Malaria

Thursday, October 3

I didn’t sleep well. The anxiety sometimes rolls in like a consuming fog that makes me gasp. It makes breaths hard and clouds my mind. At 2 am, I was reading about hypertensive emergencies and finding that all treatment algorithms are not possible here. My fleshly feeble attempts to gain control by having a plan. Many of you just chuckled because you do the same.  As if sleepy stressed thought processes in the middle of the night are going to have pearls of wisdom to offer the morning. Silliness!

Then I turned to reading a chapter of a new book. Total disinterest while my eyes scanned words my thoughts drifted everywhere else. Finally, prayer. Why does it always wait until I am at a place of fatigue and desperation. Because, that is where I end. It is the place that God can show His glory and grace. His movement is clear because of my awareness of my limitations. Then quiet and sleep. Praise God! This adventure is hard and taxing but draws me near to Him. 

I awoke sleepy but less anxious. I will just strive to be present in each moment knowing that God clothes me with what I need for the tasks He will give.   The view this morning of the mountain was also striking with the mountain top obscured by clouds. Unusual for this time of year.

Morning report was typical. I hate even typing that because it includes reports of patients that passed away, or seized through the night, or have painful days ahead.  But it is the standard.

When all the wards finished reporting it was time for me to present.  I presented the case of the intussusception that we had a week or so ago.  I had a power point presentation using the projector (we had no power but the battery pack worked)  I used the case to make it practical and then did teaching about intussusception. It went well. Everyone paid good attention.  I used a long hiking sock to explain the anatomy of the issue and the students seemed to enjoy that. The medical staff had good comments. 

Afterwards, I rounded with the intern, Pempo, and the medical students.  Stella continues to have issues with leg edema. Her circulation is so poor.  Florida, with nephrotic syndrome, continues to be very hypertensive. She did not receive her meds through the night so I had to have discussions with nursing about that.  Several patients were able to go home. Their diagnoses included tuberculosis, malaria and anemia, gastroenteritis, and dysentery.  

We have a few new patients.  One stirred up some bees and had multiple bites over her face and head.  Another, named Aefasio, is 4 years old and has known epilepsy and yesterday had continuous seizures for about 12 hours.  He was given traditional medicine and then brought to the hospital. He received several doses of anti-seizure medicines here and also tested positive for malaria.  He has been unresponsive and unconscious since. We spent a long time getting his medications correct and getting appropriate IVFs.

We went to the nursery after all the Pedi patients were seen.  We saw a few babies there. Little Telesa seems to be gaining a little weight but I worry her heart defect may be a significant issue.  I had a few minutes before lunch to review some things and ensure all was calm for lunch. I also had texted with Catherine to get together after lunch to review the three difficult cases I have just to ensure I am not neglecting anything.  It is always good to just have someone to talk through your ideas with.

Lunch was a nice break.  I laughed because Melissa had taken the braids out of Brandina’s hair and so the trash can was overflowing with hair.  Oh the things you have to learn as a white mom adopting African kids! The large group of Swedish nurses left for the lake for the weekend.  It changed the whole feeling at the inn. It has been quite crowded as in waiting in line to wash dishes or get hot water. The common sitting area also sometimes don’t have open places to sit.  It will be nice to have the weekend without all the people.

I headed back to the ward after lunch.  I was feeling a little tired as I knew I would.  Sam was on the ward and some of the medical students were having him complete their evaluations. Catherine joined me fairly quickly.  Sam informed her that Aisha, the great clinical officer in the NICU was planning to resign at the end of the month. The timing is poor and Catherine is so sad.

Catherine and I talked through Stella and Florida’s cases.  Mostly reassurement but we did a little dosing adjustments based on some concerns I had.  It is just nice to talk it through with her as these conditions are very unfamiliar to me.  We still are hopeful that Stella can get to a place where going home would be an option. Catherine stepped out for a minute to take a call.

The mom of the child in a coma motioned for me.  I moved quickly to the bed looking for movement assuming he was seizing.  Instead, I found no movement at all. No breathing. No heart rate. I called out for a code, positioned him, called for a mask and bag, and started chest compressions.  Catherine joined quickly and after a few broken are wrong sized masks were brought, a correct one was given and she started respirations. It is very difficult with just two to keep count, call out instructions, and for me to update her on the patient.  Medications were given but to no avail. The patient had urinated during the resuscitation all over the sheets. I picked up the body so the wet sheets could be removed before the mother was brought to the bedside. I held his limp body as the hot tears burned again and my heart broke for yet another mother who will carry him all the way home tonight, but would not see his smile ever again. 

I could not even finish the death note before a 7 months old with strider was brought in.  This baby is one that is followed in the pediatric clinic and had a cleft palate repair two days ago.  I think it is just swelling from the surgery but he was not a happy camper. Needless to say, after we got him settled in and finished charting all of the adjustments of doses and talking to parents and nurses about plans the day was at an end.

The medical student followed me back to the inn.  This was only her second resuscitation to witness, so she was a little shaken.  We sat and debriefed for a while with Melissa and then Sharisa headed home. I went and took a long, kind of hot, poor water pressure shower to remove the day.  

Melissa made pancakes and the girls and I sat at the counter and ate and made silly faces and worked on the concept of “next to you” and “across from you”.  It was comfort food and comfort company. The colors of the sunset were gorgeous and a reminder of our good and sovereign God. I am happy to see this day come to a close and think I will sleep well tonight. 

Melissa made pancakes and the girls and I sat at the counter and ate and made silly faces and worked on the concept of “next to you” and “across from you”.  It was comfort food and comfort company. The colors of the sunset were gorgeous and a reminder of our good and sovereign God. I am happy to see this day come to a close and think I will sleep well tonight.