Day 26

I spent my last day in Migori busy at the District Hospital peds ward yet again. The morning started off in rounds, monitoring kiddos from the day before and learning about any new admits. It started off pretty slow and about an hour after getting to the hospital, the pediatrician and all of the interns had apparently scheduled a meeting/presentation. I’m guessing it related to their schooling, because each of the interns had prepared some information about sickle cell anemia. It was actually really interesting and informing and seemed like it would be useful for doctors here to know. Again I’m always impressed with the extent of knowledge they have here about more complex procedures and diseases, but wish there was a little more focus on the simple things. In the peds ward, we’ve seen so many patients who are unresponsive due to not only their condition but also hypoglycemia, which could be such an easy fix. Anna and a few others here in the group are working on a few initiatives to make the hospital care more effective, and one of them is checking blood glucose on kiddos who are seeming hypoglycemic and keeping up treatment for that – hopefully it’ll work!

After our meeting we brought another girl down for a chest x-ray, checked on a few patients, and acted as communication between the different departments. There is really no communication between anyone here, whether it be the doctors, nurses, or families in the same department or other departments. The nursing role here is really minimal – the nurses mostly give out meds while doctors and families do the rest of nursing care – so Anna and I have realized our main role here has been acting as patient advocates. The parents trust the doctors so fully but so much is left out, so we’ve been trying to fill in the gaps getting patients the tests and medications they need as well as educating the parents on the child’s condition and what they can do to help.

We took another good chunk for lunch, since it was relatively relaxed, and then returned to the ward to find it a little crazier than expected (and by a little I mean a lot). We walked in to a crowd of people surrounding our bed with respiratory kiddos and were updated that when one of the med students walked in, one of the guys we’ve been working with had been close to flat-lining. They immediately pushed a lot of normal saline then started feeding him… then of course he started throwing up since his body was not prepared to take in so much food. We immediately came in and sort of took over, putting him on oxygen, pushing dextrose, and starting small amounts of feeding. We’ve seen a handful of cases where kids come in and are malnourished, as well as hypoglycemic and in hypovolemic shock (meaning they are low on fluid). It’s hard for any of us to treat because in America, we don’t have these kind of cases so much. It’s hard for the people who work at the hospital as well, because it’s really a vicious cycle and no one has a solution. Usually we start by doing an IV push of about 50mL of 10% dextrose, which is a good start, but if you don’t follow up the push with continuous sugar, the patient will crash. So then you can try to follow with a continuous IV drip of D5, but in a patient with hypovolemic shock they will start to retain fluid and their limbs with become extremely edematous and eventually, if the drip continues long enough, the patient’s heart will give out. Instead of giving an IV drip, we decided it might be useful to try giving patients F75, the solution given for malnourished patients, but a lot of the time the kiddos will throw up, risking aspiration. Basically it’s a vicious cycle that we’re having a lot of trouble solving. We tried to give our kiddo smaller amounts of F75, which he held down, but at the end of the day we have to leave the hospital without knowing what goes on overnight. Once the med students got back from surgery later in the night, we found out that our kiddo hadn’t lasted much longer. It sucks when we work on a kid all day, doing what we hope would be best, but still nothing can help. I know we’d all love to implement some sort of permanent system to start saving kids lives, but it’s so hard with the lack of resources and lack of devoted doctors.

Even though my last day ended on a bad note, I’m still reminded of what an incredible trip I’ve had and that even if we haven’t made huge changes amongst the hospital, what we’ve done has made a difference to some families. Although it’s easy to focus on the cases that go wrong, we have had a handful that go right and that’s what I’m trying to take away. I only wish it hadn’t taken so long to find my place at the District Hospital and that I could have had more time there to make even more of an impact.

