So yesterday was a crazy day. I think I saw more real pathology than I've seen in a month's time back home. I started the day on the peds ward making rounds. We saw a few of the kids who had been admitted for a day or two, but then made our way to a new admission. You could see the 13-month-old boy was sick at first glance. He was holding his neck extended and would not move it at all. He laid still in mom's lap just kinda whimpering. The story was that he had been irritable and had fever for a couple days. Rightly so, Serge (one of the housemen on peds who I've been working with) was concerned about meningitis. I went to examine the boy and tried to flex his neck. He screamed! I don't think I've ever seen such a demonstration of meningismus before. Long story short, the spinal tap did show lots of white blood cells, indicating infection was present, but the more impressive thing was the Gram stain--positive for Gram+ diplococci! I've had positive cultures back home in the States, but I honestly can't remember having a positive Gram stain. So we explained the situation to mom and continued him on the high-dose Rocephin. I pray he does well, but you never know. Sadly, the pneumococcal vaccine is not a routine immunization here in Cameroon. I'd like to take a picture of this kid and send it to all those nay-sayers of vaccinations. This is what happens when you're kid doesn't get his pneumococcal vaccine!
A little further down the row was a little 5-year-old boy with a distal femur fracture. Mom reported no trauma, but upon further questioning we learned that the boy has profound developmental delay, is essentially non-verbal, and has what sounds like a seizure disorder. Ortho and PT are seeing him for his fracture. I'm not sure what else we can offer besides anticonvulsants. Next to him was a 10-year-old boy with a large cystic left parotid mass that had apparently been present for years. The boy had a previous biopsy or excision of some kind (they didn't know and his medical book didn't mention it), but now the mass had recurred. Dr. Acha, our ENT surgeon, planned to take him to theatre later in the morning.
Across the aisle was one of the saddest cases. This was a little 5-year-old boy--they all seemed to be boys yesterday--who had been in a motorcycle accident 5 days previous and had been referred from a hospital in the city of Douala (8 hours away from Mbingo). They had done a CT scan of his head, as they were worried about intracranial hemorrhage, but it was normal. They came to Mbingo for further management. On exam, the young boy could not move either of his legs or his torso, and he could feel nothing below a line drawn between his armpits. How sad! The question is when did the injury actually occur. In his medical book, a medical student had recorded an H&P, and there was not much documentation about his neurologic exam. All it mentioned was that the boy had not had loss of consciousness but that he had nausea and vomiting and that the abrasions on his head made them concerned for bleed. My suspicion is that he had to have had some kind of neurologic deficit for them to decide to CT him considering the cost. Being as he arrived to our facility without any kind of C-spine stabilization, I hope against hope that the transfer process did not cause or worsen his deficits. Sadly, we really don't have a lot to offer him either, and it was a hard conversation explaining that to the dad.
Right after finishing rounds, Anita, my houseman from maternity, came into the ward looking for me. "I have to tell you a story," she said. She went on to explain to me how a young lady with her sixth pregnancy had come in early that morning. She was 29 weeks along with twins, and shortly after arriving, the midwife went to check her as she was complaining of contraction-like pains. However, when she did, she realized that the baby was delivering. A few minutes later a young preemie boy was outside and, considering the situation, was doing quite well. The baby's placenta delivered a little later, and then the crew waited a bit expecting the second baby to come. The fetal heart tones were quite reassuring, and after several minutes, the midwife decided to check mom again and see what was the status of the situation. To her shock, she couldn't feel a presenting part. The cervix was only a few centimeters dilated, and there was no baby head to be felt! She listened for the heartbeat again, and it was fine. By this time, the U/S techs had arrived to work, and so the patient was sent for U/S. The U/S showed a perfectly healthy 29-week baby sitting in plenty of amniotic fluid. But to everyone's amazement, the U/S showed what looked like to be a didelphic uterus. A didelphic uterus is what happens when the two embryologic halves that make up the female organs only partially fuse in the midline. This lady essentially has two uteri and cervices (I don't even know if that's how you spell those words!). I couldn't believe it. So these twins, if we can call them that, were each in their own uterus. They will certainly have different birthdays, and, if the second one is lucky, different birth years! The mom's actual due date is in Feb 2011, and now that there is more room in the abdomen, she just might carry the second baby past New Years! I've never heard of such!
Of course I've seen lots interesting and weird cases since being here at Mbingo, but yesterday just seemed to be especially full! I can't imagine a day like that back home at Self Regional. I'll have to email Dr. Gentry with that case report. I'm sure he would get a kick out of it!
