This story begins the day before Valentine’s; there wasn’t
much happening in the Gen Ward, no organized rounds since my favorite doctor
and chief of medicine, Dr. Mcooley was absent.
He’s the one to keep things organized and actually takes the time to
talk us through his thought process concerning each and every patient. And he’s quite good despite the ever-limited
resources he has at his disposal. Since
there wasn’t much keeping me on the general wards yesterday, I decided to mosey
onward to casualty (their ED) where I no sooner stepped into the department, I
saw a few guys carrying in a 20 something man who was clearly unresponsive and
just writhing about. Initially, my first
impression was that he was seizing, but after we extracted a very limited
history from his non-English speaking friends and family, apparently he was delirious
and agitated, possibly from alcohol withdrawal.
He was a chronic consumer of the local gin (Konyagi) taking
approximately 500ml or more each day. 3
days ago, he grew sick with headache, fever, vomiting & diarrhea and
stopped consuming his regular alcohol intake as a result. For the past 3 days his agitation and altered
mental status had only worsened, and upon his presentation to the ED, all of us
medical students were thinking that this was probably a case of delirium
tremens from alcohol withdrawal. With
the onset of his other sxs occurring prior to abstinence, there could be
another etiology to consider (and the docs here were great to think about
cerebral malaria and typhoid) BUT they completely dismissed the idea of alcohol
withdrawal, which delirium tremens (DTs) if not properly managed will kill a
person. Yesterday, I left the ED
thinking that I would follow up with the patient in the morning since he was
admitted to the men’s ward. When I left
him, he was properly sedated with benzos (fills a similar receptor to alcohol
and helps offset the withdrawal syndrome that causes sweats, tachycardia,
delirium and seizures and potentially leads to death). Anyway, I went to the ward this morning and
found it odd that I couldn’t find my patient.
As soon as I stepped into morning report though, I heard them talk about
my guy; he was treated with quinine to address possible severe malaria and was
also given cipro to address a possible typhoid.
I don’t think any definitive tests were actually done. They cost money that most cannot afford; also
the tests are rarely done in an expedited manner as to actually help in
appropriate management. We did do a
rapid antigen test for malaria while in the ED the day prior which was negative
(yeah, it’s a poor test in a high prevalence area…whether it be negative or
positive, doesn’t really matter. If the
doc thinks it’s malaria, that’s the treatment the patient will get…which begs
the question, what’s the point of the test???)
In morning report, after the intern expounded upon what was done for the
patient, she nonchalantly continued that at 0100 this morning, the patient
died; there was no discussion as to why the patient may have died, no question
to what could have been done differently in patient care. I asked them if alcohol withdrawal and
management was a consideration during the whole event. Apparently b/c the sxs of headache and
vomiting began BEFORE the patient stopped alcohol, there had to be a better
explanation for his current condition.
They didn’t seem to get that alcohol withdrawal could be a huge
complication of the patient’s condition independent of WHY the patient stopped
drink, and so he died. He died I believe
from the dangerous DTs that he was experiencing because the doctors refused to
address his alcohol abuse and withdrawal.
Instead they fixated on a possible infectious cause. So yes, I believe there was patient neglect
and mismanagement and he died needlessly on Valentine’s Day. I will add that although I am here seeing all
this happen before me, I am still trying to put the pieces together. I have not personally reviewed the patient’s
full chart, but I have only heard from the medical student and intern after
asking them about the case.
I will further add that from a couple of posts ago, I was
shocked about the management of a patient with thrombocytopenia (low platelets)
of unknown cause and bleeding. Since there were no platelets available to do
replacement therapy, the attending ordered that Vit K be given. I had said that this would do nothing for the
patient b/c it acts in a totally different way that can’t substitute for platelet
deficit, BUT I found out that this attending is Dr. Moshi, a known drunk on the
wards. He was probably intoxicated that
day as he is most days (which doesn’t make it right, but gives me some kind of
reasoning behind his crazy decisions!) And I kid you not! All the med students and interns have come to
expect this behavior from their attending.
This is one incredible, unforgettable place I’ve found myself the past
several weeks!
On a lighter note, I wanted to mention some cultural
differences I’ve observed between Americans and Tanzanians concerning the word
love, fitting for today : ) My local
friends have come to call me ‘lava friend’ as so the pronunciation sounds in
their local accents, but they really mean ‘lover friend.’ To my Western mind, lovers are people who
have sex, definitely something MORE than platonic friendship anyway. Not here.
Yesterday the night security guard Emanuel took the night off, and I
asked our cook Witness where he was. She
questioned me concerning my inquiry about Emanuel and went on to add, “you love Emanuel.” Initially it felt weird how loosely they
throw around the word ‘love’ here, but I’m getting used to it, and I know that
they mean nothing by it. I think it’s
much easier for this people to be affectionate since their society is still quite
closed off when broaching sex…and thus the lines in the sand are rarely skewed,
and they have the freedom in their usage of ‘love’ expressions. That’s my observation anyway…Happy Valentine’s
Day everyone!
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