The woman was gored by a bull. Not just any bull, a Chadian bull with 3 foot long horns. And she was gored in the mouth, straight through her palate into her nasal cavity. But that was months ago. Now, she's just a wizened old lady who'd like to swallow her porridge without it coming out her nose. I have her open her mouth and I shine in a light. There's a small hole, slightly smaller than one centimeter right in the center of the roof of her mouth. I poke around with a clamp. There's some green stuff; looks like bean leaf sauce for lunch.
We prepare her for surgery. She has high blood pressure. Three days and three medications later her blood pressure is mostly controlled. We wheel her into surgery.
There are four medications God has reserved as gifts for the third world. One of those is Ketamine. It is dirt cheap, can be given through an IV or into a muscle, dissociates the person from their conscious brain yet doesn't hinder breathing, swallow or gag reflexes. It also increases heart rate and blood pressure (both generally good things during surgery) and dilates bronchioles in the lung increasing oxygenation. It allows us to do most major surgical procedures without intubation, ventilators, or other complicated anesthesia equipment. Too good to be true? Well, there are a few drawbacks...
Simeon gives the woman some atropine to dry up her secretions since Ketamine tends to make one salivate and shed a lot of tears. He also gives her Valium since people on Ketamine can have vivid dreams, visions or even nightmares. This is especially true on emergence from anesthesia. Valium should blunt that. So far so good.
I have put on sterile gloves and arranged the instruments on the tray. I'm ready for the patient to be knocked out. Simeon slowly injects one milliliter of Ketamine. I watch as her eyes start to twitch and then she goes out. Then she contracts her abdomen, chest and neck in a huge grunt and stops breathing. I can hear the beep beep of the pulse oximeter in the background as her oxygen saturation goes slowly but surely down. This happens sometimes with Ketamine for a few seconds. I sit tight. She still doesn't breathe. I start doing some chest compressions to move a little air in and out of her lungs. Simeon is keeping her airway open. Her sats come up a little, but are still very low. Usually, the person starts breathing right about now, or rather a few seconds (or is it minutes) ago.
I decide to intubate. Simeon opens the drawer filled with about 10 different laryngoscope handles and light sources and over 20 different lighted blades. I grab the one I want, it doesn't light up. I try changing blades. Nothing. I'm starting to panic as I go through all the handles and blades and not a single one works. We have the endotracheal tubes ready, but no way to see the vocal cords to put them in. Meanwhile the patient isn't breathing because she's all tensed up from a reaction to the Ketamine. Her sats are going way down in the background with that annoying little beep.
I see in the bottom of the drawer a laryngoscope I've never seen before. It's made of green plastic and the blade is rigidly attached to the handle which is hollow with no top. It's just a long tube attached to the blade. On the side is written, use laryngoscope light source (or something like that). Inspiration (or desperation) comes. I yell to James (the medical student/EMT from the states).
"Get me that headlamp over there on the wall. Turn it on and shine it down this handle!"
It works, a little light at the tip of the blade lights up. I quickly jam it into her mouth and see her vocal cords! I grab the ET tube. I try to put it in but her mouth is tense and the tube bends. I forgot the guide wire. I quickly fumble in the drawer and bend the wire back into shape and jam it down the ET tube.
"James, put your hand right here and push her cricoid down and to her right!" I can't see the cords. Finally, a swollen, tight little hole with two white flaps opening and closing pathetically shift into view. I thrust in the tube and it passes into the trachea.
"Blow up the cuff with that syringe!" I yell to the other medical student, Jonathan. I attache the bag to the tube and start pumping air into the patient's lungs. I see a reassuring vapor in the tube with each exhalation and an even more reassuring increase in the tone of the pulse ox which says she is now being well oxygenated.
I give the bag to James while I put on fresh gloves and make two incisions about half a centimeter from the hole in the woman's palate. Jonathan and Abel retract and Abel suctions while I free up the tissue from the bone and then move the two flaps to the center and suture them over the hole made by the bull horn.
Fifteen minutes after the surgery is over I'm able to extubate the woman and she soon breathes normally with normal oxygen saturation.
Note: No supplemental oxygen was used in the filming of this nightmare due to unavailability.
