Two quick weeks have passed, and my time at the private hospital is through. Yesterday I began working at the big university teaching hospital. The similarities and the differences between them are numerous. The private hospital follows a more western model, attempting at more private rooms, more nursing, and more services for the patients like serving food, having more medications on hand. The teaching hospital is more what you may picture for a developing country, with large open wards full of beds, filled with as many family members as patients, doing more nursing than the nurses. Both these hospitals have many attendings dedicated to teaching, and both are filled with medical students and residents eager to learn, but who are somewhat limited by their resources - by lab services, radiology services, specialists. Perhaps the private hospital is almost more dangerous in a way, because it looks so western, and your expectations are such, but the care is still somewhat what you would expect in a resource poor country. But I think a death at the government hospital is seen as that much more normal, expected, and unnoticed.
Today I learned that at this government hospital, patients' families need to go to the pharmacy and pay for almost EVERY SINGLE medication they are prescribed while inpatients (not including the Emergency Room), except for medications for TB and HIV. You're admitted to the hospital and have high blood pressure? Here's your atenolol prescription, go get it. You need antibiotics for pneumonia? You can go pick that up for yourself, and the nurse will be kind enough to attach it to your IV. Oh, you're having an asthma attack? Better get your spouse/sibling/child to go run fast and get some albuterol and a mask for the nebulizing machine, we don't stock those on the ward. Today I watched a woman die over a period of about five hours due to some combination of severe heart failure and asthma. Yes, she was ninety years old. Yes, she had heart failure, and her overall prognosis was poor, and she likely would have died in the relatively near future. But yesterday, on morning rounds, she looked fairly well and we were planning to discharge her home today. Overnight, she deteriorated, and this morning our team arrived to find her floridly fluid overloading, wheezing, and gasping for air. In the time it took for her family to obtain all of the medications she needed to get her through the morning, as well as a functioning nebulizer mask to ease her breathing, it was too late. We actually wrote a prescription for her son to go get dopamine, a medication normally given as an infusion in the ICU, a last ditch effort to keep her heart pumping and improve her blood pressure, just before she took her last breaths. He was not even at her bedside when she did.
She passed away on bed 34, the third bed along the wall from the right, below a high window, next to a large aluminum storage cabinet on her left, and about 3 feet away from the young girl with the kidney failure and hypertension on the right. It all happened very quickly after that. The nurse brought in some extra IV poles, to hang some sheets on and create a small curtain and block the bed's view from the others in her area of the ward. A couple of other workers came in, removed her IVs and her foley, cleaned her and dressed her and covered her up.
By the time we returned from lunch, there was a new patient laying in bed 34, a 46 year old woman with newly diagnosed HIV and tuberculosis, and likely Kaposi's Sarcoma too. This woman has probably had HIV since the early to mid 1990s. She lost her husband in 1995 not to HIV, which she suspected that he had based on his symptoms at the time, but to the war. But she never checked her own status until now, until she was so sick and weak that she had no alternative.
So tonight, I think about her, and bed 34's previous occupant, and hope for the best.
Today I learned that at this government hospital, patients' families need to go to the pharmacy and pay for almost EVERY SINGLE medication they are prescribed while inpatients (not including the Emergency Room), except for medications for TB and HIV. You're admitted to the hospital and have high blood pressure? Here's your atenolol prescription, go get it. You need antibiotics for pneumonia? You can go pick that up for yourself, and the nurse will be kind enough to attach it to your IV. Oh, you're having an asthma attack? Better get your spouse/sibling/child to go run fast and get some albuterol and a mask for the nebulizing machine, we don't stock those on the ward. Today I watched a woman die over a period of about five hours due to some combination of severe heart failure and asthma. Yes, she was ninety years old. Yes, she had heart failure, and her overall prognosis was poor, and she likely would have died in the relatively near future. But yesterday, on morning rounds, she looked fairly well and we were planning to discharge her home today. Overnight, she deteriorated, and this morning our team arrived to find her floridly fluid overloading, wheezing, and gasping for air. In the time it took for her family to obtain all of the medications she needed to get her through the morning, as well as a functioning nebulizer mask to ease her breathing, it was too late. We actually wrote a prescription for her son to go get dopamine, a medication normally given as an infusion in the ICU, a last ditch effort to keep her heart pumping and improve her blood pressure, just before she took her last breaths. He was not even at her bedside when she did.
She passed away on bed 34, the third bed along the wall from the right, below a high window, next to a large aluminum storage cabinet on her left, and about 3 feet away from the young girl with the kidney failure and hypertension on the right. It all happened very quickly after that. The nurse brought in some extra IV poles, to hang some sheets on and create a small curtain and block the bed's view from the others in her area of the ward. A couple of other workers came in, removed her IVs and her foley, cleaned her and dressed her and covered her up.
By the time we returned from lunch, there was a new patient laying in bed 34, a 46 year old woman with newly diagnosed HIV and tuberculosis, and likely Kaposi's Sarcoma too. This woman has probably had HIV since the early to mid 1990s. She lost her husband in 1995 not to HIV, which she suspected that he had based on his symptoms at the time, but to the war. But she never checked her own status until now, until she was so sick and weak that she had no alternative.
So tonight, I think about her, and bed 34's previous occupant, and hope for the best.
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