Hard Day

Friday, August 24

It was a hard day.  To call it anything else would be a lie.  It started as a chilly morning with many of the students at my guesthouse leaving for a long weekend at the lake.  So, I made the short walk to morning report on my own. Morning report was full of sad cases. Many people waiting for blood transfusions and there is no blood to give.  Many pregnant women with problems requiring emergency surgeries and one with seizures.

We only have a handful of patients on the pediatric ward so rounds were completed by 10 or so with everyone having a fairly good plan. We went on to the NICU to help round on the many babies there.  Several are 28 weeks and less than 1 kg (2.2 pounds). There is oxygen but not much further respiratory support. They struggle with every breath and I am always fascinated that the next day they are still alive.  There are also healthy babies. There seems to be a genetic predisposition towards twins and triplets here and so many are in pairs, although with many only one twin survives. The names are fun and almost always similar: Prince and Precious, Linda and Lindina.

The clinical officer who works in the nursery is Aisha and she is just a doll and so amazing at her job.  We talked through a few new protocols we are going to try to establish to help prevent the transmission of Hepatitis B to babies.  Again, it is amazing what we take for granted just in our admission procedures at hospitals in first world countries.

When we arrived back in Pediatrics, a new patient had arrived.  A tiny one month old, frail and dehydrated with sunken eyes staring into nothingness.  She had gasping respirations and was dying. The organized chaos of a resuscitation started with attempts to place IVs, then providing breaths and chest compressions.  We ran her down to the NICU to use their resuscitation equipment given her size but she did not survive. Her small lifeless body laying on the big table. And then the wail of a mother whose heart has just been shattered as she runs from the room.

My eyes sting with tears that make me feel guilty, for the grief is not mine.  However, the frustration with the frailty of life is mine and again the feeling of being powerless to defend against death, famine, and disease.  The forms must be completed and we must discuss the events to ensure we continue to give good care. Then is is back to the ward. But first the walk by the mother, adorned in her bright and vibrant fabrics but sprawled out on the cement walkway loudly crying with her friends around.  Utter anguish and I have nothing to offer but a sympathetic look.

I took a few moments for lunch and a cry at the guesthouse when my phone buzzed with a new admission.  I walked back to the hospital with a heavy heart wanting mostly a ride on an airplane home. I wish I had a more faithful response but that was what was real.

The new admission was a small boy with new diabetes in diabetic ketoacidosis.  He was close to a coma and had deep and slow respirations. This is difficult to explain to non medical friends, but this presentation would typically be in an ICU with blood sugar checks almost constantly, IV drips, and an abundance on lab.  We were armed with some fluids, insulin to give in shots, and a glucometer. My palms were sweaty for hours. On top of all that, this child was severely malnourished. We usually give lots of fluids to patients with DKA but with malnourishment this can lead to heart failure and fluid in the lungs.  You can go too slowly and not correct their delirious state or go too fast and cause brain swelling. Electrolytes out of balance can cause heart arrhythmias. We all put our heads, and books, and calculators together. All afternoon we did not see much change. We headed into the evening.

A dinner party was scheduled at a local home.  I did not feel like going but two of the other residents pushed and for one it was his fairwell party. We gave excruciatingly detailed directions to the nurse and walked to the party.

Although a few of us were distracted by this patient, the party did my heart good.  Great conversations with people from countries all over the world doing things to better the world and care for people.  Talking would pause as Daniel and I would get texts about blood sugars without improvement. After an hour and a half, we headed back to the hospital.  

It gets dark here around 5:30 and it was close to 8:30.  The path was dark and all of us walked by the lights of our phones.  Do understand that in this groups of students and residents, I am the old lady.  Yet, listening to their happy banter and inclusion of me, I feel blessed and hopeful.  The stars in the sky here I can not even begin to describe. The Milky Way on beautiful display like diamonds.  The cool breeze. I am reminded of just how big and mighty is my God and regardless of my helpless state, He is sovereign and still on the throne.  While my mind seizes with the “why” questions, it is not mine to understand.

With Hanna and Daniel, I checked on the patient, made a plan and then headed to bed.  Camomile tea was waiting on the counter for me, picked up by Melissa and Amelia the adoptive moms and I got ready for sleep.  Texts and blood sugar reports dotted the night but in the early hours of the morning blood sugar levels were low enough to register on the glucometer and progress was being made.  Sleep again is a precious commodity but there is hope.