Summer in the City

Today was hot. I mean Arizona in July hot. Morning report was the usual 35 patients admitted over the weekend, and about 5 deaths. 80% of the patients are not rounded on on the weekends, as the team that is covering (1/5 of the MOs) round on only their own. I was asked to see several patients, one of whom I will never forget.

The first was a 90 year old demented woman who was in complete heart block. Her heart rate was in the 30s and she lay still as if dead. She would not respond to my efforts to speak to her or get her to react to tactile stimulation. My advice to the housestaff was to let her die in peace.

My ST elevation MI patient is coming along well on medical therapy. He has had no recurrent angina and is tolerating warfarin, aspirin, ACE inhibitors, and beta blockers well. I did an echo on him today and found that he had an LVEF of 45% with anteroapical and apical septal akinesis, but no observable mural thrombus. He had mild MR, and PA pressures were not high. I advised a stress test after discharge (we don't have a treadmill at PMH).

I was asked to see an unfortunate young man with right heart failure: elevated neck veins with a prominent V wave, tense hepatomegaly, and peripheral edema. He had marked prominence of P2, which made me suspect PA htn, but I was wrong....it turned out to be a tumor plop! The guy had a 66x33mm RA myxoma that obstucted RV inflow in diastole! The picture above may need a magnifying glass to see clearly. The patient comes from Zimbabwe, and the Botswana government won't pay for him to go to South Africa for surgery. He is really in a fix, and I feel powerless to help him. Hopefully the medical staff can figure out how to obtain the needed open heart surgery for him.

In the middle of the day, the director of the training program, a Montenegran named Gordana, took me to her nice home for lunch. I met her husband Branco (Croatian), who is a professor at the U of B. They have been here since the early 90s when the civil war in the Balkans drove them to seek the haven of a more peaceful environment here in Botswana. They raised their two children here, both learning careers in Europe, but both planning to return here to work.

I walked home in the heat over a dusty path with the 10-foot tall termite mound, amazed at how placid and reassuring life in Portland, Maine is. Too bad it's winter there.