As I head toward the hospital, my eyes find the windows to the pediatric ward. A baby is crying. I can see one of the painted giraffes on the wall through the window. On the other side of the building, a small gathering of women has lined up around the rainwater tank with large buckets. The hospital, like the entire district, has been out of water for over a week now. I decide that while taking a bucket shower in the company of worms is an inconvenience and a little bit gross, having to run an entire hospital without running water is a much larger problem.
I have to walk through the male ward to reach the pediatric ward. The stench of vomit, urine and death flood my nose and I begin to walk faster. There are eight to ten men to a room, mostly with tuberculosis and complications from AIDS. If they were to be anywhere other than in sub-Saharan Africa, many would be in an intensive care unit. But here they are, lying in their beds. Some have begun to move about the ward, carrying the urine filled bag attached to their Foley catheter. A woman sets up a cart with hot sorghum porridge, looking like watery clay that some men wait in line for hungrily. I am taking care of one of the male patients. I peak by his room, see him sitting on the bed, staring.
I admitted this patient when I walked into the clinic one Friday afternoon to the nurses exclaiming: “Doctor, will you see this patient? He is having trouble breathing”. I winced at the sound of the word ‘Doctor,’ because although I am still a fourth year medical student, the nurses’ call me ‘Doctor’ and expect me to make decisions with the calm confidence of a physician. I have been in Lesotho, Africa for about a month doing a two-month rotation at one the referral hospitals during my last year of medical school. I wince again when I see the patient is a fifty year old man. As a budding pediatrician, I have spent almost all of my fourth year doing pediatric rotations. Since I am the first one back after lunch, I have to see the patient. His breathing is becoming increasingly labored.
The vague history I receive from a family member is that over the past two weeks he has become increasingly short of breath; now he is unable to speak and is complaining of left sided chest pain. I am already forming a differential diagnosis in my head, but continue to ask the review of systems (where the physician asks a series of systematic questions about every body system). His review of systems is negative, except for abdominal pain that is worse than the chest pain. The abdominal pain broadens the differential from primarily respiratory and cardiac disease to include the gastrointestinal system. An acute abdomen, a surgical emergency where bacteria has spread within the abdominal cavity, must be ruled out. Meanwhile, the nurses have given him oxygen by a nasal cannula, which he keeps trying to remove. Another nurse is preparing an albuterol nebulizer, which helps to open the airways in the lungs. An IV is started.