No clinda

It's been hard to get a computer and internet service that loads up blogger, hence the lack of posts in the past few days.

Friday was my last day on the adult infectious disease ward.  It was yet another reminder of the lack of resources here.  The 30 year old woman I wrote about last week, the one I said would probably not make it until the morning, was still hanging on on Thursday.  She was still just lying in bed with her eyes open and a frightened expression on her face, but her blood pressure was up to 110/70 (from 75/55 on Wednesday) and she was getting the antibiotics she needed.  On Friday morning we checked up on her and her blood pressure was down to 85/55.  Apparently she hadn't gotten any doses of clindamycin or IV fluids since 6 PM the night before.  Clindamycin, we found out, is out of stock.  The lack of IV fluids can just be attributed to insufficient nursing coverage overnight, or poor communication to the night staff of the precarious condition of this particular patient, who can't drink or eat on her own and is entirely dependent on IV fluids to keep her hydrated and for treatment of sepsis.

Though I was uncomfortable with the fact that she didn't get her doses of clindamycin overnight, I could understand that it simply wasn't available, and therefore beyond the power of the night staff or the patient's attendants to administer the antibiotic.  Of course it would have been good to start treating with an alternative antibiotic, but that decision could arguably wait until the morning.  But the lack of IV fluids didn't sit well with me.  It just highlighted the fact that the system could so easily lead to the neglect of a patient that requires one of the simplest and oldest medical interventions available.  The bottles of normal saline, D5half etc were all just a few meters away in another room, but no one bothered, or to be more fair, no one was available or informed, that this patient needed to be on maintenance IV fluids overnight.

On Friday there was some discussion about how patient care is handed off to the night team.  Apparently, for some patients, the transfer is done by word of mouth, but for most patients, the night team just reads the notes in the patient's charts, which sit on the patient's beds.  That means the night intern(s) have to go around the ward and decipher what is going on with each patient based on the notes.  And it's not like back home where vitals are obtained every few hours, which at a minimum would give the night intern some indication about whether a patient requires some urgent attention.

Given the high rate of communication errors back home, despite verbal signouts on every patient and the help of electronic medical records (with all its benefits and drawbacks), I think it's a safe assumption that the rate of errors that happen here is significantly higher.

Today was my first day on the pediatric oncology service.  I write about that next time.