Friday, July 9, 2010
Monday, July 5, 2010
Central Africa Republic
It starts with a hum, then a buzz followed by an ever increasing noise that soon identifies itself as an unavoidable telephone ringtone that is a poor imitation of the William Tell Overture. Sarah walks over to the shelf, grabs the small silver object and passes it to me. I open it up and glance at the screen: an unknown number.
"Hallo?" I query.
"As salaam alek." A deep cheery voice greets me in Arabic.
"Wa alekum as salaam." I respond.
"It's me, Mahamat Shadara," the voice continues. "You operated on my leg, remember?"
"Yeah," I do remember him and have wondered how he was doing. "Kikef?" I ask back in Arabic.
"I'm bringing a brother from Central Africa with two broken feet." I'm assuming that he's using the colloquial expression meaning two broken legs.
"Ok, where are you?"
"We just left Moundou and are almost at Kelo. We're coming to Bere. He needs to be operated on today."
"Ok, ok," I try not to promise to operate today since I have no real idea what his problem is. "Bonne route!" I hang up.
Several hours later, as Sarah and I are finishing up some pasta salad along with an episode of "House, MD" the phone rings again.
"We've arrived at the hospital." It's Mahamat Shadara's voice again.
"D'accord, j'arrive." I finish my meal and my distraction and head over to the ER.
There is an old beat-up Toyota pickup in the middle of the courtyard between the ER and the OR. I assume the patient is in the back. A large Chadian walks over to me with just a slight limp using a cane. He holds out his massive hand and grasps mine in a firm grip as a huge smile lights up his face.
"Docteur, as salaam alekum."
"Wa alekum as salaam, yom katir..." The Arabic greetings continue on for several minutes before we walk over to see the patient.
A foul odor wafts up from the back of the truck where a weak looking man looks like he's barely hanging on. His head is propped way up on a pillow. Yellow shorts cover his waste and a dirty white sports jersey can't hide the thin arms and partially healed scratches. An old piece of foam probably carved from a used mattress is between his legs which are both twisted out at impossible angles. As I suspected, he probably has bilateral tibia fractures. Both are covered in layers of old matted cloth surrounding reeds and all covered in gentian violet. The flies buzzing and his burning hot skin confirm my suspicions that one if not both of the fractures is open and severely infected.
"How long since the accident?" I demand.
"Xamstachar, fifteen days," Mahamat confirms. "He came all the way from the Central African Republic. I brought him here because you helped me so much if anyone can help him it's you."
I'm not so sure, but I get the process rolling.
"Dinah," I call out to the pharmacist. "Call Abel, Simeon, Samedi, Abre and Youlou. We have an emergency surgery and I need there help immediately."
The family members along with our medical students grab the metal spring bed without legs that the man is lying on and lift him out of the bed of the truck. We bring him into the OR. Sarah and Salomon each find an IV and start pouring in antibiotics and IV fluids. I start cutting away the layers of old cloth and reeds around the fractures and uncover a hardened layer of what looks like dried roots, probably some traditional bone treatment. The right leg has some superficial wounds that look like scrapes or pressure sores from the binding. No bone is showing and it looks like the fracture is closed. Good news for him.
Meanwhile Samedi has arrived and is putting in a urinary catheter while Simeon is cutting away the wrappings on the left leg. Henri has come and done a hemoglobin which is 5.7 g/dl. He needs blood. Henri goes to get the stuff to cross match his blood and hopefully find donors among his family members since we have no blood bank. The left leg is completely open with bone fragments jutting out and dirty, peat moss like flesh around the wound edges. Pus and an awful odor pour out of the injury. There is also a green looking gash along the outside of his left knee. There's no way to save that leg and we need to amputate immediately.
Henri comes back. The patient has O negative blood, one of the rarest types and the one type that can't take anything but that one type of blood. None of the family is O negative. We'll have to operate without blood. Simeon brings a blood pressure cuff and a large elastic wrap. I start at the toes of his left leg and wrap tightly to try and squeeze as much blood out of the leg as possible and back into his circulation. Then Simeon pumps up the blood pressure cuff around his upper leg which acts as a tourniquet.
