Today in clinic was a bit different then the last. I was in the infectious disease ward doing rounds with the residents, doctors, and other student in the program. Everything word was in Spanish and medical jargon, so it was easy to get lost. The other students, being 4th year medical students and residents, could at least understand the medical lingo so they would turn to me and give me an update on what was going on.  “Pneumonia with air trapping” or “Leishmaniasis which can cause organ failure if left untreated” would be whispered to me as we stood around the patients bed, arms crossed, listening to the doctors and local residents read off the chart and debate the treatment.

We got to one of the patients rooms and the doctors and residents put on their mask and told us not to go inside. The patient was a 14 year old boy who had severe TB and Hepatitis. We watched from behind the window as they went over the chart and then pulled the mother out of the room for further questioning. There were two attendings on the ward and they were debating whether or not to stop the medication. The dilemma was whether the Hepatitis was being caused by the TB, or the medications used to treat it.

The Doctor, a tall Bolivian who enjoys a position of power, stands in front of a short, stalky Bolivian woman dresses in traditional dress. A long thick skirt hangs down to her dark brown path-beaten feet, shawl is draped over her layers of hand made blouses. The Doctor is asking her for information about her sons case, taking a history that could save her sons life. If his hepatitis started before treatment began it would be proof that it was caused by TB and they would up the dosage of his meds. If it began after the treatment then they would stop the treatment completely to allow his liver to heal so that treatment could be resumed. The answer lies in the Mother but all she knows is that her son is sick.

“Help me help your son,” the Doctors pleads in Spanish to the Mother. The woman mumbles some Spanish, saying her boy is sick and that he’s been sick for a while as she stares at the floor and then nervously looks up at the Doctor.  It was not what the Doctor wanted to hear and he was getting noticeably frustrated. He looked down at her and noticed her short clubbed fingers and quickly pulled his mask up to cover his nose and mouth. The signs of chronic TB stand in front of him as she too was inflicted with the disease. She nervously rubbed her short, thick fingers together as the Doctor continued the interrogation, his voice rising and becoming more impatient. “No sé, no sé,” she repeated as she shook her head. “La fecha, la fecha, I need the date of when you first noticed these symptoms,” the Doctor asked strongly. Obviously not getting nowhere he announced that he had no time for this right now and walked out of the infectious disease ward.

The boys health is rapidly declining and he has since been moved to intensive care.

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