Friday, January 31, 2020

When the Well Runs Dry

When the Well Runs Dry

Andrew catches me off guard.  He’s been rounding and I’m half way through a hernia operation.  After I finish, we are to start a big case together.  

Not normally one to panic, Andrew bursts into the OR and asks if one of the ER docs could please come help a kid who is barely breathing.  We have two ER doctors visiting.  They are providing great anesthesia care while they are here, so they’ve been mostly in the OR.  

Andrew is emotional while he’s getting his story out, profoundly disturbed by the situation, choking back tears.  Typically smiling and positive, something is clearly amiss.  Child badly burned.  Dressing changes at health center for a month.  Just got to our hospital.  

Andrew can’t believe someone would leave a 2 ½ year old with a curable wound for a month!  

Mark and Niko (our ER docs) deftly slip a central line into the baby’s neck and a line into the baby’s left lower leg bone.  Expediting my hernia, I observe the situation evolving in the pre-op area.  

It’s simply too late, like for so many children dying here.  I know this.  My colleagues do not.  Children come to us too late too often.  There is no ICU, let alone Pediatric ICU, let alone a Pediatric Intensivist.  

Mark and Niko continue to work on the young child.  No heart beat.  

The baby’s entire right leg is wooden; cold, black, dead and mummified.  The mummification of his leg extends into his hip. 

We give epinephrine to restart the heart.  We start CPR.  More medications.  Fluids.  We get blood to transfuse.  He is clearly anemic (his hemoglobin later came back at 2, a number usually 12 or more).  It’s all too late.  

I talk to the mother and a family member who’s a nurse.  The child had been burned in early December.  The nurse at the health center had clearly not been competent.  The family didn’t realize the gravity of the situation.  The child stayed home and went in for his daily ‘dressing change.’  I try to imagine why the nurses at the health center kept doing the dressing changes, since the leg was not getting better, was dying, was now rock hard and dead.  There’s no living tissue to salvage.  

The child dies.  

Who could imagine this?  

We could.  


Those of us who’ve been here, we are used to death, both missionary docs and Tchadians.  Used to neglect.  Used to corruption in the system.  Quite sure the nurse who cared for this child wouldn’t be disciplined if we turned him in?  

We rarely cry anymore.  

It’s not that we don’t care.  We care or we wouldn’t be here.  It’s just that this is part of life in this place, even if it is so readily, too readily, accepted.  Accepted in cases unnecessary.  

Our bodies and minds fatigue of begging and pleading with parents to do the right thing.  To stay in the hospital just a little longer, so their child might live.  To come to the hospital just a little earlier, so their child might live. To pay just a little bit for medications, so their child might live.

Please, let us help you, we cry out in frustration.  But our cries aren’t wet anymore.  That well has run dry.  

Doctors in America typically have debriefings with nurses and psychologists after a pediatric death.  When there is a pediatric death, the department has difficulty continuing.  ‘You never get used to it’ is the common refrain.  

We have learned differently, that yes, you can, and we have.  When you lose a kid every two to three days to malaria, or to an ischemic dead leg, you get used to it.  Your well runs dry.  

But Andrew.  But Staci.  But Sarah.  But Megan.  They still have tears in their wells.  They have heart still.  They have not yet tired.  They are touched.  They are not jaded by the corruption here.  They believe everyone will do the right thing.  They trust.  They have energy.  They have vision.  

Thank you, Lord, for sending them here.  They are here to bear the burden of caring and to elevate the level of services this hospital provides.  

For this baby, it was too late.  I knew it; they didn’t.  And if they maintain that attitude… And if the container of ICU equipment arrives… And if we can recruit a Pediatric Intensivist… And if we can train nurses… And if we can get more parents to come to us a little earlier…  You know what?  Maybe for that next baby, maybe this team can save them.  

And maybe the tears from the well will overflow with joy, not sorrow. 

Wednesday, January 22, 2020

Rainy season!

Driving around here in rainy season is never boring!!!

Lyol goes for a swim in Morocco

All my kids are fish drawn to water. Here’s Lyol during our Casablanca layover. 

Push it Good!

So our starter has been out for a year. Our anti-theft device of requiring a push-start every time is foolproof!