Beeper

My beeper goes off at 4am.  Oh wait, no.  I don’t have a beeper.  Do doctors in America even use beepers anymore with all of their fancy gadgets?  Maybe they just get texts via their smart phones.  I don’t know.  It’s been too long since American medicine. 

Let’s back up. 

I used to wake up with a knock at the door, but the last several months, our husky dog, Sheba, has been quite demanding to sleep outside since it’s uh, um, “cold” season.  From her cool spot in the wet dirt of the flower garden just outside my window (don’t worry, the flowers don’t really grow there), she half barks in a kind of whiney bark that only huskies can do.  She knows to not bark too loud or we will make her stay inside since she’ll wake up the children. 

All this to say that a nurse is at the gate.  They are too scared to come to the door anymore with Sheba sleeping outside. 

But the arrangement works, and I’m awakened. 

Nemadji came to tell me that bed 2 was ‘complicated’ again.  She said that Sabine told her in sign out the patient seized yesterday and…

Wait, back up.  The patient never seized!  We went through this yesterday with different nurses.  I knew this would get messed up in sign out.

“Nemadji, she is hypoglycemic!  Please give her serum glucose 5%, (since we have no 10%, and definitely no 50%). Please come get me if she doesn’t wake up.”   

It’s 4am.  I try to go back to sleep.  Not happening.  I rethink the previous day. 

Honorine had come in on her third pregnancy with a fever of 40 Celsius (104 Fahrenheit)  and a negative malaria test at 34 weeks (by the scan this admission).  She was acting like a normal malaria patient.  She got a day of IV quinine, our best malaria medicine.  Her vomiting stopped.  She started eating.  We switched her to oral quinine.  On her third day of treatment, yesterday, she was still eating some.  But if they don’t look perfectly well, I keep them an extra day because pregnancy makes it harder for the body to recover.  No more fevers, eating… just looked a little weak still. 

Yesterday while I was in the operating room, one of the maternity nurses came in to tell me that bed 2 had seized. 

Since I didn’t remember who she was, I asked if her blood pressure was normal.  They said, yes it was 130/80 and explained she had come in with malaria.  Okay, thank you I said, continue the treatment and give diazepam as needed.  Cerebral malaria.  We see it more often than I would like here. 

Five minutes later, the same nurse came back and said they had taken a manual blood pressure and it was now 150/90.  And that she had seized again. 

Hmmm… I don’t know what to believe now.  But I am scrubbed, so can’t go evaluate her yet.  I’ll tell you one thing, I do not take real vital signs for granted.  Sometimes I feel like they make them up to go along with the diagnosis they think she should have (like eclampsia). 

After I finish in the OR, I go over to evaluate the patient to see if we need to do a cesarean section for eclampsia or not. 

The nurses who had been with her earlier, not 15 minutes prior, were now gone and new ones were on. 

I go to see the patient, who is in a coma.  Post-ictal comas happen after seizures often and she had also received diazepam. 

I have the students retake her blood pressure.  110/70.  140/90.  110/60.  It’s all over the place with the electric blood pressure cuff.  They tell me the manual blood pressure cuff is broken. 

Awesome. 

So I just sit at the foot of her bed and observe her. 

There are about 20 people gathered around her bed in a giant room of 16 beds, all full with patients and their families. 

One of the students spoke their language, so she helped translate for me.  I asked, “So, what did the seizure look like?” 

“She didn’t seize.”

“What? The other nurses told me that she had seized and then went into a coma.”

“No, she came over to her bed, laid down, and said she felt like she was going to die.” 

“Sabine, demandez glycemie, s’il vous plaît! (Sabine, please get a glucose level!)”

I am writing this blog at 5:15 in the morning.  Now my children are waking up.  I am getting interrupted.  Juniper wakes up with a diaper full of poop.  Doesn’t look like she will go back to sleep.  Seriously.  Way too early!

5:30am.  All four children are up.  Olen is asleep.  Hmmm….How did that happen?  Anyone who has kids knows that you never need an alarm clock to wake up either!

To be continued…