Gratèl

Gratèl. Gratèl. If yesterday was the day for obstetrics in clinic then today was the day for rashes. One after another. Moms bringing in their little boys and girls with various skin conditions. Pitiriasis versicolor. Scabies. Impetigo. Eczema. It was enough to make me an unofficial dermatologist. Although I am horrible at trying to identify rashes. Especially the erythematous rashes on dark skin. There's no erythema! If you're lucky you can see a faint purple hue to the skin, but that's the extent of the color change.

The first patient was actually an adult male. He was 24. But he was here with his mom. #SeparationAnxiety #PeopleProllySameTheSameThingAboutMe His main complaint was dizziness and what I perceived to be near syncope when changing his position. Near syncope is that feeling where you get a little tunnel vision, your legs get wobbly (wobble baby wobble baby wobble baby wobble), and you feel like you might pass out. It's a super common complaint both in Haiti and the U.S. #FunFact people don't bwe enough d'lo. If you're dehydrated, it's tougher on your pipes to keep that blood flow and maintain the pressure of the blood feeding your brain. No brain flow and obviously you're gonna pass out. Kinda protective in a way if you think about it. If you pass out because your body can't get blood to flow to your brain, then by being on the floor you eliminate the force of gravity. So cool. But he was fine. It was 1 pm and he hadn't peed all day. #SignPost I obviously did the mature thing in my counseling... I told him mom to make him drink more water. I tossed in a script for iron pills because he seemed a little anemic, but that was more to keep them coming back. His story is only relevant because he had such an impressive display of tinea versicolor on his trunk. I just happened to catch it, but it was diffuse hypopigmented coalescing patches with annular borders and slight scale. It's a harmless rash, but from a nerd standpoint it's really cool to see under a fluorescent light (No clubbing for this guy).

Then came the scabies patients. You can just see them scratching themselves in the waiting room. Digging their nails all over their trunk, axillae, arms, legs... basically anywhere they can reach. You just have to wonder what the patients next to them are thinking as they share the bench. No, "share" offers a poor mental picture of the reality of the clinic waiting bench. It's like when you have four friends for two seats at the football game, but everyone's standing, so you think you can get away with it. Well, imagine if everyone in the row did that. And now think about that first TV timeout when people go to sit down and suddenly it's getting really cosy. That's what the clinic bent is like. Nothing is off limits either. Breastfeeding. Coughing. Contracting. Bleeding. Vomiting. Eating. All in the comfort of your neighbor's lap.

I really tried to talk myself into thinking one was pityriasis rosea, but just to make sure I consulted with Dr. Ulysse and she just looked at me like, "Are you stupid? This is scabies for sure." Fine. #CommonThingsAreCommon #DiagnoseWhatYouCanTreat so he got a topical agent to try and eliminate this parasite from his skin. One problems. It's a really complicated set of patient instructions. And it's one of my biggest frustrations with Haiti. Compliance in the U.S. is like 10%. That's right. Those of you out there thinking, "Well, he's certainly not talking about me!" How many times has your doctor prescribed you dietary changes and exercise? Stretches instead of pain pills for muscle aches? Rest for sore joints? Avoidance of stress and meditation for anxiety and depression? Avoidance of caffeine and screen time before bed for insomnia? And have you ever missed a dose of your meds? If people did everything doctors said at 100% then we'd have no patients.

But to sit and try and instruct a mom, who prolly has to take care of like four other people in the household (conservative estimate) and just hiked two hours with an itchy, infested toddler on her hip, on how to make wash the patient, cover them in this medication, and then repeat it for two more days, and then wait a week and repeat it once again, and oh by the way boil any sheets, toys or clothes that could have come in contact with the kid.... Ugh #RunonSentencesAreFun Speaking of fun... Mom, you should probably repeat the process with everyone who has shared a bed, or been in close contact, with the patient. She literally laughed at John when he finished the instructions. And God bless John. He's give "my" instructions on scabies so many times he doesn't even need my prompt. He does it all on his own and I can trust what he's saying. #GivesMeMoreTimeToDocument #ThatsKindofAJoke We even tried the Ebberwein "Teachback" method (I'm sure he has a patent on it), but it was an epic fail. Oh well, it was our last patient in a rather tumultuous clinic day and I had to go to the bathroom. #WellHydrated

With such a large team here I never know which restroom is gonna be open, but I found the one in the guys' bedroom vacant. Now, if you've ever cared for a patient with an itchy rash, especially if you suspect some sort of infection as the etiology, you get just a little itchy yourself. And sure enough, I had held this boy with scabies in an effort to build some rapport and by now... My shoulder blades were squeezing together a little... I was swinging my head down to rub my neck and shoulder together... Just feeling a little creepy crawly. Even as I type this the same crawling sensations are running over my skin. It's expected. You know it's going to happen. And even though you know you didn't contract whatever infectious rash afflicted the patient you just can't help it. But as I stood to use the restroom I couldn't help notice a new sensation. No, it wasn't burning when I was peeing. It was on the outside of my left arm... in several places. My hands were a little occupied, but I tried to shake the sensation out of my left arm and dismissed it as paranoia. And then I looked down. And sure enough, three little mites, or bugs, or something were crawling all over the amazingly well-defined tricep area of my left arm #HaitiFit #SarcasmAgain.

WHAT DO I DO?! I can't swat at them because I'd lose control and spray the floor. I tried to hold the stream, but I couldn't. WHY DO I HAVE TO BE SO DAMN HYDRATED?!!? It was torture. Seconds felt like hours as I just knew those things were making their way to what they saw as a permanent home. Burrowing under my skin and building a mantle place to hang all of their family photos. "Quickly... Quickly... Quickly..." I thought, as my stream started easing up. Kegels, ENGAGED!! And as soon as I felt control, my right arm went flying around and smashed my new hitchhikers. #CrisisAverted #StillMightTakeAScriptForIvermectin... #IStillFeelItchy