Disaster Response B #7
The patient load is changing. Over the weekend we had 140 ER visits one day and 130 the next. Today is less. It seems that there is a whole lot of congestive heart failure now. People lost their meds in the storm and can’t see their own doc so they’ve been without meds and now are coming in very short of breath. Last night someone about 30 was at home and had worsening breathing for a few days. Everyone was living in their upstairs rooms because the bottom of the houses had been flooded. The car had been ruined with the flood, so they went to find a neighbor with a car in the middle of the night. They tried a number of times to call 911 and couldn’t get out. The cell phone system was down. Once they found a neighbor with a car, they had to carry her down 13 stairs to the car. They piled her five sleepy, young children in the car and headed in to our hospital. They raced into the parking lot with the horn blaring. Our nurses ran out to see what was going on, and found a woman barely breathing. She was brought in and intubated. She was given medicine to make her urinate off the extra fluid and the staff arranged transfer to the referral town on another island. A helicopter landed in the parking lot to pick her up.
One of the people I saw for a surgical consult was a woman with a fungating breast cancer. She had had it for a long time and when it was small back in 2012 had seen her doctor who had said it was nothing and they didn’t do anything about it. Later it became huge and ulcerated, necrotic and smelled horrible. She saw a doctor and was referred to an oncologist. The oncologist flies in from another island and charges $600 to be seen. Then chemo the patient said costs $3000 for the first round. They heard things were cheaper in Cuba, so flew there to be evaluated. So they’ve been going to Cuba for every round of chemo. She wanted to be seen to see if we could do anything else. I looked at her breast and it was all raw, red tissue all over and firm and dimpled out into the armpit (peau d orange). She was improving some with the chemo. The local surgeons said that chemo was free by the government, but she said it’s not what she found out. I advised her to continue the chemo, and referred her to the local surgeons to be seen again here.
I did a right inguinal hernia repair in the OR and then removed a toenail on an older man with an ingrown toenail. Then there was a older man with a left inguinal hernia that I repaired. I saw another man with an inguinal hernia in the ER and set him up to do his tomorrow.
I was asked to see a 98 year old woman in the ER who’s son was with her. She had a large pendulous breast with cancer on one side maybe about 8 inches in size and another breast cancer on the other side about 2 inches in size. Both appeared mobile and I could likely get them off. At least it would take away the smell of the one breast that was necrotic (dead tissue). She had been loosing a lot of weight and her son was very attentive and concerned about her weight loss and some pressure ulcers that had developed on her spine in the low back. She wasn’t eating much for a few weeks because she didn’t want to and it appeared like she couldn’t stay awake to talk to us. I decided that in her wasting condition that it wouldn’t be wise to do a surgery on her- that it would speed up her demise and she wouldn’t heal in her malnourished state. The son was fine with that as he was afraid of her having surgery too.
Tonight’s meal was pasta with veggies. Different than the other nights- somewhat tasty.
As I sat there and talked to a few of the other doctors and staff, the ER doc asked me to see a patient in the ER. This man had had a mass on his tongue a long time. He is a smoker. The mass had gotten larger and eventually filled up his whole tongue. Tonight as I looked at him he appears about 40 with a large mass under his left mandible (jaw bone). It was about 2 inches long and stuck out about 1 inch from the surface. This appeared to be one of many metastasis that I could feel in his neck. There is nothing we could do for him and recommended that he see an oncologist and wrote a referral for him. The suffering of people is incredible, both from disease and from the hurricane. God give me continued compassion for each person I see, and give me wisdom to treat each ones physical and spiritual needs.