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One More Day

June 8, 2016

     Today I had the privilege to see a follow-up patient from Tuesday’s clinic. She by far was the patient I saw in the most pain and in the most danger of developing serious complications of her disease. She slowly shuffled towards me in Tuesday’s clinic with her face so scrunched in pain from her extremely severe rheumatoid arthritis, that I thought she had eaten something sour. Once she sat down and I saw her check-in sheet, I saw that her pain was not the only problem. She had a blood pressure of 232/130 and had right eye blindness and decreased urine output (signs of end-organ failure and deemed a hypertensive emergency).  My heart began racing. She also had a JVD and a lateralized PMI (signs of enlarged heart and heart failure). Having given up time on my Internal Medicine rotation to go on this trip, I had missed out on some critical care experience… or so I had thought! My first instinct was “This lady needs to be in a hospital”--but the patient said she could not get a ride to the hospital 40 km away for another 2 days.  This acute problem needed to be addressed ASAP and all she had was our clinic, full of students in training. Slowly, I worked my way through all of her problems and consulted Dr. Sheetz on how exactly to go about treating an ICU patient in our pop-up clinic in a third world country with limited medications for 2 days until she could make it to a hospital.  We pieced together a plan of action for some medications for her hypertension, probable congestive heart failure, and RA and set up a follow up visit the following day.  This morning, the patient was brought to the front of the line to my station. She had an improved BP at 210/100 and her face was slightly less scrunched – which met our goal. As little as that sounds, that made a difference to me. To be able to have some continuity of care and to personally be able to visibly reduce someone’s pain meant the world to me. And more importantly, I could see in her daughter’s eyes that it meant the world to her family that maybe her mother could be around a little longer and manage to play with her grandkids more.

 

     We are coming to the end of our clinic days. Tomorrow will be our last day of getting to hear real Cambodian’s stories. Clinic is the whole reason we are here. We have a little time left in the country as tourists, but no longer will we be interfacing with typical Cambodians on a daily basis and hearing the concerns of the people at a grassroots level. No more farmers with osteoarthritis from years of bending down and harvesting rice or from roping up water buffalo. There will be no more Khmer curry-induced gastroesophageal reflux to diagnose. As a future pediatrician, I have to admit I did not enjoy every Tums or Tylenol that I prescribed, however, I did enjoy the privilege to hear their stories and their concerns and the opportunity to give them something that could calm some of their discomforts. From chronic to acute, these people were our teachers. They were our professors, our comrades, and our experiments at times. They taught us that “common things are common”, that a handmade bracelet can make even a grown lady smile when she is in a lot of pain, and that looking someone in the eye when telling them the bad news that they may be infertile from a childhood preventable infection can help provide them with some measure of empathy and love in an otherwise stoic society.

 

Gayle-Anne Wright, Medical Student

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