I have seen numerous sad cases this week. The first one was a 50 year old woman who was carried into my exam room on Tuesday. It appears that she had had a stroke. She could not speak. The right side of her face and mouth was drooping and her right arm seemed to be rather stiff. Her blood pressure was 211/108. I decided to try and get her to take an oral dose of nifedipine for her blood pressure. She did open her mouth for me to put the medication in but she was unable to take a drink so I used a syringe to give her some water to swallow the pill. She couldn't do it, the water just ran out of the side of her mouth. We had quite a few patients still waiting so Jay offered to put in an IV and give her a dose of IV blood pressure medicine so that I could continue to see patients. He gave her a dose of hydralazine then just hung a bag of normal saline to keep the vein open in case we needed to give her more medication later on. Initially when she came in there were multiple family members at her side. We have a policy that only two family members or friends can be at the bedside at a time so hopefully we can still get to the patient, so they had decided to let her sister and her mother stay, the rest of the family was waiting outside. When we re-checked her blood pressure it was slightly lower but she was still out of it, she could not talk and had lost control of her bladder. I proceeded to see other patients. This lady's family had stepped out for a few minutes and my assistant had also. I was sitting at my desk with my back to the exam table doing consults on a lady and a couple of her children when they was a crash behind me.  No verbal noise at all, just a thud... as this lady hit the floor. She must have been trying to roll over or something and fell off of the table. Her IV stayed in but of course the tubing was stretched tight and she was bleeding from her forehead. I quickly slapped my bare hand to her forehead to try and control the bleeding. Roseline is in a room across the hall and she must have heard the racket because she asked what was going on over there in my room. I told her my patient had fallen off of the table and was bleeding from her head, and yes, I needed some help. Jay must have heard the commotion also from the office so he came to help too. Roseline grabbed some gauze and held pressure to the lady's forehead while I went to wash my hands and get some gloves on then we lifted her back onto the exam table. When I removed the gauze from her forehead she had a wound almost in the middle of her forehead from hitting the corner of the shelf on her way to the floor. It stopped bleeding pretty quickly so we just put several steri-strips over it. Then Jay talked to her family- he told them that we suspect she has had a stroke and do not know how much if any of her previous functions she will regain. She is conscious, but does not seem to comprehend anything that is going on, cannot speak, and cannot swallow. It also does not seem like it would be of any use to take her to a hospital at this point. The family seems to comprehend the situation and take her home.  I heard this morning when I got to the clinic that she died last night. Fifty years old- that is life here. Real, every day life. On a positive note, I didn't have to fill out an incident report for the fall...

     Yesterday a woman and her 11 year old daughter came for consultations. The woman looked sickly but not deathly ill like she needed to be in the hospital. I did the daughter's consult first. Rather vague symptoms- stomach ache, head ache, diarrhea for 6 days. I had written for several medications for her then I proceeded with the mom's consult. She too had vague symptoms- head ache, stomach ache, etc... then she said she has had diarrhea for a year. Caution lights go on in my brain- I need to test this lady for HIV.  We have rapid HIV and syphilis tests at the clinic so I test her... she is positive for HIV. My assistant and I talk about it a little and decide to test the 11 year old also.  We are almost out of syphilis tests and the Mom's test was negative so I just do the HIV test. She is positive also! We ask the mom if she has any other children. Yes, she has another daughter (18 yrs old) who is here but they weren't getting a consult for her. The mom goes to get her and I test her also. Her test is negative. Where did they get it from? Did they give it to each other? Did someone else give it to both of them? Surely this wasn't congenital, I don't think the mom would still be alive if she had had it 11 years and wasn't getting treatment. We do not have the medication to treat HIV at our clinic but we take down their names and phone number and will pass that information on to someone who has a clinic in Croix-des-Bouquet. This clinic will then get in contact with the patients and provide medications and follow up. It is sad... I wonder how the child got it...

     Another patient I had yesterday was a man with an enlarged prostate. We have numerous patients with prostate problems who cannot pee and so need a catheter. Some of them come every month for a catheter change, some don't come that often, some only come when the catheter isn't working and they are in intense pain. It has been very difficult getting a catheter in this patient in the past. A little over a month ago when we changed it last I was not happy with how it was draining. It did not flow well at all so I had flushed the catheter several times and gotten multiple clots out but it still was not draining well. I left the catheter in place because it was at least partially working and told him he had to go get this checked out at a hospital. So, yesterday he comes back in a lot of pain and with bloody urine in his catheter. His catheter looked suspiciously like the one I had placed a month ago so I asked him if he went down. No, he hadn't.  He didn't have the money. So I asked him what he wanted me to do, I had done my best last time and he needed more help than I could give. Well, he didn't go down because he didn't have the money, but now he is back at the clinic wanting his catheter changed. I tell him I will try. I tried, several times, several different sizes, with no success. I cannot get it past his enlarged prostate. I give him pain meds, and an antibiotic for a UTI because his urine was bloody. Roseline comes in to help me explain to him that we have done everything we can here at this clinic. He needs more help than we can provide. If he is unable to pee without a catheter he needs to go to the hospital and not come back to us...It makes me feel bad, but I have done everything I can. We give him a little bit of money before he leaves to help with the expenses of more testing etc... 

     Yesterday I also saw a man with a mass on his neck. It appears to be some kind of a cyst and not an infection. It has been there a long time and just slowly gets bigger. They say a nurse from our clinic has drained it before, it was not filled with pus, rather a yellow liquid. It was quite a large lump and was bothering him so I asked him if he wanted me to try to drain it again. Yes, he did. So I got out the lidocaine and numbed a spot on the side of the mass then stuck a needle in it, and aspirated 22 ml of dark yellow liquid. It was a rather satisfying feeling when he left with a normal looking neck that only had a bandaid on it. I don't know what kind of a cyst it is, the fluid may re-accumulate, but hopefully it won't, at least not for a while.

     Casey and Rebecca and their boys were planning on coming today to visit but several of their COVID tests were positive so they can't come. I'm disappointed,  but I'll get over it.