Another week in Soddo

The sky is slowly turning from dark black to light grey.  You can start to see the outlines o the palms and avocado trees rocking in the wind.  They are strong, they've done this dance many times before.  It  is windy nearly every night. The sounds of gates, windows, and other lose pieces of hardware banging sporadically through the night sound much scarier in the dark.  The doors of the house moan and creak in the wind storm. It reminds me of a beach house - loud but resilient.

The family we share our guest house with is leaving today.  It's going to be strange to have the house so quiet. There are three kids in the family who can most often be found in avocado trees and sitting on top of swing sets (not anywhere near the actual swings).  We asked their daughter how she got on top of the swing set once and she replied, "it's easy, it's just like when you're climbing up walls." We will miss their company.

This week has been filled with more of the same in the ER, but as we sat in our living room last night swapping case stories with a couple (ortho resident and FP doctor) who arrived this week, we realized we are so absurdly excited about the patients we have seen here. We showed them pictures and described things we have read about but never seen before. We talked about the highs of our triumphs and the lows of our failures.  Although working in a county hospital makes you somewhat accustomed to witnessing the suffering of the world, it still hurts to see patients in pain or dying, especially from things that seem so easy to treat at home.  But, like most ER docs, we keep working in hopes that our next patient will have a better outcome.

The highlight of our week was a very critical patient who we were able to resuscitate enough to get him to the OR. We had to place a central line and start him on vasopressors in the ER. The nurses haven't done this before, so it was up to us to mix our own dopamine drip (the only pressor available that day). There aren't IV pumps available to adjust the rate of infusion either, which means we also had to calculate a rate....in drops per minute.  We mixed our concentration of dopamine into 1 liter of normal saline and then converted the dose we wanted our patient to get from mL/min to drops/min so the nurses could count approximately the amount of pressor the patient was getting per minute. Who says doctors can't do math?!  So far he is doing well post operatively.

The sky is bright now. Coffee is ready. Time to head off for another day.

P.S.  Some of our patient stories are intentionally vague.  Every single day here we have patients with shocking physical findings, great radiology studies, or interesting stories or we get to do procedures we've never done before, but we are trying to save some of the details to share with our UTSW residency friends at home...can't give away the answers too soon!