This week I finished my rotation on the CCU and I have started my new week rotation on Nephrology. From the last time I have blogged a lot has happened. We had a patient who went to the Cath Lab for an angiogram, and I got to go with them. An angiogram is a diagnostic test where the doctor/surgeon will put a catheter in a patient’s femoral artery to look at the patient’s heart by injecting dye and taking X-rays. This patient is quite poor and his left anterior descending artery is narrowing and he needs a PCI, stent, but because he is poor he cannot afford the treatment, and therefore will not receive the treatment. The cath lab is a sterile environment, but sterile here and sterile in the United States is very different. I have made friends with two of the Nepalese doctor interns. They are the sweetest, and have helped me be able to see and do more in the hospital. We went to tea everyday in the hospital canteen, and one day they took me to lunch!
Another experience that occurred was my first code here. The patient was very sick. She had her mitral and tricuspid valve replaced many years ago. She had an AKI, pleural effusion, and hypothyroidism. She was in septic shock, and came to the hospital many days after she had already gone into septic shock. This was the first patient who had a central line and a ventilator that I have seen in the hospital. She was not on sedation, and I am unsure on how often they performed oral care, I only observed them performing oral care once. Her blood pressure was 64/34, and her pitting edema was the worst I had seen. She was restrained but her restraints were two fingers taped together, and then gauze between the two fingers tied to the bed.
This week I started nephrology. Most of the medications are in ampules, I was discussing with a nurse about syringe filters, but they do not use syringe filters like we do when we pull up medications from glass ampules. There were three patients on the floor that are receiving dialysis, they only do hemodialysis here. I felt the thrill and listened for the bruits. Last week there were two patients who had kidney biopsies. The cost of a kidney biopsy here is 14,000 rupees which is around $140. The kidney biopsy is sent to India, and it takes 10 days to get results. The patients in this unit look miserable. A lot of the patients have AKIs or ESRD. Many patients wait months to even come visit the hospital. I asked a nurse why it takes so long for a patient to come into the hospital, the patients believe that one more day they will feel better, and they will get better so they don’t come to the hospital. One patient with ESRD waited over a month to come to the hospital. It amazed me how long it takes for people to come to a hospital, especially with such chronic illnesses.
This past weekend we went to Lumbini, the birth place of Buddha, which was over 100 degrees everyday. We arrived on Saturday after a 4 hour bus ride on a public bus with out it conditioning and more people than there were seats. Then we took the city bus to Lumbini which took an hour. That was the worst part of traveling, there were so many people, it was so hot, it was dusty, and it was dirty. We finally arrived at our hotel, and opted for a non-air conditioned room, which was great when we arrived because our room was coo, but by the time we go back to the room it was SO HOT. We got lunch and met up with a volunteer who had volunteered with projects abroad a few weeks before I arrived and she took us to Buddha’s birthplace and toured us around because she had done it the previous day. Buddha’s birthplace was something special. It was amazing to watch Buddhists in their home environment. We witnessed chanting, prayer, and meditation. We saw monks, and many prayer flags. The next day we went to see all the Buddhist monasteries that other countries have built in Lumbini. My favorite few are Germany, Nepal, and Thailand. They were beautiful, so much architecture and color. Each country’s monastery depicted their own Buddha, that represented their culture. There were Buddha’s and prayer flags everywhere, with sacrifices, gifts, and lots of food given to the Buddha. During our time in Lumbini, we saw a lot of poor people, beggars on every corner, but then you arrive to the monasteries and they are marble, and beautiful, you see both sides of economic status. It was truly an experience of a lifetime.
Today my host family had a mourning ceremony. They are Hindu, so a year after a family member dies they have a ceremony and the whole family comes to town, so we have a lot of people staying at our house right now. There were probably close to 60 people at the ceremony, and close to 15 people staying at my house. My house dad invited all the volunteers, so we all went and ate with them for lunch. The food was so good! It was a really neat cultural experience to see the end of the ceremony and see my host’s family whole family. The food here is amazing. My favorite thing so far is shahi paneer, which is a gravy made up of cream, tomatoes, and Indian spices, with cottage cheese, served with roti, similar to pita bread! A lot of the food here is fried and oily, and there is not much meat, but the flavors are so good!