It’s incredible to think that a month ago this time, I was nervous as could be, hoping panic attacks wouldn’t hit me and crying at the gate in the JFK airport. Everybody says these kinds of trips change them so drastically and although I don’t feel like I’ve changed too much, I can still tell how this trip will affect my future as a nurse and as a person. I’ve learned so much not only about medicine, but about truly being a nurse, advocating for your patients, asking questions, and taking chances. I’ve also made some amazing amazing friends, and I’m so glad to say I’ve found a family in Kenya. I can’t imagine how my trip would have differed if I hadn’t happened to come into Kenya with such an incredible group of people; luck was truly on my side. It was such an easy adjustment to make and I didn’t doubt my decision to come here for a second, it was so easy to feel comfortable with them early on. Special shout out to Anna (if she ever reads this) for being the best mentor I could have had on this trip. I’ve learned so incredibly much from her about technical procedures as well as just how to be a great peds nurse. Here’s to hoping she’ll actually come to Philly to work and help me survive nursing school :)
 

Finally, even though I know I’ve said it a million times, thank you thank you thank you to both of my parents. I know sending your kid off to Kenya by herself can’t be an easy decision to make (and funding it certainly isn’t that much easier!). Thank you both for believing in me, supporting me, and making this trip smooth and easy. I’ll probably have to spend the rest of my life showing you both how incredibly grateful I am for having this experience… and I’m already looking forward to my next one (shocking, right?).

Also thanks to anyone that’s been keeping up regularly with this blog!! Hope you’ve all enjoyed the craziness that has been Kenya. So for now, asante sana, Kenya and nakupenda… hopefully one day I will make it back to you!

Days 24 and 25

On Monday I woke up feeling not too great, definitely not as bad as what we affectionately refer to as “D-Day,” but still not 100%. I still headed to the hospital and back to peds with Anna, but this week we had a new group of med students to work with! I was sad to see Thomas and Tyler leave, but neither of them were particularly interested in peds in the long term plus the two new guys coming in seemed like they would work really well with the kiddos. We didn’t show up to the hospital until about 8:30, since we’ve learned the doctors don’t actually do anything in the morning, but when we showed up it was surprisingly crowded and busy! Apparently on Monday there are grand rounds, where the consultant, our pediatrician, shows up and thoroughly reviews every patient with all of the interns who are currently in peds. Usually in the morning Anna and I check on all of our critical kids while the doctors either sit in the back chatting or review random patients in the ward. 

It was so crowded though, that Anna and I couldn’t even get to half of our patients and could hardly hear when the doctor spoke. We had to spend a lot of time outside of the patient ward instead, waiting for some room to do something. We did see a few of our kiddos, checking their oxygen saturation and vitals, but in the end focused on one of our little babies who was very unresponsive. The mom originally called mine and Anna’s attention to her; even though we’re not doctors they seem to trust infinitely. Not only do the moms see Anna and I doing a lot of work the doctors should be doing, but also apparently here they seem to think white people can heal you within a day or two. Anyway, when the mom brought us over, she showed us how her daughter’s feet were really cold, showing poor perfusion, and how lethargic she was. I think she had been in the ward for a few days, but had been overlooked by the doctors. 

We of course paid attention and immediately called the intern’s attention to her as well. They decided she was hypoglycemic and immediately started preparing D10 (a 10% dextrose solution) to be given as an IV bolus. In nursing we learn always before administering any medication to check the systems the medication could potentially affect; in the case of administering sugar directly into this baby’s blood stream, my first instinct would be to check her blood sugar just as a reference and to ensure the correct action is being taken. I asked the doctor, can I please go get the glucometer that they keep in the laboratory, since there’s only one, and I was told no because hypoglycemia is more severe than hyperglycemia so either way they were planning to administer the dextrose. Although technically if the baby was a little hyperglycemic it wouldn’t be the end of the world, choosing to be ignorant about something that could so easily be checked made no sense to me. Eventually I convinced the doctor to let me go grab it and, as suspected, we found the baby’s blood sugar to be so low the glucometer couldn’t even read it. 