We wheel him into the OR where I quickly slice through the thigh muscles down to the bone. Pus gushes out. Right along the bone is more of that green, necrotic tissue. I saw through the bone and toss the leg into the trash can which gets knocked over. Youlou rapidly puts it back right while I try to chase down and cut out all the necrotic looking tissue. I also find the main artery, vein and nerve and clamp and tie them off. Once the debridement is done and we are down to healthy looking muscle, I ask Simeon to gently let down the tourniquet. Samedi and I spot the bleeders and clamp them off while Simeon reinflates the cuff to stop any oozing. I tie off the vessels, pack the wound deeply with diluted bleach soaked gauze and wrap the whole wound up tightly with an Ace wrap.
Simeon lets down the tourniquet and the dressing stays dry. I move to the right leg which I cast from toes to thigh after cleaning and dressing the wounds. I'll cut a window in the cast tomorrow so we can do dressing changes and if the wounds clear up then I may put in an intramedullary rod. Right now it's too much for him in his weakened condition. As we turn him to clean him off, I notice pressure sores over his sacrum which I also debride and dress. Finally we wheel him out to the wards.
I don't know how he stayed alive for 15 days in that condition, but people here are tough. I hope he makes it through the night.
"Hallo?" I query.
"As salaam alek." A deep cheery voice greets me in Arabic.
"Wa alekum as salaam." I respond.
"It's me, Mahamat Shadara," the voice continues. "You operated on my leg, remember?"
"Yeah," I do remember him and have wondered how he was doing. "Kikef?" I ask back in Arabic.
"I'm bringing a brother from Central Africa with two broken feet." I'm assuming that he's using the colloquial expression meaning two broken legs.
"Ok, where are you?"
"We just left Moundou and are almost at Kelo. We're coming to Bere. He needs to be operated on today."
"Ok, ok," I try not to promise to operate today since I have no real idea what his problem is. "Bonne route!" I hang up.
Several hours later, as Sarah and I are finishing up some pasta salad along with an episode of "House, MD" the phone rings again.
"We've arrived at the hospital." It's Mahamat Shadara's voice again.
"D'accord, j'arrive." I finish my meal and my distraction and head over to the ER.
There is an old beat-up Toyota pickup in the middle of the courtyard between the ER and the OR. I assume the patient is in the back. A large Chadian walks over to me with just a slight limp using a cane. He holds out his massive hand and grasps mine in a firm grip as a huge smile lights up his face.
"Docteur, as salaam alekum."
"Wa alekum as salaam, yom katir..." The Arabic greetings continue on for several minutes before we walk over to see the patient.
A foul odor wafts up from the back of the truck where a weak looking man looks like he's barely hanging on. His head is propped way up on a pillow. Yellow shorts cover his waste and a dirty white sports jersey can't hide the thin arms and partially healed scratches. An old piece of foam probably carved from a used mattress is between his legs which are both twisted out at impossible angles. As I suspected, he probably has bilateral tibia fractures. Both are covered in layers of old matted cloth surrounding reeds and all covered in gentian violet. The flies buzzing and his burning hot skin confirm my suspicions that one if not both of the fractures is open and severely infected.
"How long since the accident?" I demand.
"Xamstachar, fifteen days," Mahamat confirms. "He came all the way from the Central African Republic. I brought him here because you helped me so much if anyone can help him it's you."
I'm not so sure, but I get the process rolling.
"Dinah," I call out to the pharmacist. "Call Abel, Simeon, Samedi, Abre and Youlou. We have an emergency surgery and I need there help immediately."
The family members along with our medical students grab the metal spring bed without legs that the man is lying on and lift him out of the bed of the truck. We bring him into the OR. Sarah and Salomon each find an IV and start pouring in antibiotics and IV fluids. I start cutting away the layers of old cloth and reeds around the fractures and uncover a hardened layer of what looks like dried roots, probably some traditional bone treatment. The right leg has some superficial wounds that look like scrapes or pressure sores from the binding. No bone is showing and it looks like the fracture is closed. Good news for him.
Meanwhile Samedi has arrived and is putting in a urinary catheter while Simeon is cutting away the wrappings on the left leg. Henri has come and done a hemoglobin which is 5.7 g/dl. He needs blood. Henri goes to get the stuff to cross match his blood and hopefully find donors among his family members since we have no blood bank. The left leg is completely open with bone fragments jutting out and dirty, peat moss like flesh around the wound edges. Pus and an awful odor pour out of the injury. There is also a green looking gash along the outside of his left knee. There's no way to save that leg and we need to amputate immediately.
