I had thought this text had uploaded, but I guess not... hmmm.
So some of the more interesting stories I'll try to list here.
One thing I was impressed by was the number of “hysterical reactions” or pseudoseizures that came in to the ER. I suppose I shouldn't be. I mean, I'm hesitant to diagnose depression in the Bronx (“Hey man, it's not your attitude/outlook or brain chemistry-- I agree with you, your life sucks.”) where at least you're not getting dysentery or malaria 3-4 times a year and your poverty does not preclude getting a ride thanks to public transportation. So why shouldn't there be a relatively high burden of psychiatric disease in a recently post-conflict poverty stricken nation? About once a day a girl/young woman would come in, not speaking, or unconscious, or staring. They'd usually get a dose of quinine before I was able to resuscitate them with an advanced ER procedure known as a “sternal rub.” (yes, think of it like a noogie-- except in the center of the chest. Really annoying and likely to cause you to come out of your psychologically induced coma). I can't argue with the quinine, though. Top diagnoses for acting screwy, depending on age, were cerebral malaria, HIV, hypertensive encephalopathy, and hypoglycemia.
So, they'll tell you in Liberia that the language is English. Not quite. Most people do speak a kind of “pigeon” English. I think it's equivalent to the way some Dominicans speak Spanish. Letters/sounds left off here or there, different idioms, etc. So it's not always easy. We actually started on a phrase book for the people after us. “Tryin' small small” means “getting somewhat better.” “Running stomach” means “diarrhea.” “O'Ga!” means “My Goodness, this is really painful.” And, interestingly, “Fell off” means “passed out” or “became unresponsive” or “felt weak.” (“Fell out” is sometimes used in the Bronx-- any others people know about?). So, when I came across this young man who “fell off” and has been “weak” since, I initially didn't think much of it. Get a malaria smear, give fluids, dextrose, etc. However, sometimes, “fell off” means something much more literal and in keeping with how I use the phrase. Sometimes, “fell off” means “this guy fell off the roof he was working on, landed on his head, and hasn't really been able to move his arms or legs since, so we brought him here in a wheelbarrow with his neck hanging over the back of it.” Overcoming this linguistic barrier I feel, was, in retrospect, key to his eventual care and disposition...
I decided to start calling him Lazarus. After ~ 6 weeks on the floors, getting intermittent physical therapy, he's able to stand on his own again (Partial cord syndromes, his diagnosis, have a good prognosis a few months out). He was so happy to see me when I went up on the wards that he got up and sat down several times to show me. He may not be playing soccer again anytime soon, but he's walking, so things could've been worse.
I always enjoyed Michael Jackson as much as the next person (Rock with You, Don't Stop Till You Get Enough, and Billie Jean are overplayed, The Way You Make Me Feel and Smooth Criminal underplayed), but certainly didn't get all bent out of shape when he died. (It was ridiculous, BBC and Al Jazeera- London desk were covering news, while “the Situation Room” was on Michael Jackson all-day all the time for what seemed like a week. Yay America and your declining world relevance!) Liberia, like most of the world, however, felt differently. There were two days there when everyone felt a little sadder, was a little quieter (not easy, in Liberia) in mourning for the King of Pop. In particular, one young man came in to the ER the day after the announcement. Seems that upon hearing of the death of the King, he let out his best “Dangerous”-era “O!/Hoh!” and dislocated his jaw. So, after I finished laughing at him, myself and the medical student grabbed and yanked. Not so successful, and well past the end of my shift, so I gave him some muscle relaxants and figured I'd try again in the am. Apparently, he'd relocated during the night and was able to be discharged by the overnight team. I guess it wasn't a bad dislocation. Not a Bad, Bad, really really Bad, one anyway.
I feel I should break up the text here with a picture I only got at the end of my stay, as it was from the OR. Often surgery is the diagnostic modality of choice here, so there is a certain significance to claiming that an abdomen is "surgical," especially for kids. In any event, they had thought this tyke had a typhoid fever perforation, but on opening the peritoneum, t
urns out it wasn't the case. Here you can see the surgeon taking out the worms (ascaris) from the small hole in the small intestine before repairing the hole and putting the kid on antibiotics and anti-helminths. Enjoy!
Early on in my stay, I was given the Liberian name “Flomo.” For almost 5 weeks, I tried to get people to tell me why I was given this name. Louie was called something that apparently means “owner of a town,” and as far as I could tell, both Marcia and Rachel were called “Kebbe,” which is a name from Lofa county. Lofa is one of the biggest counties and quite a few people who moved to monrovia after/during the war for protection are from there. It is common knowledge among hospital staff and I assume Liberians in general that Lofa women have the biggest backsides. I'm not sure how this is appropriate, because if either Marcia or Rachel attempted to tie their children to their backs with their Lappas, the way most Liberian women do, their kids would slide off to the ground. Sorry if I'm telling you something about yourselves that you didn't know Drs., but it's true.
In any event, I too, it was decided, needed a name indicating I was from Lofa County. (and yes, the children would slide off my skinny Irish ass as well, though I don't think that entered into the decision making process). So, I was called “Flomo.” The name had shown up a few times as either a first or a family name, so I was a little familiar with it, even though I was told it didn't have a “meaning” per se. But, over the course of my time there, I noticed something-- Flomos died. Like, a lot. Chances are, if you were named Flomo (first or last) and you made it to the JFK ER, you were not getting out. I mentioned this a few times to the nurses, and thought maybe a different name would be better. They all loved it. To the point where they would say in the morning “Hey, it's Dr. Flomo! Do you think he'll leave today?” One time I felt particularly uncomfortable when a nurse in triage (full of people, mind you, any number of whom could've been named “Flomo” to varying degrees), explained to another nurse that “Dr Shannon doesn't like to be called Flomo because Flomos always die.” Ha ha-- not so funny if you are overhearing this conversation and just registered your uncle, Flomo Flomo from Lofa county. And if you were Flomo and triaged to bed 19, just frickin' forget about it. Bed 19 was not kind to Flomos. Or to anyone else, for that matter. Come to think of it, Beds 19, 10, 8, 6 and 5 were just not good beds to be in. So, I instituted a “No Mo' Flomo” policy in the ER, which the nurses also loved. I would not be called “Flomo” on days I wasn't feeling well, and all Flomos under my care had to have rock-stable vital signs before I would see them-- even if this meant lying to me.
--aws
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