommunication, but they told me she would need to go to Guatemala for platelets. That should tell you how behind the times Belize is with their medical care. It is a small country, but come on. This girl is on steroids which will hopefully increase her platelet count.