It’s a while since I’ve blogged a day in my life. This sort of post is pretty boring for my Nepali readers, but gives a unique perspective of the diversity of the cases we deal with here. This was how my day ran last Thursday. I was rostered to endoscopy and outpatients.
On the morning ward round, I helped review all the current inpatients on our unit, and we saw two new patients admitted overnight, both burns patients. One was an 8 year old with a scald burn from spilled tea. One was a 7 month old who precociously crawled into his household cooking fire and got burned on both feet and hands.
Endoscopy list (upper endoscopy only, no sedation)
- 56F with chronic gastric ulcer
- 50F with hiatus hernia – ?contributing to her epigastric pain
- 96M with duodenal ulcer – presented with haematemesis
- 32M with oesophageal varices – presented with haematemesis
- 18M with oesophageal varices – presented with haematemesis
Both the varies patients I referred to our colleague who does vatical banding. Although a common pathology here, I have not learnt to do banding.
General surgical outpatients
My resident had seen some patients in clinic before I got there, but he saved some for me to review. I’m mostly keeping the patient demographics secret to protect patient anonymity.
- Plantar warts with one giant heel wart, present for 20 years – booked for surgery
- Left breast cancer in premenopausal woman, biopsy negative – booked for mastectomy and axillary clearance
- 2 Hydrocele – booked for free surgery under a current government funded hydrocele camp
- 2 Minor skin lesion – referred to minor operating room for excision
- 2 Review of postoperative wound – reassured
- Haemorrhoids – booked for surgery
- 4 Inguinal hernia – booked for surgery
- Asymptomatic gallstones – reassured
- Bilateral staghorn calculus with polycystic kidney disease and chronic renal impairment – referred to higher centre in Kathmandu for treatment
- 3 Renal pelvis stone – referred for PCNL
- Keloid ear piercing – good response to intralesional steroid injection, so another dose prescribed
- Chronic epididymo-orchitis – given long course of broad spectrum antibiotics
- Uterine prolapse – booked for preoperative investigations
- Urinary retention due to benign prostate disease – referred for TURP
- Hydrocele and contralateral hernia – booked for surgery
- Symptomatic cholelithiasis and polyp – booked for surgery
- Chest wall pain – given symptomatic treatment
- Lactating breast abscess – admitted
- Previous patient with splenectomy for haemolytic disease popped in to say hello. He has had a good outcome and has needed no further transfusions since surgery.
- Incisional hernia in appendicectomy scar – booked for surgery
- Penile infection leading to penile auto-amputation, now presenting with chronic non-healing wound and incontinence (!) – admitted
I remember being completely overwhelmed in outpatients by the diversity of cases and my lack of knowledge, but I quickly learnt the basic management of many conditions. I continue to be challenged by language in outpatients, but I can now pretty much understand and make myself understand. I should also mention that the patients booked for surgery generally have their operation within 2-3 working days.
Cris, I am constantly amazed by what you have to deal with over there and how you cope so well. God bless you and your family. Leonie