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.
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