The Ultimate Sacrifice

Saturday, March 24, 2012  Day 15

Another Saturday spent in the hot SL sunshine!

We arose early and made rounds after breakfast. Earlier in the week there were 3 patients that Phillip had been monitoring for an acute abdomen. Two of the cases went to surgery with which he assisted. The third patient he continued to monitor throughout the day on Wednesday and Thursday until she began to show signs of improvement at which time he called off surgery.

We did not round yesterday since we spent the day in Medina, so when we came into the hospital door this morning, we were met by the nursing staff who informed us that this non-surgical patient had expired.

I will never forget the look of shock, disbelief, and immediate guilt on Phillip’s face. “What happened? I don’t understand. She was getting better,” he mumbled quietly to me. I knew it wasn’t something he was going to let go of easily whether he admitted it or not. Dr. Asher and I both reassured him that there was nothing that could have been done but as I walked over to the peds ward I heard the wailing begin in the breeze way. I peered out the window feeling guilty for watching but too intrigued to turn away and not knowing any other way to show respect.

I saw her daughter drop to the ground shaking profusely on the hard concrete- her body limp as if she had lost all control of function. The pain was paralyzing for her. I continued to watch as family members came to comfort her and help her up from the ground.

I watched until a woman speaking something to me in Krio interrupted me. I recognized her as Foday’s mother, the child from one of Phillip’s surgeries. She came to inform me that her son was able to go to the bathroom- a great feat for a post-operative patient who’d just had an open abdominal surgery for a perforated bowel because of typhoid.

“We done send de sample,” she tells me. I look over to the child and notice he has a tube in his nose. Apparently he’d had some trouble through the night. Dr. Tom instructs me to keep careful watch for signs of improvement so that we can try to take the tube out as soon as possible. So after lunch I made a short trip down to see the tailor in the afternoon heat so that I could go check on Foday. He was doing well with no vomiting so I tell the nurse that she can remove it. “Ok but I have a new malaria patient with a hemoglobin of 2.3 and I have to start the IV for a transfusion so you’ll have to do it yourself,” she says a bit flustered as she runs past me with a bag of blood in hand.

“Great, “ I think. “ I don’t even know where to start. Hopefully I can just pull…”

I instruct the child on what I’m doing and he thankfully agrees. I tug firmly and gently and slowly it is freed. “Whew!” I hope he didn’t know I was just as scared as he was.

I leave to go check on the malaria patient and as I walk in the door I recognize the limp pale child. I ask for his chart. He had been admitted only 10 days prior for the same condition. His hair had not even grown back from where they shaved his head for his last transfusion. I have never seen a dark child so pale.

The nurse wiped the scalp clean as she began looking for venous access. She slowly advanced the needle, but with no success. I convince her to try for the arm, so she hands me the needle. I stick once. The sweat is just rolling down my back now. Missed. The child barely squirms or flinches. I try again…nothing. The nurse tries once more for scalp access. Finally- a flash of blood! But still no drip yet. We tried to adjust the needle with no success. A second nurse is called in and eventually after sticking almost every vein in the child’s body we get access and the transfusion was started.

After all the drama, I decided to rest until after dinner when Dr. Tom got called in to check on an employee who’d passed out. Phillip and I both go with him, and as we are finishing up, the nurse comes over to inform us that there’s a victim of a dog bite in the peds ward that we need to see. We walk over only to find out that there are actually two victims- the child and the father who tried to save the child. I let Philip and Dr. Tom talk to them while I go over to check on the malaria patient from earlier. He was still very pale and lethargic but I am hopeful that he will recover.

We leave the ward only to again be stopped. A lady on the women’s ward with a history of vomiting blood is now passing blood in her stool. Phillip goes to check on the woman since he’d seen her earlier in the day. Her hemoglobin is 5.0 and she is very sick. Dr. Tom, realizing that our blood stores are low and that there is no family here in the middle of the night to donate for her, quickly volunteers to donate. Phillip without hesitation piped up and refused. He decided that it was easier for him to give and to save Dr. Tom’s donation for a time when there was no one else available. I was floored. How is this even okay? For a moment I thought they were joking, but then I realized there was no laughter, no smile, and no other donor. After a few minutes, the idea settled in and I realized once again I’m in Africa. Phillip graciously walked to the lab with Dr. Tom to get typed for his donation while the woman lay sleeping, too ill to even know what a sacrifice he was making. I was amazed. What a great way to end the day.