Henri comes back. The patient has O negative blood, one of the rarest types and the one type that can't take anything but that one type of blood. None of the family is O negative. We'll have to operate without blood. Simeon brings a blood pressure cuff and a large elastic wrap. I start at the toes of his left leg and wrap tightly to try and squeeze as much blood out of the leg as possible and back into his circulation. Then Simeon pumps up the blood pressure cuff around his upper leg which acts as a tourniquet.
We wheel him into the OR where I quickly slice through the thigh muscles down to the bone. Pus gushes out. Right along the bone is more of that green, necrotic tissue. I saw through the bone and toss the leg into the trash can which gets knocked over. Youlou rapidly puts it back right while I try to chase down and cut out all the necrotic looking tissue. I also find the main artery, vein and nerve and clamp and tie them off. Once the debridement is done and we are down to healthy looking muscle, I ask Simeon to gently let down the tourniquet. Samedi and I spot the bleeders and clamp them off while Simeon reinflates the cuff to stop any oozing. I tie off the vessels, pack the wound deeply with diluted bleach soaked gauze and wrap the whole wound up tightly with an Ace wrap.
Simeon lets down the tourniquet and the dressing stays dry. I move to the right leg which I cast from toes to thigh after cleaning and dressing the wounds. I'll cut a window in the cast tomorrow so we can do dressing changes and if the wounds clear up then I may put in an intramedullary rod. Right now it's too much for him in his weakened condition. As we turn him to clean him off, I notice pressure sores over his sacrum which I also debride and dress. Finally we wheel him out to the wards.
I don't know how he stayed alive for 15 days in that condition, but people here are tough. I hope he makes it through the night.
Thursday, July 1, 2010
High Risk OB
It all started with the usual knock on the door at 3AM. Faka, the charge nurse for the night team, is outside as I open the screen door. A dim flashlight illuminates his face as he looks up from a patient's carnet.
"A woman just came in with presentation of the umbilical cord. She's been in labor at home since yesterday. The were no fetal heart tones. She had some bleeding but it stopped."
"What time did she come in?" I interrupted.
"Just 20 minutes ago." Faka replied.
"Was it a normal vertex presentation?"
"I think so."
"Go and find out. Since the baby's already dead and the bleeding has stopped, if the fetus is head down, then she can deliver normally."
"Ok." Faka moves off into the night as the crickets, frogs and pigeons take over with the usual Chadian night sounds.
I decide to stay up until Faka comes back. I read for a while but after half and hour I assume the woman has already delivered or is doing well so I go back to sleep.
After worship, Faka gives his report to the rest of the staff.
"...and the woman still hasn't delivered and has no contractions."
I stifle my frustration and announce that we'll all go to see the patient right after the rest of the morning report.
The woman is in a dark room. The electricity is off. I go to the OR and hit the remote start for the generator. I come back to labor and delivery and find the woman in a clean room behind a blue curtain on a delivery bed with no mattress under a noisy fan.
The umbilical cord is sticking out between her legs. The abdomen is a weird shape. On closer inspection, the placenta is also half hanging out and the odor of rotting flesh wafts up into my unprotected nostrils. I examine the woman and find a hand sticking out next to the placenta and umbilical cord. This woman has three reasons to need a c-section four hours ago: placenta previa, cord prolapse and transverse presentation.
A few minutes later in the OR I have Abel douse the cord and placenta with Betadine while Samedi and I scrub. The infant's skin is already peeling off as I pull the limp form out of the abdominal incision. I leave the skin partially open to prevent infection and we clean up.
Prudence is waiting for me outside the OR.
"A woman just came in. This is her 5th pregnancy and she's been trying to deliver at home since yesterday morning. I can't exactly tell what the presenting part is."
"Ok, I'm coming." I slip off my OR shoes and into my sandals as I turn the corner and down the outdoor veranda to the maternity ward.
At first I also can't tell what part of the baby I'm feeling till my finger goes into the child's mouth.
We quickly prepare her for a c-section as well. As I open the uterus I can tell the fetus was stressed as a thick green fluid oozes out. I pull the baby out but the head is huge and her lower uterine segment thin and about to rupture due to prolonged labor. The baby is soon crying as Prudence uses the bulb suction and briskly dries and stimulates him. Meanwhile I repair the tears in the paper thin uterus and finally control the bleeding. I rinse out the abdomen well and close.
