Whining

OK. I don't normally like to complain, but the 'RealFeel' temperature today was 124degF.

Pukur

The Pukur is where we swim as a family with the local water snakes.  With the recent rain it's really filled up and the boys have been practicing back-flips off the little platform.

This Close

It's after one, and I'm about to drop off.  This post is not for kids.

So... doctors have 'clouds'.  Imagine a little cloud that follows you around - kind of like Charlie Brown.  If you have a black cloud, you seldom sleep on call and it's always busy.
If you have a white cloud, you usually sleep and have quiet call nights.

During residency I was voted runner-up for "Most likely to develop bedsores while on call".  It may not have been meant entirely kindly (most of the awards weren't) but I think I took it pretty well.  :)
I've always had a white cloud.   This past week, though...

The first night was the worst night of my professional career for mortality.  I lost four patients in one night.  While I'm told it's not that uncommon here, I've never even come close to that many deaths in a single night before.

The next call night was again crazy - no deaths, but I came home spattered with blood and some other stuff.  You remember "ER"?  I always said that real life wasn't quite so fast-paced.  Well, it can be.

Tonight is quieter.  I expect to lose one, or less likely, two.  You are close to death here.  So close, it's as if you were sitting down for coffee and a chat with it regularly.  My part is delayed - I must wear a cloak of professionalism to insulate me when I need to function despite being a few feet from a wailing mother and baby whose husband-father is dying under my hands.  But if you are the family, or the patient it's really close and really personal.

Do you have questions in your life you prefer not to think about?  Are there big ones: the life-changers - that you ought to think about but it's easier not to?  Don't put them off.  There's no time like the present and they are worth answering.

It's Raining...

...and we have eleven children in our apartment.

Trouble

Pancoast's

There may be a few more medical posts these weeks as I am working a lot while 2-3 other docs are away.

That big white thing in the upper right lung (your left) shouldn't be there.  It is a medical student quiz question: a Pancoast's tumor.

These cancers often damage very specific nerves and medical students the world over memorize the rhyme, "Meosis, Ptosis, and Anhidrosis".  Ptosis (toe-sis) is a droopy eyelid on the affected side.

In his case there is nothing I can do aside from offering consolation.

Sawm

Sawm or fasting, is mandatory during the month of Ramadan from dawn to dusk. There are exceptions: those for whom it would be dangerous to fast (elderly, diabetics, small children, etc) are are not required to.  Fast is broken after sunset with Iftar.
   I'm not clear on whether fasting is mandatory for a manual laborer or a rickshaw driver.  Regardless, it might be uncomfortable to be seen eating or drinking during daylight hours.  On the streets, where usually there are myriad small food stalls, we now see this:

Snapshots

Sunset from our front stoop

One Tree Hill

A Medical Meander

Here's a bit from the professional side of my job.  Warning: longish medical post.  

TB in the right upper lobe, last week.

"Bugs", or bacteria, are interesting and for such  'simple' organisms, they're awfully complex.   Here's a tidbit - maybe not dinner party conversation, but interesting all the same - the first dose of antibiotics in a typical infection often kills over 95% of the bacteria.  All the remaining days of treatment are spent just mopping up.  This mopping-up may be due to bacteria that are hiding in an anatomically protected place, are partially resistant, or are simply tolerant of the antibiotic because of the slow-growth phase they are in (some antibiotics only kill rapidly growing bacteria).  So the interesting bit: bacteria that end up in sub-optimal areas of your body, places where they have a hard time growing, are often more likely to survive the initial few doses.  Always finish your course of antibiotics!

TB is not typical.  Very slow growing to begin with, it is inherently resistant to most common antibiotics and it grows slowly enough that you might say it has the time to develop resistance to antibiotics: if you make the mistake of treating it with just one, or even just two antibiotics, no dice.  No, you have to hit it with four separate antibiotics simultaneously to kill it.   And if you ease up on it at all, e.g. you stop after six weeks of treatment, the few remaining bacilli in those sub-optimal locations raise their heads, see the coast is clear, and begin reproducing again; you relapse.  This is why it takes 6 or more months to treat run-of-the-mill, fully-sensitive TB.  Let's not talk about drug-resistant TB.

TB also is interesting because of its long history and its predilection for growing in weird places.  One place, the lymph nodes of the neck, has a fun historical name: Scrofula - it's just fun to say.  Try referring to someone as "an ill-favored, scrofulous knave" and even though no one will have any idea what you're talking about, they'll know just what you mean and will probably think you've been reading too much Shakespeare.

Scrofula is one of a select few historical illnesses where I just like the names: scrofula, marthambles, scurvy, the falling damps, dropsy, hockogrockle*, and my all-time-favorite - thundering apoplexy.




*Marthambles, the falling damps and hockogrockle are not actually real diseases - they were illnesses claimed to be cured by quacks & cure-alls in the early 18th century.  But wouldn't you love to diagnose someone with 'the falling damps'?  Try it, the next time you have the chance.

So Different

Found this in the hamper

Sometimes everything is SO different you just want to hide in a box.

Having 'tea'

Sometimes the differences are more welcome and you feel 'up to it'.

four cheeseballs. *

Through it all, the these four have been the stars.  Their flexibility and welcoming attitude is awe-some.  

 Before coming, older-and-wisers told us, "The extent to which you are willing to make yourself uncomfortable will be the measure of your success in adaptation."
Some days are easy, some aren't, but they're almost all new and interesting.

* well, three.  Mary was sick in this photo.  She's better now.