The night before last, one of the other doctors admitted a 22 year old male who had ingested concentrated paraquat whilst intoxicated.  At the time of admission he was 24 hours post ingestion and his presenting complaint was pain in his mouth and throat due to chemical burns.  The night shift doctor handed over the case, along with a wealth of information regarding paraquat accumulated from internet searching and ringing the poisons helpline in the United States.  The outlook from all this data was bleak, especially given our lack of facilities to deal with multi-organ failure.  I have no experience with paraquat poisoning, but from published case reviews it appears that paraquat ingestion anywhere in the world is a one-way road.  more…

After the blow to my confidence last week with obstetrics patients, I have developed a healthy fear of the uterus and have understandably been reluctant to see ante-natal, labouring, or post-natal patients.  Any organ that bleeds 500ml a minute is a thing to be feared in my book.  Of course the problem with my reluctance is that over 50% of what happens here has something to do with pregnancy, and again today we found ourselves without an obstetrician for both a delivery and also an ante-natal clinic.  Me, again? Oh no. more…

Before I arrived here, I was concerned about quite how bad my first on-call could be given the new environment, the language, and the vastly different presentations that I could see.  I’d done my homework, I knew that Guatemala ranked highly in both maternal and infant mortality rates, but I’m not sure I’d taken the time to consider how I might personally react to an horrific on-call.  The transfer of a numerical statistic to human contact is a difficult step to take. more…

One of the most exciting aspects of working here is the opportunity to have a good rummage among the rarities of diagnoses that I learnt about for the MRCP.  There have been a few cases now, which have rung a big bell in my head, related to conditions which I never thought to save space for in my brain, as they seemed so obscure and unlikely.  more…

I thought I might be broken in gently to the new job, but I arrived last Friday in Santiago, and was thrown into a 24hr on-call in the ER on Saturday, which was thankfully remarkably quiet.  Sadly I have had to convert to transatlantic terms, as when I use the term A+E, my American colleagues seem to think I’m talking about the cable channel ‘Arts and Entertainment’.  more…

I’ve spent the last week relaxing in Antigua, Guatemala, hauling myself through 6 hours of Spanish lessons a day in a last minute attempt to quell the panic before I start work. I’ve discovered that learning to take a history in Spanish is somewhat like those 3rd year days of worrying; what came after the ‘history of presenting complaint’; was it the ‘social history’ or the ‘family history’?  Will the patient notice if I get it round the wrong way?  Do I really need to think of a memorable, inappropriate rhyme to recall the order of a medical history? more…

It wasn’t until the last couple of weeks that I began to have terrible, panic-stricken nightmares about my dreadful communication skills.  I wake in a trembling state, sweating because I can’t remember how to ask my patient ‘Does the pain radiate anywhere else? Does it come and go?  Is it sharp, stabbing pain?’
In my night terrors, it’s always the same patient, and me standing open mouthed bubbing like a goldfish. Now don’t worry, this memory problem isn’t pathological, I’m not dementing or growing a tumour, I’m moving to Guatemala for work.  Despite my 6 months of Spanish lessons slotted in around understaffed rotas, without a doubt I’m going to have some total communication failures.  The Calgary-Cambridge model probably isn’t going to cut it in the event I forget the words for ‘I need some help, she’s haemorrhaging’. more…