Clinic got off to a late start this week. Lucky for all of us, Leonel decided to stick around for a few days, he came into clinic to show the new attending the ropes. The way things were supposed to work out originally was that the new attending would start working in the clinic basically without knowing the hospital’s system or the hospital at all since there was no overlap between attendings. With Leonel around the transition was much smoother.
Tuesday, Dr. Stephanie, the new attending, called me out of the clinic to come see “something interesting.” With more than a little trepidation I followed her down the long corridor into another clinic where a girl of about eight was sitting with a giant, weeping ulcerated wound just above her ankle. Leishmaniasis, they said. Carried by fleas, this parasite eats away at the skin, but causes no pain. Although the girl had the cutaneous form, there are visceral and other forms of leishmaniasis that can cause deformities and other ailments. This girl’s lesion had been steadily growing for four months; tests had been done that confirmed the presence of the parasite and a secondary infection. Apparently it’s not endemic to this area, she had been bit on the mainland and brought the parasites with her (one doc mentioned that other fleas may bite her now, becoming vectors that could infect other people with the parasite).
When I returned to clinic there were a string of run-of-the-mill complaints- colds, constipation, 10 day old babies in for well visits, followed by two seven year old boys with unusual pathologies- one’s yellow eyes, upper right quadrant tenderness and inability to eat suggested Hepatitis A, a disease that, Leonel said, many American pediatricians have never seen. (After calling me in to take a look, he asked, “By the way, have you been vaccinated against Hep A?” I told him I had received the first of the two inoculations. “Oh” he said, pausing, “You may want to take a step back, then.”)
The second boy’s story came out a bit muddled: He had been tooling around with a screwdriver and either scratched his eye with it or was around his father while his father scraped paint off the walls and managed to get some of that in his eye. In any case, the eye was inflamed and Leonel was concerned he may have scratched his cornea. Charles caught that it was actually a relatively large ulcer at the top of the eye. We had to look at the eye as if it were a hologram, adjusting the kid’s head and our perspective to get the light to hit the surface of the eye at just the right angle to see the ulcer, a cloudy triangle.
We rented “Dear Frankie,” a movie about a scrappy but damaged Scottish boy and his scrappy but damaged mom, and watched it on my computer, using the speakers Leonel had bought. In the middle of the movie, Leonel got up abruptly to check something out on the floor. He said there was a frog in the apartment, that he had seen it hopping. Audra and I were surprised- how did a frog climb all those stairs? We went back to watching the movie. Afterwards, as we were cleaning up the hot chocolate mugs and putting the chairs back, I said I hoped the frog found its way back out and Leonel confessed it wasn’t a frog he had seen. “Cockroach?” I asked. He reluctantly said yes. Regardless of whether he lied for my peace of mind or because he thought I would flip out and disrupt the movie, I appreciated the gesture. Things are going to be different when he leaves.
Later this week there was a mayonnaise jar with a cancerous uterus floating inside it that is perched on the orderlies’ desk in the maternity ward. It sat above the charts for the newborns that lie side by side, waiting to be read through and signed by the attending. It looks more like a naked, twisted cassava root than a womb. Apparently, as someone randomly came in and told us in clinic, it and the woman it was once a part of are wanted in pathology. I also saw my first instance of soda in a baby’s bottle. I had been on the look-out for it since Audra had mentioned it was common practice but this was my first real sighting. There really is no question why half the children who come through the clinic have brown teeth rotting slowly in their gums.
As part of her introduction to the clinic, we took Dr. Stephanie to the “country bar” in Coxen Hole, one of Dr. Charles’ favorite haunts. A piece of cardboard taped up above the women’s toilet reads, “VORNING,” then a little space before the line, “Don’t do no dope in the toilet.” Then it said the same thing again, slightly more formally, in Spanish.
For all the tearing asunder from their rightful places that goes on in the hospital of organs, food and waste products, there was one reunion story this week. When I first came to the clinic, Leonel, in his infinite optimism, taped up the vaccination record card that Jennifer Suoza Flores had left behind. “She might come back for it someday,” he said. For weeks it sat square in the middle of my field of vision when I looked just above the computer monitor. Then finally, I go to call the next patient in for triaging and who was it but Jennifer Suoza Flores herself. If this were a made-for-tv movie, my handing back the scrap of paper would have been in slow-motion, with grandiose music in the background.
Things growing where they shouldn’t seemed to be the theme of the day: one case of hair fungus, where a young boy of seven had a huge round bald spot towards the back of the right side of his head, and of course the usual parade of worms and intestinal parasites although made more noteworthy this time by one of the mothers saying that although she hadn’t noticed anything abnormal in her kid’s stool, they had traveled north instead of south; he had been chewing on ascaris worms the night before. In addition, the past two days have featured several repeat customers. Hep A kid came back, looking healthier and the probable malaria twins returned, too, although only one of the almost identically named identical twins’ malaria smears came back positive. But malaria tests are like fishing; you keep casting your line out until you reel in the result you want.
