Hospital Civil (Week 2 Feedback)

An unexpected experience in the Urgencia

• We are on rounds. Two beds away from her. She had been intubated (she was in a severe coma according to the Glasgow Coma Scale). Even with intubation, her abdomen and throat made random, violent movements with every breath. Nurses rush to the doctors and ask if he could check on the patient whose heart had stopped beating. One doctor climbs on the bed and starts cardiac resuscitation. After a minute, he gets off and a nurse climbs on and continues the duty. Others are standing by the defibrillator machine, waiting to move in. But they do not. The nurse climbs off the bed. The heartbeat flat lines. A doctor announces time of death, 10:23 am. Why had the doctors let the patient die without doing everything medically possible to save her? Did they believe that, with their limited resources, resuscitating a brain-dead person with a failing heart was not fair to other patients needing to be intubated who had a better chance of recovery. Initially, I was disappointed by the lack of more effort. I had always taken the side of quantity in the “quantity vs. quality of life” debate. But then seeing the lady, who finally looked at peace, I may have understood why the doctors chose to “let nature take its course.” The debate is more complex that I previously thought and I am not sure what I would have done if I were in the doctors’ place. I believe, with the limited resources and big patient population, the doctors are forced to make such decisions often.

General health problems in the Urgencia:

• Diabetes: Advanced stage (kidney failure, brain problems, gangrene, etc.
• Accidents:

1. Alcohol related (ex. falling off a bull)
2. Traffic related (this increased my already heightened fear of the buses!)
3. Work-related (ex. cutting arm while making chocolate)

• Others:

• One suicide-attempt
• Attacks against others (two men, who had protected their sheep from a thief, were attacked with knives. Although hard to believe, this is true!)

Physical condition in the Urgencia is very poor.

• The Urgencia is not big, (relative to the number of patients there) and dually serves as an ICU (as many patients stayed there for several days).
• 22 beds (way more patients; on thursday, there were 30; some where put in hallway); “Casa llena,” as an intern named Miguel calls it, is a an always-present condition in the Urgencia.
  
• There are only ten beds equipped with a heart monitor and intubation equipment.Felicia had told me that Wednesday night, two patients needed to be intubated, but all the machines were being used. Therefore, the two patients were manually intubated with the help of interns who stayed up and took turns squeezing balloons.
• Loud construction work on tuesday morning
  
• Windows open to street; early in the morning air that comes in is good, but as traffic increases, so does the smell of smog that blows in the ER.
• On the first floor, close to the ER, the ceiling is either completely gone or dangling. Water drops fall every so often from the torn ceiling. The tiles on the floor are also in ruins.

Trauma

• Doctors here are very eager to have students shadow them
• I suggested at the group meeting on Friday for students to visit this department. The orthopedic doctors see patients from 10 to about 3 in the afternoon. They see about forty to fifty patients per day.
• Dr. Gil, whom I was shadowing, explained the diagnosis of every patient that came in with me. He showed me x-rays, pointing to where the bone had fractured.
• He had a patient who had experienced a knee injury and now had blood collected behind her knee cap (Dr. Gil had me apply pressure to her knee to notice the Jell-O-like feel of it). Dr. Gil drained the blood quickly and the patient was off. I had a great experience shadowing Dr. Gil. I highly recommend it to anyone going to Hospital Civil.

OB

I saw one C-section

• Vertical abdominal cut
• Four minutes – baby & placenta were out

Just as in the Urgencia, the doctors expressed lack of resources, and especially space, for the number of patients.

• Each day 25-30 babies are born; of these, 10-12 are by C-section
• C-section is performed only when it is absolutely necessary.
• The department is very small for the number of patients. Therefore, after giving birth, the mothers and babies are discharged ASAP.