I am back at the hospital on A&E for the 2nd week. I was pleased to see that Dr. Abu looks a bit less frantic than he did in the first few days I worked with him. It seems like the trial by fire works.
Today was kinda... dare I say it... calm. I'm thinking that I'm only saying it after the fact it doesn't break all the ED rules about actually saying the bad words of the ED. (See also... "slow," "quiet," "not busy," etc.)
We saw some bread and butter emergency type stuff... a guy who had a stellate laceration to the eyebrow from where someone had hit him. It sounded like he said that police did that to him. I do appreciate that the dynamic with police seems to be almost universal. A woman who has a long history of psychosis who seemed to be rather content just bouncing around the free beds in the department. And the nurses seemed content to let her do it because she was easier to manage that way. At least when she was playing musical chair with the beds, she was willing to leave her clothes on. Which begs the question that I'm not really sure how they handle psychiatric patients after they leave the emergency department.
There was 1 case that really fascinating and unusual. A woman in her 50's who came in after a fall with a swollen knee which was clearly a large effusion of some sort except she didn't have the ability to really straighten that knee. Dr. Abu told us that it was a patellar tendon rupture. I admit I had my doubts but all of the clinical signs confirm his suspicions. Flexion seemed to be a little limited by the amount of fluid and some pain, but relatively easy for her to do. She could only extend the leg herself by inching her toes along the bed. On the knee exam, there was a distinct difference comparing R to L. The tibial tuberosity on the afftected side was really prominent and had a indentation proximal to it where the patellar tendon should be. It was a really cool and interesting exam.
We debated doing a joint aspiration, but elected against it because there were precious few signs to indicate that it was infection rather than trauma that caused the effusion. So, we wrote for a x-ray of the knee. However... TIA... the power was out, hence to x-rays while I was there to confirm that this was, in fact, a patellar tendon rupture.
After the hospital, I was slated to go volunteer at the local school that is run for some impoverished children who live close by with Dolas. The school is run entirely on donations. The school's primary function is to offer a safe place for these kids to come during the day. Many of them are orphaned, abandoned, or neglected by their parents. They come to school for 2 meals/day (breakfast and lunch) and get educated in the meanwhile. It is meager but the head matron seems to have a real calling for it. There was a miscommunication, however, and the kids had already been sent home for the day when we arrived. I took some donations (just some exercise books, rulers, pens, and candies for the kids) and left them at the school with the promise that when I returned the next day the kids would be there for me to hand out the things I had brought.
So... we headed back to the house. I was content to lay by the pool basking in the warmth of Mombasa (that I had so dearly missed in Nairobi and Masai Mara which were much colder than the coastal town I am now accustomed to sweating bullets in). I also used the afternoon to just catch up on some computer stuff... emails, school work for classes and graduation, etc. especially since I'm not sure what, if any, internet connection I'll have while in Egypt. Already looking forward to it! These last 2 blocks of medical school are undoubtedly the best!!!
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