Bug in ear

Back in the states, and I  had an experience just now that I didn't realize would happen here.  It is 4 am and I am working a shift in the ER tonight.  We just had a 20something woman come in with something in her ear.  When I came to inquire she said "a bug or worm is in my ear. I was sleeping and woke up feeling something moving"  Part of me thought, yeah right, there can't be a bug in your ear.   So I grabbed the otoscope to look in, and there in full color was a cockroach.  Not a big one, but a cockroach just the same.  I about squirmed when I saw the little creature move, it's antennae twitching.  I calmly told her that there was a bug, and I would be, very quickly taking it out.  Part of me was recoiling. Those who know me, know I detest cockroaches; more than any other insect on earth. My skin was crawling as I sympathized with her, wondering what it must feel like to have it moving around in there.  I put some lidocaine jelly in her ear first, to numb the ear for my planned prodding.  She began to squeal, as this seemed to make the bug angry.  Then the amazing happened- it crawled out...the jelly forcing it into the air. I quickly grabbed it.  Letting the gathering nurses and techs who had been watching see the prize. 

Tajikistan

Pictures are more fun in some ways then boring words. SO I'll post some more. We are almost done with the trip. It's been a blur of activity.  Literally family medicine as a specialty is brand new here in tajikistan. So, our lectures and workshops are helping shape the future of family medicine here.  The system is very "sick".  30-40% of doctors here don't work as physicians, they are taxi drivers and such, because the pay is so poor.  A doctor here makes 15 dollars US a month... that's right only 15 dollars.  They live only by taking extra money from patients.  This has created an impossible system.  If someone comes to the hospital then, they must pay out of pocket the doctor, the nurse, the cleaners that sweep the room, the security people that guard the hospital... every single person demands pay.  The patient must even go supply their own medicines, even in the hospital.  Doctors must also pay bribes to hospital leaders- so dept. chairs demand a portion of earnings, and hospital heads also must get gifts and money.  It is all very corrupt.  The gov't also assigns patients to doctors.  So someone is given approx 1500 people they are to see...then, the rules are that the family doctor must see each of the 1500 patients, at their homes, every three days.  IT is RIDICULOUS.  How can anyone person see 500 people in one day?  For this, again ,corruption ensues, so doctors fake their records...they make up all their visits, and really only get to 4-5 homes a day. This is only the beginning of the problems.  The picture above is of a Foley catheter in the hospital...at least their version of such. 

"When we are dying"

We recently had an Hispanic man on our service. He was 41 and came to the hospital feeling tired and weak, and had a hemoglobin of 4.6.  It's a number that doesn't mean much unless you are familiar with hemoglobin numbers. It's a number for blood.  If the number is below 13 for men, he is anemic. Blood transfusions usually happen under 10.  As you can imagine - 4.6 then is VERY VERY low.  Although he was Hispanic, because the low blood count caused him to be quite pale, it gave a khaki/beige appearance to him. We did a lot of tests; the haunting suspicion was that he had myelodysplastic syndrome, a kind of precursor to leukemia. We did bone marrow biopsies, transfusions, and all sorts of blood tests. We got to the point we were ready to let him go home, needing for him to come back in a month for another bone marrow biopsy.  That's when it hit us - a kind of afterthought - this guy doesn't have insurance. In fact, he's not even a citizen, he's here illegally. How will he even hope to afford his bone marrow biopsy? Let alone treatments for his condition? The morning we discharged him from the hospital we spent some time reconfirming his inability to pay for services. In Spanish he told how he hadn't even been to see a doctor in years because he had no money. He knew something was wrong, and he was getting sick, but also knew he couldn't afford getting better. I can still hear his next words translated by a Spanish speaking resident, "The only reason we come here (the hospital) anyway, is because we think we are dying. Then the money doesn't matter because we will soon be dead" Does that seem right?  He is one of thousands, unable to get help in this land of plenty. He is one of many people sick, knowing something is wrong, who continue to be ill because they cannot pay to get better.  

There is good news for him, this single father of 2. The hematologists who do the bone biopsy are donating it for free. As for future treatment - I am not sure who will pay.

Bleed like stink

"They won't do a biopsy of the mass, those tumors bleed like stink"  This was the 3rd time in a week that I had heard this phrase - "bleed like stink". I try to imagine what this could possibly refer to. Unfortunately this leads to images of blood droplets micronized and floating in the air, being inhaled by the doctors and nurses by someone's bedside. NOT what it means.  Blood doesn't smell, and stinking doesn't seem at all related to bleeding.  The phrase is used to mean 'bleed A LOT', tons and tons...but why the phrase? It's one recognized widely, but who's ever said WHY?  I did some research.  It was tough to find - but here's what I know:

According to the Oxford English dictionary "like stink"  is a pretty generic modifier meaning 'intensely' or 'furiously'.  In other words its an expletive- "If I see a snake, I'm going to run like stink" -  The phrase 'mad as stink' came to be an alternative to saying 'mad as hell' in old English. Somewhere along the way, then, instead of saying bleed like hell - or bleeding intensely, bleed like stink came to be.  Interesting.