Busy morning running around with wards, the chronic clinic, back in the afternoon to help with theatres.
Patient on the table: reversal of colostomy
General anaesthetic
Drawing up the meds for JR,
Chloramphenicol, the antibiotic
Halothane in the ventilator
Ketamine to sedate
Suxamethasone to paralyze
Rocuronium to relax the muscles
Neostigmine and atropine to reverse
Atropine and ephidrine on the side in case the heart rate or the BP drops
Patient comes down to theatres from Lukulu DH- diagnosis rectovesical fistula, reason for transfer further management. Visiting doctor, Dr. Paul Meyers goes to review. We can smell the patient from across the hallway and into the minor procedures room. "When you're finished here, give this other patient ampicillin, ciprofloxicin, and flagyl, max doses for all. And bolus him 1 litre IV fluids.
Pay attention to the task on hand
Pre oxygenate the patient to 100%
50 mg ketamine... Wait... Kaumba? Still responding, another 25 of ketamine ... Wait... Kaumba? ...No response...patient asleep.
100 g of sux... Wait for the patient to twitch... Great! paralyzed
Hand JR the laryngoscope, she sees the vocal cords, hand her the endo tracheal tube
Tube in, attached to ventilator, check to make sure equal bilateral air entry into lungs. Yup! Secure tube to face and switch ventilator on.
"Here are the rest of your meds JR. Antibiotic already in. I'm out to see this other patient. Shout if you need me."
Big man... Maybe 75kg?
The smell is overpowering!
Remember the conversation overheard between dr. Paul and dr. David... "Touched the area and GAS came out"
(GAS as in group A strept, not as in gasoline or flatus) :S
The man struggles for breath, respiratory acidosis and hypoxia, trying to compensate for the build up of carbon dioxide
Restless and agitated and clearly in pain he tosses from one side to the other
"Ok Wilson, I need you to lie still, I need to put two cannulas in so we can give you some medicine"
If he's hearing me, he shows no sign of it as he twists his body around to the other side.
First cannula, in the back of the hand- fail. Second, in the antecubital fossa (the inside of the elbow) in... But maybe tissued, not sure, check later. Third, in the other antecubital fossa, success, leave to get IV lines, return to find cannula on the floor... Sigh... Confused patients... Recannulate
Two IVs in. IV fluids running. Turn to counter to spike flagyl to run thru other cannula (checked to make its working). Hear him thrashing and a bit more restless, turn to find him half off the table. Drop IV stuff and reach for him. Too late
"Help! I need help in here!"
JR and Chilanda come running
Me on the floor next to this huge man, checking responses, checking my cannulas, checking oxygen level and heart rate. JR brings BP machine to check BP. Everything is ok
"At least he didn't hit his head"
Conscript the guard at the door and three random bystanders to help lift him up off the floor to a trolley with rails.
Alone with my patient again.
"Help me! Please help me!"
"We're trying Wilson. Just hang in there, ok?"
Get antibiotics running, add gentamycin and ceftriaxone.
Non rebreather mask on so patient is receiving 100% oxygen. So agitated and restless and confused. Fighting to take the mask off. Literally fighting with this big man to keep the mask on
"Help me!"
"We're trying Wilson. Please leave the mask on, ok! Doctor's gonna finish this operation and then do yours ok, just hang in there."
Find a few story like tracts to read to him, to sorta keep him focused. 'The richest man in the valley will die tonight, the richest man being the one who knew Christ as Saviour.'
"Do you know Christ as Saviour? "
Time passes.... Very slowly, the clock is on the wall right next to me. I can see each minute pass...
I start to hum, my usual retreat when waiting (patiently)
'Day by day and with each passing moment, strength I find to meet my trials here'
I savour the thought behind each line. Don't we have an amazing, loving, wonderful God. Even when things are bad, He is still amazing and wonderful and loving. Even right here in this moment He is with my patient, He is enduring with him the terrible agony he is suffering. He has brought him here at this time for eternal purposes that I can never know and never understand until I have reached the other side. Oh! But why didn't they send him yesterday? Yesterday when they first told dr. David they were sending him.
"JR can you come look at him, he's not doing so great. "
Check blood sugar. 22.1 Check with fam- no known history of diabetes. Give 10units actrapid
Time passes... Nearly 45 mins ...
"He's not fighting me for the mask anymore and none of my pulse oximetry are picking up a reading"
Blood sugar is 15.4 so that's ok
Heart beat auscultated and about 100 beats... Doing ok...
"Sorry JR, I think we're losing him... He's not hardly breathing anymore. Are they going to be finished surgery soon?"
Another 30 mins
Unable to get BP, unable to auscultate heart beat, eyes glassy and fixed, not even responding to me callig his name
I see the doctors out. "David, Paul, please come look at him, he looks terrible."
I know that look. That look from the patient when they can't fight anymore and that look from the doctor when we can't do anything more.
5 mins they stood there... "It's probably better we didn't do surgery... He wouldn't've tolerated the anaesthetic, and likely would've died on the table. At least this way, he doesn't have huge fasciotomy wounds in the area...."
Time of death : 1815
Pull out the cannulas, straighten the patient out to the family
"I'm so sorry! We did all we could, it was just too late"
And the wailing starts
Too late. We were too late to help him...
I wonder where his soul is now?
Sorry, no happy ending here... this is the rough side of life in the bush... the rough side of life...
but He has a plan, a sovereign, plan made from before time began. He knows why... and I ... I don't know why... but I trust Him
Day by day, and with each passing moment,
Strength I find, to meet my trials here;
Trusting in my Father’s wise bestowment,
I’ve no cause for worry or for fear.
He Whose heart is kind beyond all measure
Gives unto each day what He deems best—
Lovingly, its part of pain and pleasure,
Mingling toil with peace and rest.
Strength I find, to meet my trials here;
Trusting in my Father’s wise bestowment,
I’ve no cause for worry or for fear.
He Whose heart is kind beyond all measure
Gives unto each day what He deems best—
Lovingly, its part of pain and pleasure,
Mingling toil with peace and rest.
With a special mercy for each hour;
All my cares He fain would bear, and cheer me,
He Whose Name is Counselor and Pow’r.
The protection of His child and treasure
Is a charge that on Himself He laid;
“As thy days, thy strength shall be in measure,”
This the pledge to me He made.
Help me then in every tribulation
So to trust Thy promises, O Lord,
That I lose not faith’s sweet consolation
Offered me within Thy holy Word.
Help me, Lord, when toil and trouble meeting,
E’er to take, as from a father’s hand,
One by one, the days, the moments fleeting,
Till I reach the promised land.
