Carry On

A little apology in advance...this has been the hardest entry for me to type so far. It was such an emotionally challenging day and as hard as I tried, I felt as if I could never portray how draining it was- there are just not enough adjectives in the English language. But to sum it up, I will leave you with this before you begin to read:

There has never been a time in my life where I have experienced every imaginable human emotion all in one day...

Grief, despair, hopelessness, regret, doubt, anger, denial, joy, love- you name, it was all there and hopefully you can sense that here.

Friday, March 30, 2012

Today felt like it should have been filmed as an episode of the TV show “24” because it was hands down the longest 24 hours of my life and I thought it may never end…

MORNING

The morning started with a nice breakfast but was foreshadowed somewhat by the fact that we all missed chapel.

Stephanie and I decided to tackle the women’s ward while Jenny went with Phillip to see the patients on the ped’s ward. When we arrived to see the women patients, there were no charts ready for half our patients and the ones we did have, didn’t have labs or meds done. There were several new patients who didn’t even speak Krio so it was difficult to obtain any history of their illness. (One patient was admitted for altered mental status. She was very disoriented and spoke only in her tribal language so it was impossible to obtain any information.) Two of our patients were still waiting for procedures for the third day in a row and three patients were not allowed to leave because they still owed money.

And…we were shorthanded so we were splitting one nurse between women’s and ped’s ward (about 50 patients). So there was no sign of any progress in the near future. Stephanie and I finished rounding on what we could do at about 10am. Dr. Tom was still nowhere to be found so we leave to go check on Jenny and Phillip in the ped’s ward. They are also finishing up.

We go to see their last patient with them when suddenly a crowd of about 4-5 people coming through the door dragging the limp body of a small boy about 8 years old. They tried to get him to walk, but he kept falling. Finally they get him to a bed. Jenny and Phillip rush over to start examining him. The mother of the child is standing at the bed observing when all of a sudden she drops to the floor and begins to wail. The child lay with his head thrown back- nares and mouth wide- struggling to breath. Quickly Jenny begins to read his admission note from the outpatient nurse that shows that he was given albuterol and steroids for wheezing and a cough. They begin the exam while the family watches. Stephanie and I go to the mother and escort her and the newly forming group of spectators from the bedside, trying to get the mother to calm down so they can finish the exam.

Just as we get a few feet away, I turn to see the two brothers start to cry and wail. I can see Jenny’s face. The kid stopped breathing with Phillip’s stethoscope on his chest. It was hardly noticeable, yet his family knew instantly. After looking at each other for a second that seemed like an eternity Jenny and Phillip start CPR as Stephanie and I move the relatives out of the way. Jenny screams to me, “I need something to help this kid breath!” I sprint down the breezeway- not knowing what I’m looking for, not even knowing what options or resources I have available for this type of situation. I stop in the OB ward and grab Emily, the nurse practitioner who knows the hospital much better than myself. “Quick, we need help. This kid stopped breathing in peds,” I quickly spurt out all in one breath.

We race back to peds. "There's an oxygen tank and a mask in the OR, if we can get him there," Emily informs me calmly. When we enter the room, Jenny and Phillip are still compressing his chest but he he's not breathing on his own. I stare at him as they stop briefly to check him. "He has a pulse!" I scream and point to his arm. He is lying with his arms above his head and in the glare of the light against his dark skin, I can see the thrill of a pulse over his brachial artery.

"Let's take him," Emily gives the command and it slowly registers that this is not a normal occurrence in SL. There was no doubt or discussion for us as to whether we should try life saving measures, but in Kamakwie you have to question everything especially since there is no way to continue care if life does resume. There are no respirators, cardiac monitors, intensive care units, etc. It was something I was not used to and very uncomfortable having to think about in such a quick manner.

We move the child to the OR, his limp body in Phillip and Jenny’s arms. I watch as if in slow motion as they rush him down the breezeway past his still wailing family. We hook up the portable oxygen to the battery source in the OR (it isn’t charged) and start manually pushing oxygen into his small lungs with a bag. We watch his chest slowly rise and fall with each pump of the bag. I can feel the blood rush every time Jenny pumps on his chest. I check for a pulse while they're bagging and realize it’s weak at best and is slowly diminishing. She stops and it becomes weaker and weaker until I can no longer feel it. He has no spontaneous respirations. 

His lifeless body lays there stretched out on the table, the oxygen still blowing through his nose but without his chest moving. We turn it off.

Finally with blank expressions on our faces, we’re forced to look at one another and deal with the truth that none of us wanted to admit: There was nothing more we could do. We weren’t changing the outcome. We had to stop. Jenny leaves the room in silent tears and Emily follows to go talk to the family. Phillip, Stephanie and I stand in silence, staring at the young boy. The frustrations of the day slowly fill my mind.

As hard as I try, I can’t hold back the tears.

Anger consumes me:

“This should not be happening. We should not be here. HE should not be here. This never would’ve happened if things were more organized and systematic.” I try to blame the nursing staff. “This never would’ve happened if we’d had more help. We shouldn’t have to be handling this on our own. We’re just students!” I had to blame someone or something. I was so angry. We did everything we could, exactly the way we were supposed to, exactly the way we’d been trained, but still we fell short. “How could this happen? This can’t be real. He’ll wake up soon. He’ll breath again.” The denial quickly crept in.

I look back at him and the reality sets in. I feel his leg. It's already growing cold.

We exit the room still in silence. Finally Dr. Tom shows up and we spend the next several minutes recapping the order of events of the morning that seemed to have lasted forever. Without any good explanation, reason, or cause for a normal, healthy appearing young boy to stop breathing we turn back to our other patients and continue working as if nothing ever happened. As if we hadn’t just walked past his crying, weeping, wailing family staring at us for answers- their tear filled eyes pleading for some explanation. As if this was some switch that we were supposed to be able to just turn off and walk away. As if I’m not supposed to question every single step of what happened to this child over and over again in my head- feeling the heavy guilt of every action.

I go back to work plagued by the longing eyes of that family- comforted only by the peaceful look on the child’s face as he silently rested. I wondered how much strife this family had faced before- how many times they had undergone this unnecessary pain. Or was this pain less than those they’d faced before? I wondered if it ever got any easier for them. I struggle to just make it through the rest of the morning, but somehow by the grace of God we carry on…