The little ones & day trips

The failure to thrive baby who was abandoned at an orphanage passed away today. As Veena and I walked into the 6 unit bed to pre-round, I saw her empty bed. The only sign she’d been there was a bag full of her belongings. If I hadn’t known better, I would’ve thought she’d gone home. We were getting ready to discharge her despite the fact that her weight was trending down. The saddest part was that no one was with her when it happened—the attending found her in the wee hours of the morning. In some ways, I’m glad she is resting now, as it pained me to see her cachetic, air-hungered face every morning, knowing she was slowly wilting away. 

Dr. Vivek, our attending

Sisters

One of our cuties ;)

There’s another kid on the wards who I love. One of the few kids who can speak English, I ask him questions and examine him in the morning. He reminds me of one of my favorite patients back home, who came to Stanford for expert evaluation after being sick for at least 4 years. After a long work up, the etiology of his complicated condition ended up being restrictive pericarditis. I followed him through my medicine rotation and sub-i and scrubbed in on his pericardial stripping on the last day of my sub-i. However, I also clearly remember the ensuing months of post-op complications when he was near death. I’m afraid for my kid here. He’s about 7 and there is a questionable history of pulmonary TB followed and disseminated TB for which he was maybe treated. No one had looked through his charts to see if he'd even had sputum cultures. When I asked if they do susceptibility testing for TB, I was in disbelief to hear they don’t. There’s MDRTB in this part of the world and there are affordable ways to test. The fact that his diagnosis is questionable is ridiculous; even more so is the fact that this kid is tachypneic to the 40-50s and he doesn't complain of shortness of breath because it's the baseline he's had for the last 4 years. We sent him for an ECHO to another hospital on Tuesday (bc we don’t have a good ECHO or a peds cardiologist) and his findings (increased right sided pressures, septal bowing, dilated IVC, thickened pericardium) are consistent with restrictive pericarditis. Tomorrow we’re transferring him to another hospital so that he can get a pericardial window. I’m worried.

It’s been pretty tough to get my project started. I’ve had a few issues at the hospital and hopefully all the time I invested as well as the materials I brought aren’t a waste. I won’t write more about this because it makes me angry to think about it and the multiple discussions I’ve had with the various people involved.

Every day I’m thankful I’m here with Liz and Veena and living in the guesthouse. It’s nice to discuss what we see/do in the hospital. I’m not going to lie, it has been frustrating at times (in case my venting doesn't give it away). Rounds and discussions break into Nepali and I’m left clueless. The residents and interns are soft-spoken so I can’t hear clearly and often miss what is said in English too. That said, there are a few awesome residents and interns at the hospital who have made us feel welcome, including Suprava, Neeva, and Shilpa. It helps that they see that we’re interested and care.

Marian on the far left. Toilet builder extraordinaire and Nepal expert!!

 Wednesdays and Saturdays are our days off. The residents get the same days off. We’ve been using these days to explore the area around Patan. Our first Wednesday we stayed really local, and explored the first of the Durbar Squares, in Patan. It’s a UNESCO site and holds the royal palace. It’s dominated by Newari architecture. The square itself is Hindu, with abundant temples. The buildings are so elaborate, with amazing engravings. I took tons of photos, which you can access here.

We went to our second Durbar Square on Saturday. Taking a taxi into Bhaktapur we passed a few shantytowns. With the rain and lightning storms we’ve been getting every afternoon, I wonder how their makeshift homes are doing. Bhaktapur was more spread out and less crowded than Patan. There were some quite interesting engravings mixed into the religious buildings which I'm sure many have written about. That day, we tried this yummy yogurt called King Curd that reminds me of Greek Yogurt back home. We treated ourselves to a nice Mediterranean dinner in Thamel that evening.

Getting ready for New Year!

Our timing was off ;)

    

Juju Dhau, King of Curds

Yesterday we went to the Monkey Temple, aka Swayambhunath. The view was great and worth the endless stairs we trekked up, though it would’ve been better without the crazy pollution that plagues the Kathmandu Valley. There weren't as many monkeys as I thought, but it wins for one of being one the most touristy areas I'd been in so far. At the end of our trip we were trying to take photos by an awesome wall, and before I knew it two Hindu men came up and placed a tika on our (Mathanki, a Kiwi med student doing an Ob-gyn rotation at Patan who lives in the same guesthouse, and me), foreheads, demanding a donation for the blessing (and cursing us if we didn't). Next time, I'll be ready for the situation!

Walk Clockwise ;)

HUH?!

   

Stairs!!