The hospital day was busy. Dr. Clara made rounds on the Womens, Peds and Mens ward. Pretty impressive, and all before 10 am. The rest of the morning was spent at the Thursday Staff tea and seeing outpatients.
A young man with extreme jaundice (looked like his eyes were full of orange juice) came in. He had ‘flu-like’ symptoms, dark urine and general malaise for a week. I did not a liver edge, but Dr. Clara says he has hepatomegaly. And, his labs you ask? Well, we don’t have a chem 7, LFT’s or a hepatitis panel, so I checked his urine which had ‘4 +++ urobilinogen’ and assumed he had viral hepatitis. He was admitted on supportive therapy.
An insulin dependent diabetic woman came in today for her monthly insulin refill. Turns out we don’t have any insulin in the pharmacy and have been out for a month. She, too has been out for a month. Remarkably, her blood sugar was okay this a.m. I asked around the hospital about the lack of insulin. No one was really surprised or very worried about it. Some of the nurses suggested we just put her on oral meds. Dr. Clara said the woman would have to go to Mashingo and purchase the supply for herself. The patient of course did not have the money or the means to get to Mashingo. And, though she is going blind from her diabetes and has peripheral neuropathy, I am not sure she really grasped the implication of not having her insulin. I was actually surprised that she had not gone into DKA from lack of insulin. From her history, she had required it since 1992 and yet this month she had lived without any injections at all. Hum. I will ask Dr. S about this tomorrow. If any doctors are reading this, can you explain why or how an insulin dependent patient didn’t go into DKA without insulin for one month?
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