Behind the White Coat

Earthquake Relief

So I have been a little MIA lately, due to mostly my beatdowns on the medicine wards.  As my cousin Zohare pointed out, my post regarding the earthquake is overdue.  Between my work, and my attempts in contributing to the relief effort, and other crazy things, I have had just about zero time to post on this blog!

Anyway, for those who may be less informed, on October 8th, 9:52am local time, Northern Pakistan was hit by a 6 minute earthquake measuring up to 7.6 on the Richter scale.  The quake devastated the region, with the epicenter at Muzaffarabad, and affecting parts of Afghanistan and Indian-controlled Kashmir as well.  As of my latest info, the death toll surpasses 40,000 in Pakistan alone.  This is the worst natural disaster in the history of the nation.  The capital of Pakistan, Islamabad, lay barely 60 miles from the epicenter, tumbling buildings, causing landslies, and changing the lives of many forever.  My family all hails from there, so it definitely hit close to home.

Apartment buildings crumbled into piles of rock, children at school during the morning were crushed in the rubble of schools across the region, entire towns have been lost, and thousands of families are left in dissaray with not even a roof on their heads.  An additional 60,000 plus have been injured in some way, with the children taking the worst of the burden.  The death toll will continue to rise with the upcoming cold wintry weather and with the spread of infection and disease.  The cold and rugged weather also poses difficulty providing relief to the more mountainous areas, and will continue to be a challenge in the coming weeks.

The response by Pakistanis and those across the world has been swift and plentiful.  Already people from all over the world have sent help in the form of money, supplies, warm clothes, tents, medicine, and even heading up to try and find survivors who still lay buried among the ruins.  In New York area, the response has been fantastic.  Already we have shipped boxes and boxes of clothes and aide over via PIA who has been helping us get relief to the area.  We will continue to ship relief for the next 2 weeks as well, so if you have no resources and still want to help, you can definitely do so.

Currently the most valuable thing to the people is shelter.  Tents is what we need. Lots of tents! Sleeping bags are good to.  If you have a resource or can donate any of these, please do so. Contact one of the organizations listed below, or contact myself, and we can make it happen.  Medical supplies are in need too!  I have managed to get my medical institution to donate a number of supplies including IV fluids, syringes and needles, gauze and bandages, and other basic medical supplies. Medicines such as painkillers, antibiotics, antiseptic creams, etc. are also in dire need.  If you have a resource for these, do help!

My cousing Zohare is also involved in the effort from the Pakistan side.  Check out his site at http://zohare.blogspot.com  I have listed a number of organizations below that are directly involved in the effort, or even just collecting donations to go towards the quake relief. 

Thats all for now, with my quick 15 min I had to spare in my hectic dayI will update the issue as more is unveiled...

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Ways to Help:

Citizen's Foundation

www.thecitizensfoundation.org

Oxfam

http://www.oxfam.org.uk/what_you_can_do/give_to_oxfam/donate/asian_quake.htm

UNICEF

http://www.unicef.org/

Mercy Corps

http://www.mercycorps.org/

International Federation of Red Cross and Red Crescent Societies

http://www.ifrc.org/

The Edhi Foundation

http://www.paks.net/edhi-foundation/

 

DIL (Developments in Literacy) Organization

www.yourdil.org

Klau 5, Ali 0.

You know it's not even how efficient you are, or whether you work fast, there is just so much goddamn work to do that you end up staying late alll the time.  Friday I was on "short call", so I got my one 6am  admission out of the way early.   But I didn't leave the hospital until like 9pm! (When signout in theory is 530pm).  Klau just has so many sick patients!  I got 8 right now, and people just deteriorating left and right.

I go this one guy who ill call Mr. Chidi.  He is this 450 pound Nigerian guy with all the standard probs in the book: heart disease, diabetes, pacemaker,  and it goes on.  His Sleep Apnea is so bad, I saw him go apneic for about 14 seconds as he lay in the hospital bed like a beached whale.  He roams the halls like a gorilla, waddling, and doing that "I'm stretching my arms move, but I really am using it as an excuse to reach for something."  Though it wasn't to cozy up with a girl, it was to strategically swipe a banana from the food cart.   But anyway, Mr. Chidi came with a little shortness of breath and sugars in the 500s, but he was fine to go the next day or so.  Until the IV they put in his neck (only vein was the external jugular) got infected, and he went into sepsis.  Great.  So he started crashing Friday night keeping me running around well into the night. 

