Once again peds ward has been full to overflowing, with an entire third row on the floor most days. But unlike the typical peds rounds which consists of alternating cases of pneumonia and gastroenteritis, I have had some unusual cases over this last week. There have been several with strange abdominal illnesses that I never really figured out (hepatitis or typhoid or who knows what?), but thankfully with medicine and prayer they recovered. I cared for a three year old with fever and some sort of inflammatory arthritis. Another one of our patients presented with acute flaccid paralysis, PNG's version of Guillan Barre syndrome.
Joe #1 is about 12 years old, more or less. He came to the hospital last week with severe headache, vomiting, and weakness of the left side of his body. His work up was negative for any kind of acute infection such as meningitis or malaria. This left two diagnosis at the top of my differential list: tuberculosis or brain tumor. In an ideal world, he would be rushed off for a CT scan of his head and we would likely have a certain cause for his illness. However, there is only one CT scan in the country and Port Moresby (where it is located) is only accessible by plane. Most families cannot afford the price of a plane ticket or cost of the CT scan (somewhere between $100-300). Joe will not be getting this much needed test. As a doctor, how do you care for such a patient? You treat the illness that you can treat. If the cause is TB, he should get better. If he has a brain tumor, his condition will continue to worsen. For now, we wait and pray.
Joe #2 is maybe a couple of years older than the first Joe, and sleeps two beds down from him. He has seizure disorder or epilepsy. Joe had been doing well for some time so he stopped taking his medicine. Unfortunately his seizures returned this last week with a vengeance. Convulsions continued despite several medications, and we almost lost him a couple of times. Joe is no longer seizing, but he is confused and combative. I am concerned that he has some permanent brain damage. So again, we wait and pray for a miracle.
It's a good thing that my God is a God of miracles!