The doctor prepped 30 mL of D10 in an IV bolus and went to administer it, but then found the IV site in her head was no longer patent. We tried to find other sites in her hands, feet, arms, and neck (her jugular) but poor baby was so dehydrated that no veins were available. The baby couldn’t even properly cry she was so dehydrated, instead it was more of a long gasp. I think, like myself, the intern was starting to get nervous about how badly the patient was doing, so we put in an NG tube (feeding tube) and gave her oral dextrose. Afterward, they continued to look for an IV site and found a new one in her head and immediately administered an IV bolus as well. When we were done the doctor told us he actually thought he put the line in an artery instead of a vein, which was frustrating, but he said in reality it wouldn’t matter that much. Finally we hooked her up to a continuous IV of D5 and let her wait it out for an hour, hoping it would help. By that time it was lunch so Anna, Thomas, Audrey, and I all headed back to the house for lunch.

I still wasn’t feeling 100% by that point – slightly concerned with all the TB I’ve been exposed to (jk mom and dad, calm down) – so I decided to take the afternoon off to rest and relax, hoping that I’d regain enough energy to head back for a full day at the hospital on Tuesday. I spent the afternoon napping, reading, and hanging out, then later we watched a movie (featuring Mr. Bean, since Tyler thinks he’s literally the funniest person on the planet for whatever reason) and I headed to bed way early. Luckily, it worked and on Tuesday morning I was feeling much better than before!

Tuesday we were all way unmotivated heading to the hospital. I was up by 7:00 thanks to all the noises of Kenya – including a mosque doing the call to prayer every hour of the morning, church bells, and dogs barking – but we didn’t actually leave for the hospital until 8:30 ish. By the time we got to peds, shockingly rounds were going on again, which I was thrilled about even though it meant less for us to do. We checked on all of our kiddos again that we’ve been monitoring, and then Anna and I tried to create our own role today by reading through some of the patients charts, then doing head to toe assessments and informing the doctors of our findings. We looked mostly at our malnourished babies, checking for pressure ulcers and any other abnormal findings, but also a few other patients where we found some skin breakdown or joint pain that the doctors had overlooked. We did a few small procedures, like NG tubes and checking insulin, then discussed a few kiddos that had to be brought down to X-ray. 

Unlike in the hospitals at home, the patients have to be escorted down to X-ray because according to the interns, the patients will try to run away without paying if they’re let out of the ward. The patients and their families end up paying quite a bit to stay because not only do they pay for board and care, but also if the ward doesn’t have a certain medication or piece of equipment, the families have to go down to pharmacy to buy it. It makes sense since obviously hospitals in Africa aren’t the most affluent, but sometimes they can just get stingy; the people down in lab wanted the families to pay every time a patient needed their blood glucose tested, which I can’t imagine would cost more than a dollar and some families don’t even make that in a day. Anyway, we started bringing down our chest tube girl, who they suspected may still have some problems with her heart, for a chest x-ray. 

It seemed like she wasn’t doing half bad even though she wasn’t 100%, but when we checked her x-ray it showed that the other lung was now doing worse. They’re now planning to put in another chest tube for her on the other side, but they don’t do bilateral tubes so they’re going to take out her original tube and hoping that her lung won’t collapse again. I hate that she’s struggling so much, but she’s such a great sport about it and still will talk and sing to us, even when she’s having trouble breathing. I’m definitely going to be sad saying goodbye to her on my last day. 

We were told the rest of the inpatients had to go to x-ray at 2:00, so we left for lunch with intentions of returning at 2:00. We actually made it back by 2:45, but were able to get all of our kiddos down to x-ray successfully! Most of them have either TB or pneumonia – again, exposed – and hopefully the doctors will start taking action tomorrow. After work, we all headed to the market again to pick up skirts, get my last minute gifts, and pick up water. All of the women here wear their babies strapped on their backs with these cloths/scarves, so of course I had to get one 1) because they’re cute and 2) to prep for the future. Another relaxing night in store before the packing and craziness of travel – I can’t believe I only have one more day left! Everyone here is refusing to let me remember I’m leaving tomorrow, so I’m going to continue to pretend I’m staying until the last possible moment, even though I am excited to go home and eat real food!! Check back for my very last blog post tomorrow – eep!

