RIP Rafael

The one and only Gladys, at Asilo

Day 14/ April 10th: Today did not have a great start. We began around noon with a boat ride to Asilo. I walked into the room where the men sleep to find that Rafael's bed was empty and stripped. My heart sunk. His bed neighbor confirmed my assumption by telling me, "el se murio a las ocho cincuenta."
"Lo siento," I replied, and let myself outside to take a minute of peace. It is bittersweet that Rafael passed away. He was suffering very much with malnutrition, muscular contractions and multiple wounds that would have taken months to heal if they ever did. He passed away from aspiration pneumonia, meaning he aspirated some food or liquid, and an infection formed in his lung. The workers never called Ben, so I am hoping he did not have much respiratory distress before he passed. I know he is in a better place now, and I hope that I helped in some way, at least by keeping his wounds from worsening, and by being a friendly face each day visiting him at Asilo.

Asilo

We saw a few more patients at Asilo for general checkups. I saw Alfonso, my favorite patient who has mild dementia and talks to God for hours on end each day. He is happy as a clam and is always sitting on his bed looking out the door at the sea. Nikolas is the next patient I saw. He is in a wheelchair due to bilateral leg amputations, and was complaining to me of neck pain. There is not much we can do in Bocas aside from our best physical exam, and after a thorough exam I decided to go for a trial of ibuprofen and see if it improves.

Nikolas

After seeing a few more patients we made our way to the warehouse for clinic. It was another semi-slow day. I saw 7 patients, all of who were pretty interesting. The first was a young woman who had been to the clinic a few weeks ago with a cut on her toe that apparently looked gangrenous. Today she returned and the toe looked horrific. It is granulating and pink and is the size of a grape with no fluctuance or pain. I am honestly worried about melanoma, but Dr. Ben sent her to Changuinola to see a surgeon, so we will get the final diagnosis when the surgeon sees her. My next patient was a 28 year old man with very obvious signs of tuberculosis. He went to the hospital with a month old cough with bloody sputum, chest wall pain, 20 pound weight loss, and two family members with TB. They did not do an X-ray! They only gave him 5 days of oral antibiotics and sent him on his way. We have no X-ray machine or lab to culture sputum, so I took is information we are going to arrange for one of the floating docs to go to the hospital and make arrangements for him to be tested. I really hope he does not have TB.
My last interesting patient was an 80 year old man with a 50 pack year smoking history who came in with obstructive urinary symptoms. I was leaning toward a diagnosis of benign prostatic hyperplasia (BPH), but when I asked for a urine sample I suddenly had to take another route. His urine was grossly bloody. I told him that I was worried about a growth or small tumor in his bladder and that he needs to see a urologist. He then told me that the only doctor he sees are the floating doctors, and that he believes in holistic medicine. He said he has been craving sugar lately and thinks that if he starts eating less sugar things will get better. I am worried that he will not go to the urologist when we refer him. He needs a cystoscopy and we cannot do that here in Bocas. Luckily he spoke English because we needed to extensively discuss the need for him to see a urologist. We will be calling him later this week to give him the name of the doctor and will reiterate the importance of the appointment. I saw about 3 other patients before the day was over. I am drained! It seems to be hotter than the normal 90 degrees today, which makes me feel lazy!
It is really nice to have Dr. Ben here. He cares so much about his patients and also really likes to teach. The other two doctors that have been here since I arrived are very young and don't teach very much, I think because they are fighting to keep their heads above water also. Now that Ben is here everything seems more in sync. Today when we got off the panga at the marina, there was a patient who apparently has HIV and is always at the boat asking for meds. I watched everyone who got off the panga walk right by him with a curt "hello." Dr. Ben was in front of me and walked over to the man and sat right down on the floor next to him. They talked for about 15 minutes and I saw them looking at and discussing the man's bottles of medications. It was a heartwarming reminder of why we are here. The more people we can help the better, and even at the end of a long day it is our duty to enthusiastically care for all the people of Bocas.

Bocas Marina with Costa Rican mountains on the horizon

Tomorrow is my last day on the ship! I am excited because Ryan is heading down to meet me to explore the country together. We plan on heading to Boquette to climb the Baru Volcano, then to Santa Catalina where the waves are apparently 20 feet high this time of year, Coiba Island where we plan to scuba dive with whale sharks and schools of hammerheads, and finally to Panama City where we'll see the canal and the amazing city life.

Buenas noches,
Lindsay