Wednesday, November 3, 2010

Jump in the ocean!

I am glad I had a day of rest yesterday. I needed it today. Just watching the other doctors do their jobs made me tired. Dr. Richa Dewan, the head of the Department of Medicine, told me that I was welcome to jump in the ocean. There was so much sickness that everybody was welcome to do what they wanted to do, in terms of learning medicine and/or providing medical care. It was like jumping in the ocean. You could do all the swimming you wanted to do. After a round of the medical floor I understood.

First Dr. Dewan introduced me to her staff of residents. Here they call them post-graduate students. The senior resident is someone who had finished post-graduate. The medical floor was divided into cubicles. Some had four beds others had six. The beds were slightly smaller then a typical American single bed.

The senior resident took me on a round of the floor. The first bed had a very sick looking patient with a diagnosis of new onset of paralysis of all four extremities. He was improving so there was hope that it was some kind of self-limited demyelinating disorder. There were about three to four people on or near that and every other bed. I was about to move to the next bed when the resident interrupted me to talk about a person who was sitting on the bed of the patient. I thought he was a relative of the patient. No, he was another patient! He was very sick too, with pneumonia on top of his underlying chronic bronchitis. He was on oxygen. Then I remembered that Dr. Dewan had told me that there were two patients to every bed. It does not sink in, until you see it.  I wonder how they sleep. Do they take turns sleeping one by one?

Every patient had one family member staying with him or her. The family members provided most of the nursing care. There were family members everywhere. Since some patients are from out of town, the family sleeps in the courtyard areas. They take turns one by one, staying with the patient. Only one family member is allowed inside the medical floor at any one time. The nurses were there just to dispense medicines and take vital signs. The nurses were overwhelmed as was everybody else. There were more doctors working on the floor then nurses. There were no nursing assistants. Without a family member you are really out of luck. Thankfully, meals are provided by the hospital. I saw a child who was a ward of state. The state had provided for a caregiver for him. This caregiver was taking care of the child in a very professional manner. That kid was getting the best care on the floor.

We got to another patient who had hypokalaemic periodic paralysis. He was getting potassium by I/V infusion. It is a very rare disorder but fortunately I knew a little bit about HPP. I had seen one patient in Chicago in 1975. I asked the senior resident why the patient was getting potassium. She said since the patient had low potassium, he was getting potassium. I persisted but why give him potassium, is it going to clear up his paralysis? She did not fall for the trap. Very calmly she replied that there is no good evidence that giving potassium will help the paralysis. She had passed the test!

I was relieved that the residents did not ask me any medical questions!

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