Is that patient on our unit?

The surgical patients are divided into two units. Two or three surgeons are part of a unit, and each patient is assigned to either Unit 1 or Unit 2, depending on who performed their surgery. The patients are not sorted by unit in the wards, and I don’t yet understand how the rounding surgeons know which patients they need to see. There is no master list of patients, as far as I can tell. Rounds occur only Tuesday, Thursday and Saturday, which means these are the only days a surgeon examines the patients and updates their plan of care. Two nurses are responsible for fifty patients. Things get missed.

Walking into the women’s surgical floor this morning, we passed a grey-haired woman curled on her side in bed. “Is that patient on our unit?” Jon asked the nurse. Instead of answering, she felt for a pulse. The patient was dead. A woman I assumed was her guardian sat on the adjacent bed weeping quietly. The nurse put a screen in front of the dead woman’s bed and we continued rounds.

Later, we came to a woman eight days out from surgery to repair a perforation in her small intestine, a relatively common result of typhoid infection here. The patient unwrapped the dirty cloth – not gauze, but the colorful fabric the women here wear as skirts – from her abdomen to show us a baseball-sized opening in her belly. Her surgical wound had opened and her small intestine was open to the air. No surgeon had seen her on Saturday rounds, perhaps she was walking around when they passed by, or maybe she got overlooked by the busy physicians. The patient told us it had been open for a week. Even though here “a week” can mean between two and twenty days, the last time she had been examined was five days ago. She was scheduled to return to the operating theatre to repair the wound, but it did not happen today. Hopefully tomorrow.