Its been kinda slower over the past few days for interesting pictures, but by no means slow at the hospital!  We had a patient who coded - would have absolutely benefited from intubation, but because the ICU had no extra vents, and the PICU only had one, we began bagging.  We were able to bag the patient for so long, pulses lost again - and back and forth it went.  Eventually we called it.  Such a difficult case to accept, she died because of the lack of options available to the Emergency Department.  

This lady was suspected to have some form of uterine malignancy - obvious ascites with an umbilical hernia that was filled with one loop of bowel.  She came to the ED with a lot of blood loss to the hernia site - she said she had a spontaneous bleed to the base of the hernia and wasn't able to stop the bleeding.  It is amazing how far along illnesses go here only secondary to access.

This family is absolutely amazing.  Her mother was normal 16 years ago, has had progressive decline of her health since then.  It started in her feet with weakness and progressively advanced more proximally.  No, it's not MS.  She has taken her mom all over the world to figure out what is wrong.  No one has been able to figure it out.  She is to the point now where her daughter even has to hold her head up to see.  But she is so happy!  Her daughter made boards with the alphabet and numbers that her mom used to point at in order to communicate - as her voice went years ago, but now with the loss of strength, her daughter now points and her mom blinks at the appropriate letter to spell out their conversations.  So inspiring.  She said her mom doesn't like to miss her shows, and always puts on her best dress when they leave the house.  And, something very similar for me, she said her mom always is upset she doesn't do her hair or put on her makeup to go places!  They have been told it's most likely MSA - multiple systems atrophy.  

What is also upsetting, is that her daughter (white t-shirt) really wanted to go to nursing school, but because they are required to live on campus and she wasn't willing to leave her mom - she was rejected.  She's okay with that - as "some things are meant to be."  

 Another sweet lady who has had a mass in her throat for over 10 years.  She has seen doctors over the years who have biopsied the mass and told her she was fine.  She came to the department a few days prior, seen by the surgeon and sent home with Tylenol.  Over the past day, she said she was having a hard time breathing and was scared.  She only tolerates liquids, no longer can swallow any solids, and as soon as we started chatting, she broke down into tears about her extreme pain from the mass.  She also had ptosis in her Left eye.  After some pain control, she finally took a nap.  I had the ENT come take a look - speechless at first, she immediately said to admit her for a potential surgery with a CT scan pending.

Yes, that small area to the left of the picture is her visible airway.  Her uvula is squished right onto the free edge of the mass.  The rest is all mass....

  

This made me laugh.  Not only am I too pale to be in Fiji, but I only have about a week and a half left here, and my registration just cleared today!  Everything on Fiji time.