Days 21, 22, and 23

On Friday, I headed back to the District hospital with my stomach in knots, just waiting to see what mess was awaiting us. Walking up to the peds ward, we saw our favorite kiddo with the punctured lung sitting outside, which was a great way to start knowing that she was doing great! We walked into the ward and saw the first bed with all of our respiratory kids completely empty. Since we saw our girl with the punctured lung, we knew she was okay, and we saw one of the babies that had been in the bed being held by her mom, but the kiddo we had worked on all day on Thursday was missing. We walked out to meet the doctor who updated us on the events of the night, and we found out that unfortunately our boy had passed away. He said when he walked in overnight to check, the boy was found without his oxygen mask on and it looked like he had thrown up; we think that he may have started throwing up during the night so mom took off the mask, but then he aspirated and had trouble breathing. Even though the kid that had passed the day before was really upsetting because none of the doctors were responsive, I was more upset about this kiddo since we had worked so hard on him. The amount of people that pass in the hospital is actually crazy so I’m not sure why I was so convinced he would be okay, which made it even harder. The doctor also told us that our favorite patient had a pericardial effusion and the night before they decided to drain the fluid out, which is why she was doing so much better. Also, since the pleural tap they had done a few days before punctured her lung, she needed a chest tube placed and it was expected that would finally happen that afternoon.

After debriefing with the docs, we switched our focus to new kids that needed our help. One was another respiratory patient, which seems to occur a lot around here in conjunction with TB, pneumonia, and often malaria, who presented originally with convulsions and when we checked on him had an oxygen saturation level in the 70s. We immediately started him on oxygen and checked his serum glucose level, but beyond that once we stabilized him there was nothing more we could do. We checked on him throughout the day and ensured mom knew to turn him every two hours, but aside from that we would have to let the meds work. 

After that, we checked out a baby in the ward who came in for malnutrition but also was forming some small pressure ulcers on her butt, so Anna and I cleaned her, dressed the wound, and tried to take the weight off of that side of her body. Thankfully the ward was much slower so that was mostly the extent of our morning.

In the afternoon we came back and the peds ward was still relatively calm. We spend most of the time in the room that is more like an ICU, but since the afternoon was quiet we decided to visit with some of the kiddos in our stable room as well. Anna brought coloring books and crayons from home, so we tore out pages to distribute amongst the kids in the hopes that they’d have something to entertain them for at least a little while. The kids didn’t really have any idea what was going on, but the moms with them were so excited about it! Once we handed them out and left I guess the kids started coloring because one of them came up to me later to show me an entirely blue colored piece of paper – to give him credit he was probably only 2. Since peds was so calm and not needing our help, we headed up to maternity and on our way stopped in on our patient getting the chest tube as she was waiting to be brought into surgery. We couldn’t go in to actually see it since there weren’t enough pairs of rainboots (which we’re required to wear in the OR), but Tyler, one of the med students working in peds with us, was going to be in there so I was happy she’d have a friendly face. She’s incredibly brave for everything she’s gone through and I admire her so much for that; even though she’s only 10 years old, every procedure she goes through she puts on a brave face, knowing that in the long run it will make her better. 

