Next stop, Holy Cross Hospital.

As the saying goes, “the London buses all come at once,” or something like that. Much can be said for many of the medical and surgical dilemmas that we face at Holy Cross. Recently at work I have definitely noticed a strong flavour each week. This week it has been septic abortions – up until now I had seen zero; since Monday we have had three. Last week it was miliary tuberculosis; the one prior had children playing with death in road traffic accidents.

I very much doubt that all the miliary kids hang around together then come to hospital on the same fun bus (it’s actually not very fun to have it, from what I see; it is also not very infectious, unlike it’s partner pulmonary TB). However, it certainly does feel sometimes as if they all arrive together. Diagnosis and management would be a lot simpler if all the diseases were sieved into different categories to peruse each day – rather than the hubbub of OPD – one minute you could see a young boy with nothing more than a runny nose; the next an almost unconscious girl with an un-recordable blood pressure about to enter the point of no return (this is in the outpatient department, not casualty!); a rape victim; a man with multidrug resistant tuberculosis whom is so thin that I can wrap my hands entirely around his waist and my index and thumb around his thigh (at this point, all the windows are open and a mask is placed over his mouth – I really do not want to get tuberculosis, especially the multidrug resistant stuff); babies with malnutrition, pneumonia, tuberculosis and HIV all at the same time. I could go on. However, this hubbub, this pandemonium, this is what I love about working here – it is often frustrating and depressing, but at the same time incredibly interesting and fulfilling when you watch your patients come through these troubles. Don’t get me wrong, many die – most people just present to late, to an institution that cannot really deal with patients who require intensive care – but, sometimes they manage to ride the storm and emerge the other side, almost smiling.

A beautiful example of nail bed clubbing. Clubbing is a term given to fingers that look like this – a bit “club” like I guess. There are many causes, at medical school there was an acronym that went ABCDEFG (I think). I’m not at medical school anymore and can barely remember half of what the letters stand for. In South Africa I have a more succinct acronym for clubbing: TB.

This is what miliary tuberculosis looks like on a chest xray. Unfortunately it hasn’t come out that well on my camera – it is much more impressive in real life. But, with the eye of faith one can see that the lung fields look very “fluffy”. Together with the history of cough, night sweats, HIV and TB contacts – this is barn door miliary tuberculosis (I hope!).

This man in his twenties with epilepsy has gum hypertrophy (enlargement) as a result of being massively overdosed on his antiepileptic treatment for the past ten years.

Happy people on the paediatric unit.

In other good news - two dutch doctors are arriving this weekend. For those that haven't been counting, Holy Cross has now doubled it's number of doctors from four to eight.