Dr. Kern, what do you think of this?

Today was our first day on the wards as Tim mentioned. We got to see a handful of interesting cases and I am certain our physical exam skills are going to improve on this trip – they are very precise about physical exam here, I think we gloss over it a little and just order imaging studies. (I do like to look at imaging studies.) When we were at the bedside and a 4th year medical student was presenting her patient to the team (in front of the patient, but I don’t think the patient speaks english) the attending grilled everybody pretty hard (including us) but then broke down the murmur the patient had very very carefully. It was a mid-diastolic grade 3 murmur, turns out, secondary to rheumatic fever and she had a heart failure exacerbation. Man, I think I am lucky to hear diastolic murmurs at all sometimes. I am going to resolve to listen more carefully in the future, Dr. Packer style… Oh, and when we were talking about her lab values and found an iron-deficiency anemia he asked “And what is the most likely cause of her iron deficiency?” I was certainly thinking GYN losses but it turns out in India it is actual hookworm infection – they treat empiricly. Hmm.

Tim and I took pictures of the front of the ICU where you are expected to take your shoes off before entering. Yes, dear readers, I was barefoot in the ICU!!! I got a good picture of Tim taking his shoes off so we can send it to our MICU back home… From what they’ve told me they haven’t had any acinetobacter outbreaks here… Maybe it works?

Some thoughts after Work Day #1…

Today was our first real day ‘working’ on the wards (its more observing than working, kind of like being a glorified 3rd year med student). The work day in this teaching hospital runs from 9AM to 1PM, no duty hours violations here. Most of the attendings go to their private practices in the afternoon where they make most of their incomes.

Today we rounded with a group of medical students. We saw a patient presenting with a CHF exacerbation, but I missed the diastolic murmur key to making the diagnosis of Rheumatic Heart Disease. I must remember to broaden my differential here.

I asked one of the students who all the people laying in the hall outside the wards were. She told me they were the family members of the patients. She said they are not allowed back into the Intensive Care Units. I asked if they at least get up-dates ont he condition of their loved one and she said “Thats not how we do it in India.” All the family hears are requests to go to the pharmacy to buy another antibiotic or bag of saline. The people seem to accept that this is the way it is. I know when my father was in the CCF ICU, I was at his bedside hanging on every word the team was saying and we were asked to leave due to visiting hours, my mom and I got pretty fired up. Its is probably a good thing they didn’t ask us to wait in the hall all day without any up-dates.

The other case that struck me today was a Temple Priest with pancytopenia and fevers. The resident said that their was a delay in making the eventual diagnosis of HIV (with parvovirus?) because they assumed he would not be someone to get HIV given his profession. It turns out he contracted the virus from a surgical procedure 5 years ago. It seems even in India, doctors make assumptions and value judgements about their patients.