A few hours later, Prudence comes to get me again.
"This woman has been bleeding a lot." She tells me as we make the now familiar trip to labor and delivery.
On entering the room I see a woman breathing rapidly, somewhat dazed and covered with blood all over her legs and waist.
As we prepare her for surgery, the lab checks a hemoglobin: 7.8 g/dl (normal is over 14) We do a type and cross and find out unfortunately that she is O negative, one of the rarest blood types and one that can only take O negative, no other type. As I slice down the midline of her lower abdomen, the lab guys are desperately checking the blood types of all the relatives of the woman. None of the staff is O negative and we have no blood bank so we hope someone that came with her will have the same type.
As I open the abdomen I see a blotchy uterus with cracks on the surface oozing diluted red blood. After nine other deliveries the uterus just can't take much more. There are dark bruises around the edges and the fundus. As I open the lower segment a dead baby pops out followed by a large grapefruit sized blood clot. Abruptio placentae where the placenta separates too early causing massive hemorrhage between it and the uterine wall. That explains why she's oozing from everywhere: she has no platelets or clotting factors left.
Since the oozing won't stop and the uterus looks as if it's been beat up, I decide to take it out. It is rather simple to do but after it's out, despite by sutures, the wound edges just keep bleeding and bleeding. I try everything I know but nothing works. Her blood is so diluted it almost looks like pink lemonade. In desperation I ask for a packet of Celox, ignoring the large "for external use only" on the package I poor the powder over the bleeding edges in the pelvis and hold pressure with a compress. The problem is there's nothing to hold pressure to. Even with the Celox applied several times there is just too much oozing for my comfort, especially considering I have no blood to give her and she started out low. Finally, I take a large lap sponge, pack it into her pelvis and close the fascia and skin around the blue cord attached to one corner of the gauze that hangs out the skin.
As I watch her being wheeled out to the wards I'm sure it's the last time I'll see her alive. Later that evening I go to check on her. She's moaning and groaning and not really responsive. I grab 2 liters of IV fluids from the OR and let them pour in. WHen the first one is in, I change to some 10% glucose. She starts to at least make some sense. I ask her family to interpret what she's saying in her local dialect.
"She's in a lot of pain."
I order some IV pain medication and go home. At least with the pain medication, she'll die peacefully.
The next morning, she's still alive and so I have the family give her some water and porridge. Later that afternoon, the lab finally finds a family member with the right blood type and she gets one unit of blood. It's not nearly as much as she need's but it's better than nothing. The next morning, she's swollen and edematous but alert. I take her back to the OR and take out the lap sponge and reclose the abdomen under general anesthesia. Today, she is still critical but sits up with help and is taking some water and more porridge.
Maybe she'll make it after all.
"A woman just came in with presentation of the umbilical cord. She's been in labor at home since yesterday. The were no fetal heart tones. She had some bleeding but it stopped."
"What time did she come in?" I interrupted.
"Just 20 minutes ago." Faka replied.
"Was it a normal vertex presentation?"
"I think so."
"Go and find out. Since the baby's already dead and the bleeding has stopped, if the fetus is head down, then she can deliver normally."
"Ok." Faka moves off into the night as the crickets, frogs and pigeons take over with the usual Chadian night sounds.
I decide to stay up until Faka comes back. I read for a while but after half and hour I assume the woman has already delivered or is doing well so I go back to sleep.
After worship, Faka gives his report to the rest of the staff.
"...and the woman still hasn't delivered and has no contractions."
I stifle my frustration and announce that we'll all go to see the patient right after the rest of the morning report.
The woman is in a dark room. The electricity is off. I go to the OR and hit the remote start for the generator. I come back to labor and delivery and find the woman in a clean room behind a blue curtain on a delivery bed with no mattress under a noisy fan.
The umbilical cord is sticking out between her legs. The abdomen is a weird shape. On closer inspection, the placenta is also half hanging out and the odor of rotting flesh wafts up into my unprotected nostrils. I examine the woman and find a hand sticking out next to the placenta and umbilical cord. This woman has three reasons to need a c-section four hours ago: placenta previa, cord prolapse and transverse presentation.
