I’ve lost count of how many times the little girl with DIC and cerebral malaria has seized, and how many doses of anti-seizure medicines we’ve pushed into her I.V.
She’s getting worse.
Her pupils are not shrinking when we shine a flashlight into her eyes.
Early in the night, when I first started having to bag her, her oxygen saturation would go up to 100%. Now, no matter what I do, her O2 sat stays around 80%. Between the bleeding and the lack of oxygen, her brain is dying. And again, there’s nothing more I can do.
Her father is still standing behind my left shoulder, watching us try to resuscitate his little girl. In the U.S., we’d have intubated her and put her on a ventilator a long time ago, but we don’t have that equipment here. We have to breathe for her by hand, squeezing the Ambu bag 20 times a minute to push oxygen into her lungs.
In between seizures, I put my hand on her forehead and silently pray for her.
I want to yell, “Tabitha, arise!” like the Bible story.
Or, “Lazarus, come forth!” like Jesus said when he raised Lazarus from the dead.
“Little girl, WAKE UP!” I command her in my head. “In the name of Jesus, WAKE UP!”
But instead, she keeps seizing.
I slept in the doctor’s lounge. I got a call at 1 a.m. that a 30-year-old woman came in with shortness of breath. She had developed heart failure during a recent pregnancy, and her heart was only 1/3 as effective as it should be. Because of that, fluid was backing up into her lungs and into her legs, and she was suffocating.
She was sitting on the edge of the bed leaning forward with her weight on her arms, which were outstretched in front of her, gripping the edge of the bed. It’s a position a position called “tripoding,” and it means a person is in severe respiratory distress.
The nurses had already hooked her up to a monitor, and I saw that her heart rate was fast, and her oxygen saturation was 85%. Her blood pressure was through the roof.
I ordered oxygen, an IV, two different blood pressure medicines, a diuretic to get the fluid out of her lungs, and morphine for her chest pain.
Her oxygen saturation came up a little bit with the oxygen.
Her blood pressure didn’t budge.
We went up on the doses, still no effect.
I ordered two more different blood pressure medicines.
I sat at her bedside for more than an hour with her nurse, trying to give her enough blood pressure medicine to bring her pressure down without giving her too much. If her blood pressure dropped too low too fast, she could have a stroke from lack of blood flow to her brain.
This is a 3-part blog series I wrote about one 28 hour on-call shift at the Hospital of Hope. If the wifi works (which is a BIG if here in rural West Africa, I’ll post all three this week.)
It’s Saturday morning and I’m on call with a Family Practice doctor who’s visiting for a month from the United States.
We’ve rounded on our patients in pediatrics and maternity and medicine, and now we’re about to go into an isolation room to see our last patient.
We put on masks, gowns and gloves and enter the room, which called ISO 3, because it’s one of three isolation rooms we have for patients who have potentially contagious diseases.
My heart skips a beat when I see the patient. She’s a 22 year-old woman who’s 5’2” and a scant 83 pounds. Her eyes are yellow with jaundice, and there’s an oxygen mask on her face. She’s sitting up in bed, breathing rapidly, her thin chest heaving with each breath, as if it takes every muscle in her body to move air in and out.
We listen to her lungs, which sound congested. She has tenderness in her right upper quadrant, where the liver is located. Her lips are pale and when we press on her nail beds, it takes a few seconds for the blanching to go away. I look up at the monitor. Her heart is beating too fast — 140 beats a minute (normal is 60-100). Her oxygen saturation is 90% — which is low, especially since she’s getting the maximum amount of oxygen through the mask on her face.
We finish our exam in a few minutes, leave the room, remove our masks and gowns and gloves, and wash our hands thoroughly at the sink.
We sit down at the nurses’s station and flip through her chart. It’s her 4th day in the hospital. She was admitted for pneumonia and respiratory distress. We pull her chest x-ray up on the computer — and it looks awful. Her lungs are filled with infection.
She’s on several different I.V. antibiotics, but every day she gets worse.
“If we don’t figure out what’s wrong with her really fast, we’re going to lose her,” the doctor says, shaking his head.
It was nearly midnight. I’d been working at the hospital since 7 a.m., which meant I was heading into my 18th hour on call.
At 10 p.m. I’d gone to the doctor’s lounge to lay down on the futon and catch a few hours of sleep, but I got a call about a sick patient, so I returned to the ward to check on him, and ended up checking on a few more sick patients while I was there.
After I took care of everyone, I walked back to the maternity ward to see if there were any cute babies to hold.
Instead, there was a woman who had been in labor all day. She was 9 centimeters dilated, and was expected to deliver within the hour.
“Do you want to do the delivery?” the OB/GYN asked me.
When I was in high school, I was convinced I was going to be a doctor in West Africa. I researched medical schools. I took French as my language elective, because French is the official language of West African countries.
