Out with a Bang

Today was my last day in the hospital in PNG. Sad face. I fly out Sunday for a few days of vacation in Australia.

I have learned so much in my time here. I have been blessed in the opportunity to serve here, and so thankful for all the patience in teaching me from the doctors, nurses, and patients.

In typical spirit, my last day was kind of a knock out kind of a day. The morning started with me giving a presentation at case conference to all the doctors. I spoke about myasthenia gravis.

Then our B ward (medical ward) decided to explode with patients overnight. We had several sleeping on the floor. So it took alot of time to get through rounds, plus I tried to write a little extra to help the person taking my place. I have been happy to see some of my patients really improve. I haven't talked too much about my patients on service here, but I have enjoyed a wide range of cases. In fact, just today, I treated a likely cancer patient (I am carrying the bone marrow biopsy home with me to the USA), a pt with thrombocytopenia (plt count of 3, no schistocytes, awaiting Crt, no splenomegaly, hgb 4--thinking it's ITP), an odd presentation of polyarthritis that is improving on steroids, cerebral malaria, pyomyositis with likely osteomyelitis, pulmonary TB, HIV, Hep B, and CHF.

When I made it to the OPD (outpatient department), my first patient ended up having a broken arm. When I got back from lunch, that was confirmed by X-ray. So I casted his arm by myself (thank you, thank you very much). I diagnosed a spontaneous abortion, and prepared her for a D+C. As I was finishing with that patient, Edith, the little girl pictured above came in.

Edith was carried 5 hours on a bush stretcher to get to me (2 pieces of bamboo with sackcloth stretched across). Her thigh has been swelling for 2 months. She went to a clinic, where they were treating for abscess, although they had no diagnostic capabilities (ie no X-ray or labs). She left barely able to walk, then fell at home, when her parents carried her in. I immediately thought she fractured her femur, but another doctor felt she likely had cancer. It turns out, we are likely both right (so far we have confirmed I am right). She has a fracture of her left femur, and she has alot of periosteal changes. I did not see any pus on U/S, which likely means this is cancer. In the picture above, she has a sweet smile, and she was so brave to smile so big, because I know she was in a great deal of pain. Pray for Edith.