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Look both ways...

Shell, Ecuador 13 Agosto 2012

I'm sitting on my back porch listening to the rain.  After almost a week of sunshine, it started pouring last night and has stayed steady all day.  It's another call day, but the rain seems to have kept folks home....either that or they are still observing the holiday weekend.  The 10th of August, which I may have mentioned before, is the date of the first cry for independence from Spain and is observed as a civic holiday. The whole weekend saw lots of folks traveling, taking their last vacations of the season - and the week before saw lots of traffic trauma.

Last week seemed to be the week of accidentes de transito.  We had a kiddo come in after being struck by a vehicle. The wheel took off all the skin on the lower leg down to the muscle, just like taking off a stocking. The surgeon pulled it back up and sewed it back together to at least provide coverage for the musculature.  How much skin will survive is yet to be seen.  A young woman came in after a car accident in which her husband was killed with her left femur broken in two places, top and bottom, and her right ankle broken.  She has to wait to have a hip replacement until the lower femur fracture heals, so with both legs out of commission she's pretty well stuck.  The big traffic incident occurred Wednesday night, or rather early Thursday morning. Two busses collided at 3:00 in the morning just outside Mera, one town over from Shell.  20 of the 30-odd people injured were brought to the hospital here.  Among them was the mother of a 9 month old baby who died in the crash when he was thrown from her arms - one of which was broken and the other with a huge laceration. Her other two kids were okay. The most seriously injured survivor was a 28 yo man who was comatose with blood coming from his ears and a hemothorax.  He was transferred to the big regional hospital once he was stabilized on the ventilator, but it doesn't look good for him.  We had people stacked up in the halls and on every available surface to have wounds sutured.  I was only there for the aftermath, but it was quite the event.  

Speaking of tragic stories involving young children, I had one of the orphans from the Casa de Fe in emergency with a fever the other night.  He is presumed to be about 7 months old (his exact origins and date of birth are unknown), but he only weighs about 4 kilos (8# 13 oz.) and was abandoned presumably due to his poor health. He is blind, has a strange high-pitched cry, and on CT scan apparently doesn't have very much cerebral cortex.  It's amazing that he's alive at all.  We tried to work him up for the fever, but we didn't really find a focus and I wasn't about to do an LP when I don't really know what's in his head.  We sent him back with fever reducers and instructions to come back the next day to reevaluate.  It's just so very sad.  He cries and sleeps and cries.  It's unclear how much awareness he has, but he seems to be comforted by being held.  I'm glad he's in a place where they can devote the time and resources to his care.  

Another peds case, though much less tragic, involved a little girl with asymmetric growth of her legs.  She was sent for an angiogram of her lower extremities because there is a huge difference between the pulses. On the one side it's normal, and on the other it's like putting your hand on a garden hose at full blast. You know how all the medical shows on tv have, at least in the background, an old-school light box with a CT scan on it?  That's what we've got here. No one in the US has actual films of a CT, hardly anybody uses actual films for X-ray, it's all digital. I get an unreasonable kick out of looking at scans this way...but I digress.  Her images where amazing!  On leg shows normal vessels - about the diameter of a pencil.  The vessels in the other leg look like pipes - at least 5 times bigger, as well as being more plentiful.  So, the leg with the normal vessels is growing normally while the leg with the super vessels is hypertrophic.  She already has a leg length discrepancy which will require surgery in the future once her other leg stops growing.  

I was on call Friday night, the holiday, when a man came in with tachycardia.  He's an American with MS who is quadriplegic as a result of his disease, but he and his wife who is a nurse live in rural Amazonian Ecuador.  He has his equipment and his own personal nurse and seems to get on pretty well.  It's really amazing.  Best we can tell, he was tachy due to a urinary tract infection and dehydration and today was well enough to go home.  Really sweet guy, and very hardy.  He's not letting anything keep him from pursuing adventure.  The only other patient we had that day requiring hospitalization was a mom with preeclampsia who failed induction and we ended up taking her to c-section. Both mom and baby did fine and went home today too.  

Saturday I went exploring with a couple of the residents. We went shopping and then to the Casa del Arbol, a 600 year old 350 meter high tree with "stairs" and little porches around it.  It's 11 floors, climbing up ladders to the top, and I was wearing a long skirt.  But we made it and had a pretty great view of the surrounding country side.  My legs are still sore today!  They also had tile work and gardens, as well as guinea pigs, or cuy, which are apparently a delicacy (these were alive and very cute, poor things).  I hung out the rest of the weekend with the residents and med students.  Sadly, this weekend the residents finished up their rotation.  I'm pretty bummed about that.  We had a great time traveling, shopping, making bonfires and s'mores, teaching each other words and phrases, trading war stories.  But the 3 students are still here and 3 more residents came in today so I'm sure we'll have fun, too.  

Strange but True: The common guinea pig was first domesticated as early as 5000 BC for food by tribes in the Andean region of South America (present-day southern Colombia, Ecuador, Peru, and Bolivia). In addition to being a food source, it's also used in folk medicine, both alive and dead.  It was introduced in Europe in the 16th century where it became an exotic pet. Since the 1960s there have been efforts to introduce the guinea pig as a source of meat in other parts of the world.  Somehow, I think it's unlikely to catch on in the US...



( 7 comments — Leave a comment )
Aug. 14th, 2012 01:42 am (UTC)
I am so amazed, I really don't know how you do it - seeing all those people come in injured or dying or just in a condition where you know you can't really help. Yet you do your best anyway. That takes bravery.
Aug. 21st, 2012 03:36 am (UTC)
Thanks, dear. It's just a matter of doing what you've got to do...
Aug. 14th, 2012 02:00 am (UTC)
I don't think I could ever eat a guinea pig, as we had them in my classroom in grade school, so they're very much a childhood pet in my mind. And good golly, they seem like they'd be a lot of work for very little meat.

Good for you, doing all the good work you do.
Aug. 21st, 2012 03:37 am (UTC)
I know, right!?! Just think about all that hair!

Thank you for the kind words. :-)
Aug. 14th, 2012 05:10 pm (UTC)
Terrible tragedies unfold and then something wonderful happens...it's a rollercoaster life for you!

The tiny disabled boy clinging onto life as surely as the MS sufferer.

Guinea Pig Pie...nope, don't think so!!
Aug. 21st, 2012 03:37 am (UTC)
You're so right.
(Deleted comment)
Aug. 21st, 2012 03:38 am (UTC)
Thanks, dear! :-)
( 7 comments — Leave a comment )