Indelible Roots

I went to dinner last night with Lyna, Dr. Long, Sophos (nurse), and Bolle, a gal from the Chenda clinic. Our server was quite openly gay and the gals appeared to be trying to get me drunk. It was a motley crew with Long (his first name) with his flat affect for the most part, Sophos getting down and toasting every few seconds, Lyna toasting, but not drinking, and Bolle not drinking at all. At the end the gay waiter started hitting on me too. He then apologized if Lyna and I were a couple. He asked me so and I said yes. Then he said he wanted me to kiss her to prove it. If it wasn’t all so funny, I’d be keen to start telling people I was married and go get a fake ring.

Today at work the older woman with the burned arm and neck showed me that she could now move her wrist. When I splinted her over a week or so ago her wrist was fixed at ~23 degrees of flexion because the skin had drawn up tight circumferentially. I was actually very surprised with the increased range of motion as I had splinted her more from boredom than from any realistic prognosis of stretching the scarred skin.

Measuring her wrist I can get 90 degrees of flexion and 15 degrees of extension now, but her fingers are still non functional. So I had her come back in the afternoon when I increased the flexion on the old splint to 90 degrees. I then remolded an old splint to extend her wrist to a little past neutral. This was funny because the first two old splints I tried to work with broke into pieces when I flexed them. They had been reused one too many times.

I showed the doc this new range and he appeared suitably impressed, though he probably really didn’t care. He then mentioned that they would look at grafting the arm after the neck heals up. Her neck looks terrible by the way. She could use compression garments to decrease the scarring with the new skin graft, but there is no such thing here. I’ll get her to do some scar massage when it fully heals up.

When I’m not busy I’m now hanging out in the records and recovery rooms with the nurses. This is also where new consultations are done and I’m able to catch the occasional therapy patient. One young man came in after having fallen out of a tree four months ago. His mom reported that he lost control of his left side and hasn’t been the same cognitively. Dr. Pisay was going to send off to another clinic for what I couldn’t figure out. But I discussed therapy with him and he said that was fine. But because he is not a surgical patient, the family would have to pay for their own food, and lodging is as available. The family said they could only afford to stay a few days.

This twenty three year old man is unkempt and smelling of body odor. In the therapy room he had to be cued many times to do things and would only perform about four repetitions before losing focus. Motorically he has active shoulders, elbows, and grasp, but no fingers extension. He also is unable to maintain control of the affected arm and cannot place and hold it in position. With Samath translating I had him on hands and knees while reaching with his right hand. He had trouble with this as expected and had to be blocked from scooting his knees forward or his butt back. He has some shoulder pain due to scapular deficits which I mobilized and then had him do some assisted external rotation.

We also worked on grasp and release and he was able to extend the fingers once or twice in a row a few times. Mom constantly tried to help him with such things as dressing and we strongly told her to let him do it himself. He also seemed restless and his face is flaccid on that side. I referred him to the speech therapists who saw him right afterwards. However, they will be out for the rest of the week working at another facility, so I was asked to follow up with his oral motor exercises.

My main concern is that he is still presenting like a closed head injury four months post the injury. An MRI is $200 here, less than 1/5^th of the price in the US, but definitely out of their reach. I’m confident he can regain motor control and use of his arm, but I’m afraid we’re missing something internally.

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This entry was posted on Thursday, November 8th, 2007 at 9:00 am and is filed under Travel. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.