I listened to talks by the missionary doctors and nurses who came to our church. I watched movies like The Mission, and a more low-budget film called First Fruits, in which two (very handsome and single) missionary guys get malaria while they’re working in a developing country.
Working in medicine overseas seemed thrilling, hopeful, helpful and even romantic.
Fast forward to now, when I’m serving in Togo for three months.
I came here less naive than my 15-year-old self. But still. I thought this experience was going to be an emotional high. I thought I would fall in love with everything about Africa. I knew it would be physically and emotionally draining, but I thought any downside would pale in comparison to the rewarding experiences.
Last week, one of the doctors at the hospital was working late at night when a nurse’s aide came running in from the women’s ward.
“A woman’s intestines are under her bed!” he yelled.
A 20-something-year-old woman had come in for emergency surgery on a large abdominal hernia. A few hours later, she had gotten out of the bed, saying she had to go to the bathroom, and squatted over a bedpan, and then climbed back into bed.
When the nurse’s aide came by a few minutes later, he thought her intestines had fallen into the bed pan.
When the doctor came over to see, she found that it was not the woman’s intestines, but a 27-week-old baby, still inside an intact amniotic sac with the placenta lying neatly beside it.
The doctor pulled the amniotic sac open with her bare hands, and started yelling orders at the staff. She resuscitated the baby on the floor for half an hour and then they moved the baby to an incubator.
The staff was in awe.
It was a miracle. ‘Intestines under the bed’ turned into a tiny life now living in an incubator in our pediatrics ward.
It took over a decade, and more than three years of construction, to build the Hospital of Hope, which just opened its doors in March 2015. The hospital is inside a walled compound, and contains an outpatient clinic, the hospital itself, six houses, five guest rooms, a recreation/dining room, a pool, a maintenance shed and a water tower. The perimeter measures exactly one mile. The wall that surrounds the compound is only about four feet tall — it was built to keep poisonous snakes out, not people.
In addition to building buildings, the construction team also planted a lot of new trees that will eventually provide shade during the dry season, where the temperatures soar to 120 degrees or more.
I was talking to one of the groundskeepers, and he told me there’s a trick to planting trees in northern Togo, where the dry season is three times as long as the rainy season, and temperatures soar to over 120 degrees.
When you first plant a sapling, he said, you give it less water than it needs.
Whenever I walk through the village of Mango, where the Hospital of Hope is located, little kids stop what they’re doing, point at me, and chant a word that means “white person” in their local language. Well, actually, it literally means, “The Peeled One” because they think white people look like they’ve had their skin peeled off.
“BaCHUray! BaCHUray!” the kids yell. Their friends will run over, and then the group of them will chant, “BaCHUray! BaCHUray!” as they giggle.
I stop and wave to them, and they jump up and down as they wave back. Sometimes one or two of them will run up to me and give me a high-five. Then they hold their palm next to my palm to see what happened. Did my whiteness rub off on them? Or did their blackness rub off on me?
When patients come to the clinic, they have to give the medical assistants a reason for their visit. One of the most common complaints they give is, “Tout les corps fait mal,” which means, “The whole body feels ill,” or, “Whole body pain.”
I see at least a dozen patients a day who say that. “Tout les corps fait mal.”
Often it’s people who are 50 and older who have spent their life doing manual labor. The women carry buckets of water or bundles of firewood on their head. They go through sometimes as many as eight, nine, ten pregnancies in their lifetime. Then they carry their babies on their backs until the children are about two years old.
The men hoe large fields with a small, hand-held tool that requires them to be stooped over all day. They chop firewood, mix cement, and carry heavy loads of building materials.
The Togolese people who aren’t lucky enough to have a bicycle or a motorcycle have walked for hours upon hours. And at night, they sleep on the ground without a mattress or a pillow. They get malaria over and over and over again.
It’s no wonder their bodies hurt.
It’s been a long week.
I was in clinic on Thursday and Friday. Then I worked in the hospital from Saturday morning until Sunday afternoon. I took a short nap, then spoke at a church service on Sunday night. I was in clinic on Monday, and again on Tuesday (yesterday.) Today I’m heading back to the hospital to work another 30-hour shift.
I’m tired. It’s hot. And the only caffeine around is either instant coffee or Folger’s. An iced quad venti skinny vanilla latte is at least a thousand miles away….a little too far to drive for a coffee break.
In the mornings I try to get up a little early to meditate and pray and sit with God for a while before the day gets crazy. The other morning, I was telling God how tired I was. I remembered telling him the same thing when I was going through chemo and I was completely wiped out.
When I was on chemo, I asked God, “How is it possible that your power raised Jesus from the dead, and yet most mornings I can’t even get out of bed?”
The other morning, I reminded God of the same thing, only it was more of a request than a question. “God, you can do this. You can give me a sudden, crazy, overwhelming, blinding burst of energy to make this day easy and fun. Remember the resurrection? Kinda like that. Only maybe just half the amount of power you used that Sunday morning because I’m not dead. I’m just really tired.”