Haiti Day 2: The Things We Cannot Change

A woman came in with a 14# one-year old baby boy. She was beaming as she looked at him. Clearly a loving mother. I met her as they waited outside of the clinic. The child was very sick. He was failing to thrive and Joy noted on his file that his chest rattled when she held him. At a time when he should be taking his first steps, he couldn't lift his head and was unable to bear weight on his legs. There was something going on beyond the obvious illness. The woman's smile never left her face, however, as she presented him to me. He was febrile with signs of pneumonia on exam. We gave him a dose of antibiotics and Infant Tylenol while he was in the clinic. It wasn't until after they left that I was told that he was abandoned at birth and the woman I met today took him in. While I was focused on his illness and developmental delays, she saw him for the wonder and gift that he is. 

An older gentleman came in later in the day reporting "asthma" and blood in his sputum for 10 months. I looked in his chart, he had lost 8# in the past few months and had a history of smoking since he was young. As I listened to his chest, my mind went back to PA school when I listened to my Uncle Pat's chest to practice using a stethoscope. It was like a "telephone line through time" as I listened to this man's chest. My Uncle died of lung cancer. The man before me today didn't have a fever or other specific sign of illness. Toward the end of the visit, he told the translator he had begun having rectal bleeding and body pain, as well. Without imaging or other tests, it's hard to say for sure what the underlying issue was (cancer, tuberculosis, chronic lung disease...), I just know it isn't good. I showed him how to use an albuterol inhaler and gave him some Tylenol for the bone pain he was having. 

The final case is one that I need help from my medical peeps. There are some pictures of a rash I saw today located on bilateral lower legs and sacrum of a 52yo woman. The rash is very itchy with scaley dry plaques and hypopigmentation noted. It has lasted several months (at least).  It looks fungal-ish. I gave her clotrimazole. Please send differentials and treatment ideas.