A few minutes later in the OR I have Abel douse the cord and placenta with Betadine while Samedi and I scrub. The infant's skin is already peeling off as I pull the limp form out of the abdominal incision. I leave the skin partially open to prevent infection and we clean up.
Prudence is waiting for me outside the OR.
"A woman just came in. This is her 5th pregnancy and she's been trying to deliver at home since yesterday morning. I can't exactly tell what the presenting part is."
"Ok, I'm coming." I slip off my OR shoes and into my sandals as I turn the corner and down the outdoor veranda to the maternity ward.
At first I also can't tell what part of the baby I'm feeling till my finger goes into the child's mouth.
We quickly prepare her for a c-section as well. As I open the uterus I can tell the fetus was stressed as a thick green fluid oozes out. I pull the baby out but the head is huge and her lower uterine segment thin and about to rupture due to prolonged labor. The baby is soon crying as Prudence uses the bulb suction and briskly dries and stimulates him. Meanwhile I repair the tears in the paper thin uterus and finally control the bleeding. I rinse out the abdomen well and close.
A few hours later, Prudence comes to get me again.
"This woman has been bleeding a lot." She tells me as we make the now familiar trip to labor and delivery.
On entering the room I see a woman breathing rapidly, somewhat dazed and covered with blood all over her legs and waist.
As we prepare her for surgery, the lab checks a hemoglobin: 7.8 g/dl (normal is over 14) We do a type and cross and find out unfortunately that she is O negative, one of the rarest blood types and one that can only take O negative, no other type. As I slice down the midline of her lower abdomen, the lab guys are desperately checking the blood types of all the relatives of the woman. None of the staff is O negative and we have no blood bank so we hope someone that came with her will have the same type.
As I open the abdomen I see a blotchy uterus with cracks on the surface oozing diluted red blood. After nine other deliveries the uterus just can't take much more. There are dark bruises around the edges and the fundus. As I open the lower segment a dead baby pops out followed by a large grapefruit sized blood clot. Abruptio placentae where the placenta separates too early causing massive hemorrhage between it and the uterine wall. That explains why she's oozing from everywhere: she has no platelets or clotting factors left.
Since the oozing won't stop and the uterus looks as if it's been beat up, I decide to take it out. It is rather simple to do but after it's out, despite by sutures, the wound edges just keep bleeding and bleeding. I try everything I know but nothing works. Her blood is so diluted it almost looks like pink lemonade. In desperation I ask for a packet of Celox, ignoring the large "for external use only" on the package I poor the powder over the bleeding edges in the pelvis and hold pressure with a compress. The problem is there's nothing to hold pressure to. Even with the Celox applied several times there is just too much oozing for my comfort, especially considering I have no blood to give her and she started out low. Finally, I take a large lap sponge, pack it into her pelvis and close the fascia and skin around the blue cord attached to one corner of the gauze that hangs out the skin.
As I watch her being wheeled out to the wards I'm sure it's the last time I'll see her alive. Later that evening I go to check on her. She's moaning and groaning and not really responsive. I grab 2 liters of IV fluids from the OR and let them pour in. WHen the first one is in, I change to some 10% glucose. She starts to at least make some sense. I ask her family to interpret what she's saying in her local dialect.
"She's in a lot of pain."
I order some IV pain medication and go home. At least with the pain medication, she'll die peacefully.
The next morning, she's still alive and so I have the family give her some water and porridge. Later that afternoon, the lab finally finds a family member with the right blood type and she gets one unit of blood. It's not nearly as much as she need's but it's better than nothing. The next morning, she's swollen and edematous but alert. I take her back to the OR and take out the lap sponge and reclose the abdomen under general anesthesia. Today, she is still critical but sits up with help and is taking some water and more porridge.
Maybe she'll make it after all.
Whimper
I stare down at the man. It's almost midnight. His name is David. He's almost 60 years old, but has the muscular build of a middle aged athlete. I took out his enlarged prostate three days ago. Up till now he's had a completely unremarkable post-op course. In fact, he's done better than expected. He was already up walking, eating, clear urine in the foley bag, etc. Now, things have changed.
His eyes are half open, pupils constricted, eyes slowly wandering away from the flashlight. He whimpers and whines like a beaten dog cowering in a corner. His heart beat is a little fast, but otherwise vital signs are normal. He is snoring. Just that evening, according to his son, he drank some water and had some porridge. Then he started mumbling incoherently out of the blue.
