Sunday, June 17, 2012

The Routine

June 15, 2012

The routine has begun: my initial astonishment of how Don Sergio can take care of such critical wounds day in and day out has resolved and my dreams of getting him all the medical supplies and funding of what he needs to lessen his burden has started. Then reality sinks in: just take care of what is in front of us and on to the next patient, support Don Sergio in anyway possible and let him do what he does best.

This morning a new burn patient came to the museo who suffered a steam burn from a hot broken radiator hose the day before. We've all seen the ruptured hot radiator hose spewing steam, he was just in the way. His forearms and chest were burned but the real extent of the injury has not yet presented itself but will in a few days. Right now he has pain and all we have is Tylenol to offer and for his burns and bandages moistened with silvadene. The patient was so grateful and left with a smile even though the pain has to be intense. These people are so stoic… or is it accepting and having good coping skills? In the US he would be in a certified burn center, given IV pain meds and possibly semi-sedated as this burn is about 14% of his body surface area and part of it appears it will be partial-thickness burn.
Broken radiator steam burn.
Off we went for our house rounds and after our second pt in a barrio south of San Cristóbal our taxi broke down. Juan, our driver, called his cousin, another taxi driver, who came to pick us up. I thought of Bruce, who would have the car fixed in no time just as he did a couple of weeks ago when the same thing happened on our way back from the Grand Canyon.

Coche no funciona.

We finished our morning rounds and I was back at Bela's in plenty of time for a siesta and Manuela's lunch.

Prickly pear agua del dia, chili relleno, flor de calabaza con queso, arroz y frijoles y salsa deliciosa! Home made tortilles, blue and white corn in the basket.
The evening patient load was lighter than the day before as I saw 10 patients and was out the door by 7:20 pm. The usual wounds and luckily for me several easy derm cases (acne, eczema, benign lesions). We did have a terribly sad case of a 62-year-old Tzotzil man, wheelchair bound with a large cancerous tumor growing out of his right thigh. It was bound to the bone and the skin contracted upward toward his buttock. The hospital doctors informed him they can amputate the leg but it was not going to provide a cure.  From a brief clinical assessment I had to agree. There was firm lymphadenopathy all the way to the groin. Even if amputation removed this tumor, he most like would not receive aggressive cancer treatment (no resources).  Don Sergio informed the man of the gravity of his condition and told the patient to return so we can continue to change his bandages… at least he won't have to deal with the weeping wound, it will be kept clean. The patient said he'd return. Even though futile, Don Sergio comforts patients with his care.

One of our house calls requires a few steps.

The home was made of plank wood and had a beautiful view.
71-year-old Don Sergio always on the move.
By evening's end Don Sergio as always walked me to the door and we confirmed our meeting time mañana.  I'm always so tired after the evening shift, where does Don Sergio find the energy?
One of our evening pts with a hot water burn.

The cause of most of the child burns, especially little girls, is from hot water. Either it has been spilled or the pot broke while the water was boiling and the girls are always close to the mother and cooking. Young skin (and old skin) can suffer significant damage, usually a superficial burn will heal within a couple of weeks. Depending on the depth of the second degree burn it can take three to eight weeks. Usually these burns are a combination of both superficial and partial thickness.

Posted by Patricia Ferrer, PA-C

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