It was up early again for a 7:30 educational lecture, though this time, it was not our group giving the lecture. Even though twice a year, a large neuro team descends on FAME, there are still other volunteers that come during our time there and it’s often a bit of a struggle to decide who gets the privilege of presenting. Dr. Ken has overseen determining who will be giving the lectures and we are always happy to share the spotlight with the others. This morning, Dr. Josie, a medical hospitalist originally from Cameroon, though now living in Los Angeles, gave this morning’s lecture on hyponatremia (low serum sodium), a topic that is near and dear to the hearts of neurologists due to a very well-recognized complication that can occur when it is corrected too quickly.
In that setting (overcorrection of their hyponatremia), patients develop a condition that was originally called Central Pontine Myelinolysis (CPM) that would have a delayed onset and cause considerable and irreversible damage to primarily the motor portions of the brainstem, and particularly the pons. More recently, it has become clear that this condition actually often involves other areas outside of the brainstem such that it is now referred to as Osmotic Demyelination Syndrome and can affect many areas of the brain. The condition can be easily avoided if one recognizes that the sodium must be corrected very slowly and over days. These patients are most often managed in the ICU in the US, and they have very frequent labs to follow the correction of the sodium, though this is quite difficult here as we don’t have an ICU and checking labs as frequently as we do at home is not the norm. Merely recognizing the risk, though, goes a long way to prevent the situation and you can worry less about the neurologic complication.
We’ve continued to have one of the residents rounding with the FAME doctors in the morning, primarily on the Ward 1, which is the medical ward, but also on the surgical ward on occasion and, when Dennis is the resident, even in maternity where he can check on the babies. Doing so has gone a long way to helping the residents understand just what it is that the FAME doctors do here, which is quite a lot, and has also helped when input has been needed on neurologic patients. In the case of LJ before she left, she picked up significant neurologic issue on one patient that had gone unrecognized and clearly needed to be managed.
The morning was slow and, when that happens, especially on the days when there is an early morning lecture and it’s quite likely that not everyone has eaten breakfast (that usually means me), we put an order in from the Lilac Café for some breakfast munchies and coffee. Their beef samosas are just delicious with mango chutney and having two for breakfast is quite filling for me along with a small cup of their French press coffee. Even better, we can put the order by phone, and they will deliver it to us just in case patients start to show up while we’re waiting. The Lilac also has wonderful full breakfasts, but to that usually takes more time than we have too spare.
The Lilac Café first opened around 2012 along with the hospital as it was recognized that FAME needed a different kitchen than our canteen to make meals for the patients and, they would also need a place for families to eat while they were visiting their relatives who were in the hospital. The Lilac has become a quant café for a coffee, a cold drink, or dinner on the weekend when we’re on our own.
Caroline had an interesting patient come in to see us who was complaining of frequent right ear infections for many years, decreased hearing on the same side, and, lastly, right sided headaches that seemed to correspond to her ear infections. Though she had been treated many times with antibiotics, no one had ever really investigated why she was having the frequent infections and she had never had any imaging. I guess this would have been more interesting if you were an ENT specialist but given the fact, she had come to see us, we felt compelled to get some answers for her, and recommended a CT scan of the head with and without contrast. After speaking with the patient, she agreed to have the CT scan, which of course would be costly, but after doing all our research on UpToDate (our bible, so to speak), it was clear that she needed one to determine the proper therapy going forward. Unfortunately, she would have to come back on Thursday to get the scan, so we put her on oral antibiotics for the time being since she wasn’t febrile and didn’t look particularly sick. We’d have to wait a few days before we could make our final recommendations.
Clinic was over at a reasonable time and the residents had decided to take everyone working with us out to the Golden Sparrow later in the evening. Though I did have work to do that night, I had pretty much already decided to forego the Sparrow this trip and thought that it might be nice for all the younger people to have fun together without Babu (Grandfather in Swahili and what Teddy has always called me) tagging along. The Golden Sparrow, which had become a tradition over the years, had really started as the Carnivore, a tiny bar with dirt floor except for an even smaller dance floor that served barbecued chicken, chips, and beer. I had first gone with Kelley Humbert and Laurita Mainardi in October of 2016, but the next year, the owner had decided to expand, and had built the Sparrow.
The Golden Sparrow is a much more sophisticated establishment than the Carnivore as it has a large outdoor dining area with a much larger menu (though still includes their delicious, barbecued chicken), and the dancing is now inside a proper dance club with a DJ and disco lights. I will have to admit that there has been a fair share of dancing on the tables in the past (I will mention no names, though I will remind everyone that I have incriminating videos), but with remodeling over the years, the tables are such that it is now impossible to dance on them with a significant risk of harm. The DJ takes requests, and the dancing doesn’t get started until after 9 pm most nights.
All the translators had joined them as well as some of the other support staff and, from what is reported to me was that everyone had an excellent time and that no one had drank too much, if at all (and I have no reason to doubt it as several people who were there don’t drink). They had all enjoyed dancing and being together with little in the way of alcohol which is always a good thing considering that I wanted to make sure everyone was up the following morning for work. To be honest, I had gotten into bed just before they arrived home, though I was a bit parental in that I was happy to hear all their voices when they came in. Despite the videos that I mentioned earlier, I have often said “what happens at the Sparrow, stays at the sparrow,” and I have done my best to honor that in the more recent years.