It cleared this AM after a steady rain all night (T-storms all afternoon yesterday). I walked to the hospital along a route that avoided the flooded customary pathways I usually took. After morning report, I was dropped at the Health Ministry, where in less than an hour and 30 Pula (~$4) I was an official doctor. I was asked to consult on 3 patients today. One, a 28 year-old woman was thought to have rheumatic heart disease, but her presentation and exam suggested congenital heart disease with advanced heart failure. The exam was dramatic, unlike anything we would encounter in the US.
A second consult was a pathetic 16 year old who looked 10-12 (cardiac cachexia). She had a dramatic exam also, more likely congenital disease than rheumatic. I got word from the Philips distributor that the HD11 will be delivered tomorrow, and we'll get a look at the cardiac anatomy and physiology by echo once the machine is in place.
The GE machine available to me 2 afternoons/wk is workable, but until I can find out the password to store studies and obtain an ECG cable to track rhythm, the studies will be less than optimal. I'm in contact with GE to learn how to reset.
The 3rd patient came to "A&E" (the ER) with severe bradycardia and 2:1 heart block. He was a vigorous 80 year old man with 2 grown concerned daughters. He will need to go to Johannesburg for a dual chamber pacemaker. The presence of a cardiologist here now will help the local physicians make better choices about who to agressively manage heart-wise. I have a Penn med student working with me this week, and it has been great fun.
Subscribe to:
Post Comments (Atom)
I saw the sun, the roads are plowed, the yoga studio may be almost ready when you return. I would imagine the patients are like those in appalachia when I would go on rural heart clinics--the murmurs, rubs and gallops could be heard without a stethoscope. It's almost the weekend--time to tee'm up.
ReplyDeleteD&E