Sickness and health and all things in between

One of the biggest differences in the medicine that happens here is the fact that people leave health problems alone a lot longer than they almost always would in the UK. This means people are, as a rule, a lot sicker when they come in than I'm used to. Just today, perhaps 3 hours ago, the doctor we were doing rounds with was called away to see a patient that had just come in, sent from another, not quite so well equipped hospital nearby. He looked reasonably ok - elderly, a little thin and frail, a bit breathless. The nurses had taken one look at his chest X ray that had just been taken at the other hospital and got the doctor. He had a completely collapsed left lung. I mean completely! The X ray was just blank one side! I was astonished. I listened to his chest with my trusted Littman and sure enough, no sounds at all from the left lung. So bossman doc put in a chest drain to let the air out. He was admitted. He had been going around with a collapsed lung for a week.

And another one I'll always remember is the little boy, 6 years old but looked more like 3 or 4. He was really drowsy, not really very responsive at all. He had sickle cell disease, and his spleen was absolutely enormous. As with every patient, I looked at his fingernails, eyelids, and tongue for signs of anaemia. We always are told that you can tell if someone's very anaemic if these are pale. I've only seen them look noticeably pale a handful of times, but his were white. Even his tongue - actually white. When he stook this blanched little organ out at me, I almost jumped! His haemoglobin was 2.9 (supposed to be more like 10 in children). I've never heard of one so low - I actually thought that you wouldn't survive an Hb like that. After a blood transfusion (from one of the members of staff - I discovered quickly that there isn't a working central blood bank in this area. All the things we take for granted!) and a couple of medications, he was right as rain. I was thrilled to see him get better quickly, of course, but despite that I was desperately sad to think that many of the "sicklers" (as they are known) don't live to very old here. As "Haemoglobin" by Placebo ran through my head, I watched him leave the hospital up the lane, little hand in hand with his Dad.