I have the nurse, Faka, find an IV and start a drip of 10% glucose. I look down at him. He continues to moan in a pitiful way as if he's extremely afraid. I wonder at my reaction. I want to feel something good, but all I feel is that I wish he would stop being so pitiful and that I wasn't woken out of a deep sleep and have to be here to see him like this. I'm disgusted and angry in my feelings while in my head I'm thinking, why can't I love him? But I feel nothing. I pray silently that my feeling will change.
As the glucose runs in, David starts to wake up. Faka then starts another IV in the other arm and gets some normal saline running. David starts to have purposeful movement and mumbles something. His son says he wants some water to drink. We lift his head up a little and he swallows have a glass of water. The IV on the right with the normal saline is pouring in. I notice that the glucose on the left is running slowly. I see that the IV is infiltrated.
I stop the glucose and when the saline is all in I switch the rest of the glucose over to the right. David wakes up even more. He mumbles something else in his native tongue. I ask his son to interpret.
"He says his ancestors are calling out to him from the grave and he's afraid."
I suggest we pray for him. They are all in agreement. I grab his hand and David holds mine tightly. At the end, I tell the son to ask him if he needs anything.
"He says he wants some porridge."
"Go ahead."
They lift him up again and his wife gives him some porridge which he swallows easily. He then remains sitting up on his own. The family has visibly relaxed. David is now able to understand and respond to my questions in French as well. I tell him that now that he's better I'm going back home to sleep, but I'll keep praying for him.
As I walk back in the moonlit night, the cool breeze echos the tranquility of my soul. I fall back to sleep immediately. In what seems like the next instant, I hear a knock on the door. It's Faka.
"Our guy is dead. Not fifteen minutes after you left. Out of the blue."
I hear the wails and cries of the family waft across the lawn from the hospital. I sit in my chair in the blue light of a bug lamp. I want to cry, but no tears come, only questions that will never be answered.
His eyes are half open, pupils constricted, eyes slowly wandering away from the flashlight. He whimpers and whines like a beaten dog cowering in a corner. His heart beat is a little fast, but otherwise vital signs are normal. He is snoring. Just that evening, according to his son, he drank some water and had some porridge. Then he started mumbling incoherently out of the blue.
I have the nurse, Faka, find an IV and start a drip of 10% glucose. I look down at him. He continues to moan in a pitiful way as if he's extremely afraid. I wonder at my reaction. I want to feel something good, but all I feel is that I wish he would stop being so pitiful and that I wasn't woken out of a deep sleep and have to be here to see him like this. I'm disgusted and angry in my feelings while in my head I'm thinking, why can't I love him? But I feel nothing. I pray silently that my feeling will change.
As the glucose runs in, David starts to wake up. Faka then starts another IV in the other arm and gets some normal saline running. David starts to have purposeful movement and mumbles something. His son says he wants some water to drink. We lift his head up a little and he swallows have a glass of water. The IV on the right with the normal saline is pouring in. I notice that the glucose on the left is running slowly. I see that the IV is infiltrated.
I stop the glucose and when the saline is all in I switch the rest of the glucose over to the right. David wakes up even more. He mumbles something else in his native tongue. I ask his son to interpret.
"He says his ancestors are calling out to him from the grave and he's afraid."
I suggest we pray for him. They are all in agreement. I grab his hand and David holds mine tightly. At the end, I tell the son to ask him if he needs anything.
"He says he wants some porridge."
"Go ahead."
They lift him up again and his wife gives him some porridge which he swallows easily. He then remains sitting up on his own. The family has visibly relaxed. David is now able to understand and respond to my questions in French as well. I tell him that now that he's better I'm going back home to sleep, but I'll keep praying for him.
As I walk back in the moonlit night, the cool breeze echos the tranquility of my soul. I fall back to sleep immediately. In what seems like the next instant, I hear a knock on the door. It's Faka.
"Our guy is dead. Not fifteen minutes after you left. Out of the blue."
I hear the wails and cries of the family waft across the lawn from the hospital. I sit in my chair in the blue light of a bug lamp. I want to cry, but no tears come, only questions that will never be answered.
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