We arrived at maternity and were informed that one mom was in labor and the baby was almost out, according to the doctor (should’ve known that wasn’t quite correct given what we already know about timing in Kenya). She was pushing when we came in so Anna stood to watch while I stood at the head to cheer mama on. She was all alone and we found out later that she was only 15 years old, so hopefully she appreciated having a hand to hold! She was pushing for a while and the head started to come out (with severe molding, meaning the head sutures were overlapping), but according to the doc she was too tight and the baby couldn’t fit. They tried for a while, manipulating her cervix to get the baby out, but poor mama had no luck. They decided to do an episiotomy, where they cut the skin around the vagina, but it took them three tries, twice with dull scissors before they used a surgical blade. Keep in mind, the moms here do not have any sort of anesthesia, so they feel everything. After that was done, the baby came relatively quickly and was brought immediately to a warmer since at first he was kind of nonresponsive. I tried to stay through the end of the girl getting sutured after her episiotomy, but by that time we had to get going to the market to pick up water for the weekend.

Before leaving we stopped back at peds to pick up our stuff and check on our chest tube patient, who had finally finished. When we got there, the two med students that were in on the surgery told us that the anesthesia for her, which should have been local, was having no affect so she was aware of almost everything until they put her completely under. She loves Thomas, another med student who is huge (he’s 6’8”), and in the time she was awake during her surgery, she was calling out for him. So sad that she felt it all, but we all thought it was adorable that she wished he was there so much. He has no interest in doing peds but that’s why I love it, you can build such easy bonds and really have an effect on your patients. When I went in to visit her, she was still under a little sedation but was excited to see us there although she was STILL asking for Thomas. He was unfortunately home sick with strep that day and couldn’t visit, but we promised he’d be in the next day to visit with the rest of us. Afterwards, we headed out – in the rain – to make the long walk to the market and back to the house to have a chill night playing cards and eating guac (which everyone has been craving). 

On Saturday we finally slept in, although granted it was only until like 8:30. I had a ton of laundry to do and since it needs to be done by hand it takes forever, so I started on that after breakfast and until 10:00. At 10:30 we left for the hospital; even though we don’t have to be there on weekends, we had a list of kiddos we wanted to check in on. We started with the boy with respiratory problems that we worked on for part of Friday and he was pretty much the same - we kept him on oxygen and couldn’t do much else. One of the patients in particular we wanted to see was a two year old boy who had spilled hot tea all over his legs and was suffering from second degree burns. Anna had brought these burn pads containing some sort of silver compound in them that would accelerate healing and could stay on the patient for a week, so we wanted to try them out. First we had to warm up salt water to rinse his burns (which took forever because the warmer moved at a glacial pace) and then we brought him into their procedure room/doctors office. We should’ve known it would be an awful experience because when he came in, he was already bleeding from his burns probably because they had been left uncovered to heal and he was moving around. 

We started by using gauze and cloth and wiping him down and he really started freaking out. As a two year old, we couldn’t tell him to sit still or anything, so he was thrashing around kicking and screaming and could not be consoled. We tried to move fast, cleaning him then placing the silver pads on and wrapping them in gauze and the poor kid was not having it. It was such a different experience from the last burn patient I worked with, who had really severe third degree burns all over her arms and chest, where she was very calm and showed few signs of pain even though her dressing change had to be so much more painful. Even though I felt like we were torturing this kid, in the long run it’ll be better to help heal his wounds that much faster and he won’t need another cleaning or dressing change for a week! Hopefully that will give him a chance to recover and be a little less afraid of us as well! We thought we were finished for the day but then our chest tube girl needed an IV put in, so we stayed to comfort her as Anna tried to do that, but her veins kept blowing. The poor girl got stuck 4 or 5 times before finally having a successful IV in place but she stayed cheery, singing us songs and talking to Thomas (of course).

After coming back, with bruised knuckles I finished my laundry which took a total of like 3 hours. The rest of the day we just hung out for the most part, playing games and reading. It was the last night for three of the girls, so we were planning to go to one of the bars around our house to get samosas, which we’ve been waiting to have since we got here, but we ended up staying in and chatting and playing red light green light in the dark – each person here is truly a child at heart, it’s great.

