Dr. S went to Mashingo and Gweru today with the Cavanaghs to run errands, get Tim officially registered with the provincial medical officer and other things. Dr. Clara and Dr. Brown were in surgery (hysterectomy on a woman with a fibroid uterus that could be palpated several centimeters above her umbilicus). So that left me with the morning admits and seeing out patients.

My first was a wasted, weak and ill woman with end stage ISD (‘Immune System Disease’), c/o diarrhea, nausea, vomiting, pain when eating (esophageal candidiasis), cough, etc. I admitted her to rule out TB and to give her some TLC plus the usual arsenal of cotrimoxazole, metronidazole, and ketoconazole.

The second patient was a 1 year, 9 month old girl with swollen parotid glands (bilateral) and generalized lymphadenopathy (cervical, axillary, and inguinal) for several months. She also had extensive ‘septic’ lesions all over. The child had been seen in November and treated with no success. She was also malnourished and had not gained weight in over a year! At that time someone thought her presentation was consistent with ISD and recommended testing. But her HIV test at 1 year 7 months was negative (up to 15 months a positive test in a child can be from maternal antigens). I was wondering if she just had a bad case of chronic septic lymphadenitis but why the intractable parotid swelling? Mumps are usually viral and last about 2 weeks. And, her differential showed 75 % lymphocytes. Could this be a lymphoma? Could this be a hereditary childhood immune deficiency? I have to do some reading on this. . . but most likely, it is an ISD case with a mistaken negative test result.

Third admit was an elderly man with chronic knee joint swelling. The history is actually pretty interesting. He was admitted several months ago with bilateral calf myositis after injecting himself with ‘muti’ that happened to be medicine for livestock. Both of his calves were just about destroyed and he went to South Africa for skin grafting and rehab that lasted 3 -4 months. During that time, he had his first septic joint of the right knee. Now, he has swelling and pain and occasional fever of the left knee joint and a new internal rotation of his L hip. Dr. Brown and I tried to tap the knee but got no fluid. I put him on chloramphenicol and got Xrays of his knee and hip to review tomorrow.

I peaked in on Dr. Clara and Dr. Brown and saw the uterus they were taking out. It was huge! A red and lobulated watermelon.

The rest of the afternoon I saw out patients, including several rashes (pityriasis versicolor) and a woman who was in to see Dr. Clara about leg pain (a DVT that was treated with aspirin). When I walked in, I noticed and commented on a goiter which after some inquiry in Shona by Dr. Clara led the patient’s daughter to reveal that her mother (in her late 60’s) had had the goiter for many years and did not want anything done to it and just in the last year or so she had developed a 5 cm in diameter, round, soft, pulsating lesion on the skull in the occipital region. Dr. Clara thought of Follicular Thyroid CA which spreads hematogenously. . . we looked it up in a couple of books and think it is indeed a Follicular, hematogenously spread tumor.

Then, about 430pm, we were called to the peds ward. A child that Dr. Clara admitted with a supposed insect or snake bite and very swollen lower extremity was ‘in a declining state.’ The child was very lethargic but had also received promethazine. We hooked him up to an IV and dosed some prednisone with the fluids. He perked up after the IV.

Then, an expectant mother who was hypertensive needed to be seen. Turns out she was in labor.
An exciting day medically for sure.