Being on the Infectious Disease/Tropical Medicine unit has been pretty wild. Since we have already taken a class on infections (Attacks and Defenses), I feel like I have more of a learning base for this compared to cardiology. It is also less hectic and crowded compared to cardiology, so we have more time and space to perform assessments and discuss patient cases. Our attending is very soft spoken, but knowledgeable and helpful.
We have seen many things that we would never see in the U.S. including two necrotizing fasciitis cases, three Stevens-Johnsons patients, and plenty of cellulitis, meningitis and encephalitis. These cases are so fascinating. The different bugs and antibiotics we learned about are so pertinent here. It is eye opening that many of these patients who are very sick are so young. Encephalitis seems more common here than in the U.S., and many of them seem to be between twenty and forty years old. We also saw the most severe presentation of gout that I have ever seen. The patient had tophi everywhere, covering his hands and feet, lower legs, and even the backs of his thigh and buttocks. His hands and feet were disfigured, and for some reason he was on a ventilator as well. He looked young, probably under fifty years. I cannot imagine how one would adjust to such a condition. I wonder what his life is like now, who helps take care of him, and most importantly, what parts of his life he lost when this disease started to become so debilitating.
There are some differences that I have seen on this unit compared to those in the U.S. First, many patients are not sedated while on ventilators. I would say at least half of them are awake and able to move, and the least they can do is track you with their eyes. Second, the use of antibiotics given for various illnesses, such as cellulitis, differs. Here, ceftriaxone is commonly given for cellulitis, and many of us were wondering why because many cellulitis cases are for gram positive organisms and ceftriaxone is more for gram negative. However, we found out later that ceftriaxone is much more available in Vietnam compared to cefazolin, which explains why physicians choose to frequently prescribe it.
At the end of the day today, as we were finishing a discussion about another patient, a male patient caught my attention. I could not stop watching him. He was in four point restraints with ropes, along with a sheet that was wrapped around his chest and up underneath his arms that was tied to the head of the bed, presumably to keep him from sliding down. He was sedated and on a ventilator. His eyelids, jaw, and legs were twitching/fasciculating, but he was still fighting his restraints a little bit. Or maybe he was just involuntarily flexing his arms… I couldn’t really tell. Something about him reminded me of someone, maybe it was a patient I have had before but I’m not really sure. As the team turned their attention to him, the doctor told us he had suffered from organophosphate poisoning, which he had done intentionally in a suicide attempt. I wonder if he will make it.