island tour in Tobelo
on the band-aid boat en route to the opening ceremony in Ternate
Sultan's palace in Ternate
I am currenlty sitting in the middle of the post-op ward, listening to one girl who is crying coz the nurse had to change her clothes. There’s two boys in the play room playing soccer, and our little Santi who has gained the title as the muse of the peds ward. We’ve been so busy these past few days that I haven’t been able to jot anything down on my blog.
We started admitting kids in pre-op on the 18th, and 10 of them had their surgery yesterday (20th). Some of them went home today -- mostly kids who had inguinal hernia repairs. I admitted two kids on the 18th for cleft lip and palate surgeries. A 5-month old boy who, to me, looked “syndromy”. He had low set ears, eyes a little wide, and a mild pectus excavatum. Besides being “syndromy”, I noticed that the kid had symptoms of URI. When I asked mom about history of recent illness, she said that her son was not sick, but perhaps the bath (the one he had two minutes ago as part of the admission process) made him sick. As I looked back on the pre-screening exam, anesthesia reported that the kid has had URI for the last month. When prompted, mom said, yes, he was sick for a month with a fever but since they do not take temperatures, she has no recollection of how high it was. Parents are desperate for surgeries so they do not tell us certain things, in fear that they will be denied for surgery. I made the pediatrician aware of my concerns. When I heard that a kid was admitted in the ICU, I knew exactly who it was.
The other kid I admitted, a 9-month old who needed a cleft lip repaired. At this point, I questioned if I was over-assessing these kids, and perhaps thinking too much into things. I questioned my own assessment skills as I told the pediatrician that I thought the kid looked malnourished and dehydrated. Apparently mom stopped feeding him milk and switched to tea because the baby “didn’t like milk”. This kid, like other, also had symptoms of URI and recent fever. I passed it on to the night nurse -- my clinical findings and that I made the pediatrician aware. When I got back to work two days after, I found out that the baby did not have his surgery because he was DEHYDRATED and MALNOURISHED. His chemistry came back abnormal They had to get a full nutrition consult, hydrate him and give him calories.
I was so frustrated last night, contemplating if I was right, wrong, or over-analyzing the situation. It drove me crazy. I went to bed upset and confused, heartbroken and frustrated. In the states, we look down on mothers who neglect their kids but these mothers aren't neglecting them, they just don't know any better.
July 22, 2010
Another day of discharges and admission in the peds wards. We got one girl who is s/p neck mass resection and seems to be doing well. I love kids, and I say this with complete sincerity and honesty, but I have a
2-yr old s/p cleft palate repair\who has not stopped crying since… probably since birth. These are the times I miss ativan (kidding!). Santi left on the 0710 boat this morning, and catching a flight back to Jakarta. We all miss her. She came in with minimal vision to both eyes and left with a brand new vision, new glasses, and new sunglasses =). Katie and I took her and another 8 yr old girl (who had a palatal fistula repair and full upper teeth extraction) outside to see Ternate from the ship. Santi caught the helo, waved at them and yelled “HALO!!!”.
1st time my feet touched land after 2-week sail
view of the Mercy from land
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