The list goes on after that.  My disheveled, annoying, demanding alcoholic who confabulates and annoys the shit out of everyone.  Ripping out his IV and refusing meds, I should have just let him go into the DT's (delerium tremens - life threatening alcohol withdrawl), but instead Im again trying to stabilize his ass.  Just pump him full of Ativan and keep him off my back!  I got people in heart failure who have gained weight and gotten worser saturations since admission despite pumpin them full of diuretics to pee out the fluid, I got people going into acute kidney failure, and dying cancerous hospice patients.  My one poor lady, only 60, with end stage hemochromatosis and heart failure.  Her heart has more gallops than the Belmont Stakes.  She is sadly likely to die before I even get her a hospice bed.  And I have a young black guy who has been here for almost 3 weeks, with a still undiagnosed cancer that has spread to his liver, kidneys, lungs, and bones.  Now he has a pneumonia, a bad urine infection, and his kidneys are failing too. 

Anway.  The medicine floors at Klau aint a day in the park.  You learn a lot, but work hard.  I am on call tomorrow Sunday going in with 8 patients.  Ouch.  It may be the day that I cap at 12 patients.  Wel at least I got today off.  Too bad it was pouring rain!!!  I can't win.  Klau has the upper hand.

Klau Continues

I am running a service of dying people.  If you are admitted to my service, you are sure to either have cancer, or somehow go into renal failure.  It is really quite depressing.  I have already had to tell 3 people bad news.  "Your infection has improved, but I'm sorry to tell you that you're dying of cancer."  No shit.

One guy came in complaining of weakness for 4 months, and weight loss of 25 lbs, with shortness of breath.  Now why would you wait that long to seek help?  Guy walks in, 35 years old.  Only history is of sickle cell trait.  His eyes are yellow, his liver tests show elevated enzymes, meaning something aint right.  So we scan his belly, and he's got lesions all over his liver, and enlarged lymph nodes everywhere, and masses in the liver.  Bone scan shows lesions in more than 10 or 15 of his bones.  Cant be good.  Hopefully the biopsy (try #2) tomorrow works, because the rate his liver and kidneys are failing he's got little time left.

Not so lucky was Mrs. J, who was a 60 year old nursing home resident, with many medical problems, a stroke, and some dementia.  She was admitted for a urinary tract infection.  Nothing too crazy.  She got better, but we noticed an old scan showing she may have had pancreatitis.  So we figured we would re-image her belly before we send her out to see if everything is OK.  Oh dear.  "Sorry Mr. Jackson, your mother's infection has improved, but we just found stage IV metastatic pancreatic cancer.'"  She died of rapid onset fulminant liver failure with hepatorenal syndrome a few days later.  Thankfully she was made DNR one hour before her death.

Finally I had Mrs. D.  An elderly lady of about 66 who came in with weakness.  Her kidneys were failing, and a sonogram showed hydronephrosis, or when the kidneys are very dialated.  She had to get a nephrostomy tube put in her right kidney (a tube in through the back into the kidney to drain urine into a bag).  After that she dropped her pressure, got worse, and got an emergent left nephrostomy.  finally her kidneys were stable (with the tubes of course).  Then we noticed she had some bleeding, and we did a CAT scan.  Oh man.  Metastatic ovarian cancer to the lungs and brain.  She was a candidate for neither chemo, surgery, nor radiation.  Went to the nursing home for palliative care, and ultimately will die.  Hopefully she'll get enough morphine and oxycontin to keep her comfy when she goes.

Anyway.  The list goes on.  But I have had some sick patients.  I think I should give everyone a full body cat scan and a renal consult when they get admitted to me.  My luck hasn't been too hot!  Though today I was on call, got 4 admissions, and got out at 9pm, which is quite early.  The other day I was on short call (only one admission), and I didn't get out till 9:30!   The worst part of it all is I wake up at 5am or 6am, alternating days.  What kind of life is that?  A crappy one.  I'm gettin beat down.

Klau 1.  Ali 0.