On Sunday morning, we all woke up way early to make the 7:00 mass at the same Catholic church we had gone to before, except this time the service was actually in English. It was way more school kids than before and didn’t seem quite as festive – there was no dancing with the Bible and not as many dances to go with the songs. I still had no idea what was going on during the mass and thought for half of it they were speaking Swahili – it’s way hard to understand their accents sometimes – but I was just excited I got to wear my new skirt and see more of the culture here! After we came back the three girls had to pack up and leave and we all started to realize it’s crazy how fast it’s going. Now people really start packing up just one after the other; I leave on Thursday, Audrey (my roommate) leaves on Saturday, then two more will leave on Monday. We’re all in denial, but it doesn’t get any easier with each goodbye. 

The rest of the day has been very quiet. Since the people here are so religious, there’s not much to do on the day of rest so we’ve just been hanging out! After weeks of discussing it, we finally bought the Lion King and watched it, getting really excited with each animal we saw on our safari. Even though we don’t think the movie actually took place in Kenya, we’re pretending Pride Rock was at the Great Rift Valley and the rest of the movie takes place in Maasai Mara – wishful thinking. In the afternoon we hung outside, planning to read and sunbathe, but ended up just talking the whole time. It’s the first time I’ve actually spent a good amount of time outside, so even though I’m in Kenya and on the equator, I’m coming home way pale still. I can’t believe it’s actually my last few days here so I’m trying to soak up all of the Kenya I can. Even though I’m definitely sad to leave, it’ll be nice to be home to see my family again – plus I’m just a little excited to get a milkshake, my latest craving :)

Day 20... it gets its own post

Today deserves its own blog post because it was easily the hardest day since I’ve been here and probably one of the hardest days of my life. It started off great with a sunrise yoga session (thanks to Amelia!) then headed back to the District Hospital pediatric ward with Anna and the two medical students, Thomas and Tyler. For a while we sat around, waiting for the doctors to get it together and go on rounds, which didn’t begin until 9:00. In the meantime we met the nurse, who told us her name was Sweet Banana, which really set the precedent for the day. We started going through probably for about 5 minutes when Anna and I started to focus our attention on one little guy, who was probably only four or five years old, who was in serious respiratory distress. Obviously Anna’s first thought was to start him on oxygen, but first of all the peds ward had no oxygen available. They also had only one nasal cannula for oxygen tubing and no masks at all. Along with this kiddo, there were three other patients who needed to be on oxygen. Instead in the ward they use some sort of air compressing machine as a makeshift oxygen, but of course the machine only has two connections for oxygen. To make sure the three kids were hooked up, they split one of the connections in half using other tubing, and this was what was supplying our kid that had been working really hard. Clearly a small feeding tube transferring probably only 2 liters of oxygen total is not about to sustain someone who’s in major respiratory distress. As Anna was out in our triage area looking for something to help him out, I was trying to do what I could to position him and make sure he was comfortable, but then he stopped breathing. The ward was completely unprepared for any kind of respiratory emergency, so we started doing CPR, Anna doing compressions and I doing his respirations through an ambu bag. The doctors in the room were infuriatingly unhelpful to the point that they backed away while we were trying to save this kid and wouldn’t answer any questions in an effective manner. When I say Anna and I were the only ones doing anything I literally mean the doctors wouldn’t even come look at him while we were trying to resuscitate him. They had no medications to help him, no sort of oxygen, and wouldn’t intubate him. It was probably only a minute but felt like much longer before the doctor told us there was nothing that could be done and we should stop CPR.

