Elective 09. The first death

Today, among other things, I visit the bishop and the first patient dies. Among other things.

Firstly, Ludwig made it to and from the large hospital today, returning late in the evening (it is a long way away!) He travelled with the lady with two broken arms. Perfect planning! The X-ray for Lugwig shows opacity in both lungs, which (perhaps) shows something such as miliary tuberculosis (TB). I say might, as the doctors here are not used to interpreting X-rays (rarely see them) so are not all that sure. And I don't know! Either way, there is something very wrong with the lungs, a diagnostic success for me (secretly pleased, and feels like I am actually kinda useful here), though not good news for Ludwig. Now he has HIV, malaria and possibly TB. This could explain all of the symptoms, though, as if the TB has disseminated (spread around the body) it could be in the lymph node, blocking the drainage of fluid from the leg and trapping the fluid there. TB spreading elsewhere could cause the other symptoms, i.e. if it is in his liver, this could lead to the ascites we can see in his abdomen. The doctor in charge of male ward will be called Eggs, as he keeps 200 chickens in his house and spends all his time with them, rather than on the ward. Eggs decides that the HIV medication he started yesterday (don't need to wait for a CD4 count if there are certain infections, medication should be given straight away) should be stopped, and TB medication started to avoid Immune reconstitution inflammatory syndrome (IRIS). This is something I know all about, due to a large essay on IRIS caused by TB in HIV patients I had to do last year. It is caused by the HIV treatment making the immune system strong again, and the system reacting so strongly to the infection (TB in this case) that it can damage the body. That intercalated degree is starting to pay off already!

Ludwig's chest X-ray held against the hospital light box

Moving to the more mundane, I was invited to Visit the bishop of this diocese over lunch time. A very friendly, kind, out going, some May even say "cool' Man. I was driven by his personal 4x4 to the nearby town where the cathedral is, feeling I was wasting precious resources by this trip. Once there, and with a little admin dealt with, the bishop showed me around their 'HQ". The highlight of the trip was either seeing the gorgeous Cathedral (seats 1200) or being given some Cold water from a fridge to drink. It sounds silly, but after always drinking warn water or sodas (Only one fridge in the whole village back 'home', and its used to store vaccinations) this was a wonderful treat! The Cathedral was the nicest building I have seen since arriving in Tanzania. Shame, in a way, that all of that money goes into a Cathedral rather into the hospital and Curing patients, or into a school and teaching Children. On the other hand, I suppose that this is only form my point of view. Were I a Christian, then investing into my and every one else's eternal souls may sound like a pretty good idea.

Unfortunately on my return, one of the patients on the male ward died. He was a new admission, admitted around 1PM, referred from a rural clinic because he looked so ill. And he did look very ill. Currently being treated for a TB infection on top of HIV (diseases sometimes seem like buses...), he was too confused to talk, and on examination his abdomen was too ridged to feel anything. Able to spot  that this was even more out of our league than most patients - we Eggs involved in the care, with a view to handing over to Dr Bike after the patient was stabilised, as he deals with all HIV cases in the hospital.

Coming back Later to check on the patient on my own (Sporty and Smartie were packing) Eggs and two nurses were standing around the bed, and the patient was now on a drip. I asked if the patient had been referred to Dr Bike yet, who deals with all HIV cases. Eggs just said "the patient is deceased." I was more confused by this than anything. 2 hours ago he had hardly been well, but had been writhing and moaning, and clearly alive. This was so fast. I would love to say l was grief stricken at this young mans death, but I was just confused. Not confused at how he had died, he was very unwell when admitted. More confused at why I wasn't as upset as I thought I would be. Don't get me wrong, I was Sad at this waste, and disappointed that more couldn't be done in this hospital, with no ITU or similar facilities. Perhaps I had expected myself to he inconsolable when patients I had care over died. After all, this was the first patient I had had some kind of care over who had died. Perhaps my lack of reaction was because we couldn't talk to begin with because he was so ill, or perhaps it was because I had been expecting myself for many deaths on this elective, and had been expecting this in an underfunded, under equipped hospital. I was pleasantly surprised that after a week, this was the first  one. Guiltily, I can say I was in a small part relieved that, despite feeling our of my depth much Of the time, that this first death was not my fault.

The hospital lab, with one of the assistants working in it, creating blood smears to check for malaria

On a lighter note, My companions, sporty and smartie, are leaving first thing tomomrow. I am excited about all of the responsibility that this will leave me with, but a hell of a lot more scared about said responsibility than excited.