Hi! It’s Dr Louella again on a cool Thursday evening (at least with the a/c on) here in our beautiful island of Trinidad. I want to recount this story from work because it definitely impacted me. It entailed basic medicine, yet it was quite unique and reminded of how unglamorous a doctor’s job often is.
This was about a week ago, in a clinic dedicated to children at the health centre. My morning had been busy, because there was an asthmatic emergency, along with routine cases and those without appointments.
The asthmatic was not settling down and needed transferral to the emergency centre. Securing an ambulance is not easy nowadays and we were relieved to get one and send her off.
There was a lull as clinic was almost over. I thought I’d grab a quick lunch in the kitchen.
Some nurse or other had tried to tell me about an adult patient they wanted seen, an amputee. Honestly, I did not pay much attention at the time because I was tired. But as I picked up my lunch bag I knew I would have to assess the situation before settling down so I went in search of the patient.
She was easy to find. The female patient was seated on a wheelchair just outside the screening room. She was in fact a double amputee and had only two stumps without knees. She was flapping here arms up and down. One female relative beside her was panicking.
I identified myself and tried to bring some order to the situation. I enquired as to why they had brought her. There was a bit of rambling but from what I could decipher the elderly wheelchair-bound patient was well the day before but started shaking violently today.
Then I heard the word ‘fever.’ I was very glad that I did. I asked the nurse to include a temperature with the screening and explained to the relative that if she indeed had a fever then this would most likely be chills she was having.
Of course, she wanted to know why she would have a fever. I explained that a simple viral illness (or ‘the virus’ as we say it in Trinidad) could be the cause but when I attend to her I would be looking for a source of infection to make sure that is not the cause.
Whilst having lunch they gave me her temperature as 39 degrees Celsius. That was pretty high so she did have a fever. I ordered two Paracetamol (acetaminophen) for her and said I would see her shortly. I could not order a cold shower.
While still eating I found out that this patient’s relatives had been trying to accost the ambulance attendants for our asthmatic patient to take their mother down to the emergency facility even before she had been seen by a doctor.
It seemed quite strange to me that they would behave so desperately. I was glad I had taken a little time to explain to them that it was most likely something minor.
I didn’t spend any extra time in the lunch room that day. But now I wish I had. I went to the office, called the patient and they wheeled her into my office.
The door was still open as they were positioning her wheelchair when she lurched forward in what I thought was a sneeze. Then I felt wet stuff on both my forearms. I flew out of my seat and sprinted to the wash basin about 5 feet away.
I could not help it. I got into protect-me mode. I continued scrubbing my forearms intently until I felt clean again. I did not pay any attention to the patient and the relatives at this point. I had heard them mentioning something about vomit.
When I returned to my seat there it was. The old lady had vomited all over her clothes, the wheelchair handle, the wheel and the floor. They had a vomit bag for her. They had gotten it from the nurses when I was busy cleaning myself.
I quickly realized that I could not continue this consultation with things in this state. The wheelchair was rolling in vomit. I excused myself to find one of the cleaners.
Well I found them, but both cleaners were having their lunch in the kitchen. One asked me to relocate because they would not be coming right away. I had no choice. I could not talk to these people while staring at and smelling vomit.
(It is only when everything was over and I was recounting the events to some nurses later that they pointed out to me a few spots of vomitus on my pants. Of course I was disgusted and did a make-shift cleaning. I couldn’t wait to fling those filthy trousers to be washed.)
At the time I felt all clean, though. But I had to ask someone to leave a room for me to use it. A clerk was using one of the doctors’ offices as we are short of doctors this month so I borrowed that room and the relatives wheeled the patient over.
I understood from one daughter that it was whilst the patient was being bathed that morning that she began complaining of feeling cold and started to shake. The shaking grew worse as the day progressed. With the vomiting she was now convinced that it could be “the virus”.
The patient had had one leg amputated earlier this year and one three years prior. They were all properly healed and there were no signs of infection on the stumps. She was diabetic of course.
Examination was otherwise normal, including the chest. I confirmed my presumptive diagnosis of a viral illness and gave her medication for vomiting (“Gravol” – dimenhydrinate), rehydration salts (Gesol) and more Paracetamol. I advised on increased fluid intake.
I was pleased with my management of the patient but I still felt a little shaken. It reminded me of other exposures I have had from one of the fattest needles ever going straight through my finger; to a needle stick injury with a confirmed HIV infected needle and my developing a fungal rash on the forehead from being kicked by a baby’s booty.
But what can I say? Every day is not the same. This one could not have been prevented but we take precautions whenever we can. Importantly, I was able to bring some assurance to this family.
I will bring you more interesting cases as I explain the some of the medicine behind it as well as the social aspects.
Life is still more than good. It is great and terrific and we must ever have gratitude that we live! Catch you later… Dr. Louella!!!