I have no idea how I didn’t completely break down since it’s obviously an insanely traumatic experience plus it’s the first time I’ve ever had a patient die on me. The worst part is they wouldn’t move the kid until the grandmother could pay the bill for his hospital stay and when she couldn’t pay to have his body removed properly, she had to carry him home on her shoulder. As frustrating as it was and as unhelpful any of the doctors (who are actually interns, I forgot to mention), I can only imagine how hard it is to work there full time when there are such minimal resources. After we calmed down a little bit and got out all of our tears, we set to work to make sure none of our other kiddos would suffer the same way. We found some small masks from ambu bags and got started making oxygen masks and tubing out of the masks, feeding tubes, tape, and elastic from our N95 respirator masks that we thankfully kept with us that day. We were able to make about four, two of them were thankfully being used when we left the hospital, and we’re hoping we’ll be able to buy some for the ward. Next we focused our attention on another little guy who had presented with convulsions and was relatively unconscious. He was the first to test out our masks on the compressed air that he was sharing with another patient but it was nowhere near enough. His respiratory rate was up in the 60s (normal for him would be at the most 30) and his heart rate was at one point up at 180, which is WAY higher than normal. The doctors again of course were unresponsive to any advice so we had to push harder than I personally have ever had to push anyone to get what this kiddo need. We eventually decided to switch both of our other patients to have full access to the compressed air and instead for our really distressed patient, we used an ambu bag. For those of you that don’t know, an ambu bag has a mask that lies on the patient’s face and a bag attached which is used to manually breathe for them. It took both Anna, stabilizing his head back far enough so that his airway was open and I, holding the bag to his face and squeezing the bag helping the patient manually breathing, an hour before we could finally get him oxygen. Even after he was on oxygen we had to monitor him to make sure he still had an open airway plus he had an insanely high fever and was hypoglycemic. The docs again frustratingly informed us we couldn’t intubate, so instead we tried to manage everything else going on with him. With more pushing we were able to get the doctor to hang a D5 via his IV, which is basically sugar water to hydrate him and raise up his blood sugar (which was 1.2 and here the normal is 7-11), and we started giving him food and medication to reduce his fever through his NG tube (feeding tube). By this time it was close to 1:45 and I of course was dying of starvation since I need to be fed every two hours, so I left and went to get food. 

Anna and Tyler stayed around to make sure everything was okay, so by the time Thomas and I got back they had everything much more under control and finally (FINALLY!) the pediatrician came to check everyone out. Apparently Anna had been pretty aggressive while we were gone and was able to convince the interns to call someone. The doctor told us she suspected the kiddo had metabolic acidosis, which means the pH in her body is too low due to a variety of things including malaria, meningitis, sepsis, or diabetic ketoacidosis. Thankfully she told us we had done everything right and hopefully, in combination with more fluids, food, and good care, things will get a little better. We  gave him a catheter, since she wanted to carefully monitor his I&Os (input and output) and when we left for the night he seemed relatively stable. Before we left we also put an NG tube in one of the other kids receiving the compressed air and then focused on our girl we had met the day before with a now, collapsed lung. Yesterday, she was struggling to breathe but once they put in a chest tube she had been doing better. However today, we learned that the procedure yesterday may have punctured her lungs so her breathing is even worse. We checked her pulse-ox, which was at 82 (acceptable and healthy is at 93 or 94 and above, so 82 is really really worrisome) so we quickly set to work to make her an oxygen mask that was big enough to fit her. We hooked her up to oxygen thinking that would be that, but then she got very very anxious about the mask, probably because she had seen the kid next to her in really critical condition wearing one of these masks all day. I went to grab a mask that was easily three times smaller than what I would need, but I tried to walk her through how to breathe and eventually her pulse-ox rose to 95%! After that we prepped the nurses on what to do for the night since we obviously can’t stay the whole time. 

So even though I’m emotionally exhausted and spent half of today wanting to cry, I feel like if I can deal with the peds ward here I’ll be able to do anything back at home. I was pretty sure I wanted to be a pediatric nurse but after today I know that’s what I want to do and I know I’ll be good at it. Even though it was hard and overwhelming, I’m so glad we were able to be there today to help take care of these kids who definitely would be worse off otherwise.