April 29th, 2010 Posted in Uncategorized | No Comments »
Early this morning, around 4am, Jill woke me because the nurses had come to bring me back to the hospital to see a new admission. I had slept through them knocking on my door and window, but Jill hadn’t. The patient was a 17 year old girl who was five months pregnant. Her chart said that she had an “unsafe” abortion one week ago, then develo0ped fevers, vaginal bleeding, and respiratory distress. She was seen at an outside hospital but was not improving, so was transferred to the BMC. She had been started on antibiotics, oxygen, and IV fluids. Her body temperature was slightly lower than the normal range, she had tachypnea with grunting, and was in acute pain. Her bleeding had slowed today, but she had required a blood transfusion for severe anemia just before transfer. I quickly examined her. Her abdomen still appeared pregnant and was tender. Her family did not know how much, if any, of the fetus had been expelled. I sat at her bedside to write orders and decide what to do next. She needed an ultrasound and a D&C if the fetus did not have a heartbeat. Her family said there had not been recent fetal movement. As I was deciding if she would hang on long enough for me to run and wake John or Drew to do the procedure, her distressed breathing softened and she grew still. I looked up from my work with concern, still foggy from being up at 4am, and asked the nurse near her head if she was still breathing. I felt for a pulse, then listened to her chest, but there was no heart beat. The nurse and I stood watching her still body for movement, waiting for signs of life when she inhaled and made a sighing sound. We looked at each other the listened for a pulse again, but once again, nothing. A moan arose from the hallway where her family had gathered. The nurse walked off and I was unsure if I could leave her bedside. Her arm slipped off the side of the bed and I lifted it and placed it across her round abdomen, then followed the nurse back to the work room to finish the progress note.
There was one other patient to be seen, a man with a snake bite who was admitted the day before. His third clotting time was normal yesterday afternoon, but the nurses had forgotten to show me the patient. He was to be discharge the previous afternoon, so I wrote discharge orders at 5am and he would leave when the morning arrived.
I went home and tried to sleep until the alarm, but thoughts of the 17 year old pregnant girl kept me awake. I had just fallen asleep when it went off and we prepared for our last day at the hospital.
Jill and I rounded on the pediatrics ward. Most of the kids were doing well. I changed antibiotics on a child with bloody diarrhea, and talked with a mother of twins about attempting to nurse the second, smaller twin prior to offering expressed breast milk. My little Rasida was smiling and acting well except for the abscess incisions that were still draining. Her fevers and cough had improved, but there were two new abscesses that were nearly big enough to I&D. I helped one of the newly arrived medical students attempt to drain one, but no puss came out. We left the second alone. Her mother let me take a picture and I said good bye. I hope and pray that she is able to heal.
Susanna, Jill, and I hurried back to the houses to meet the rest of the ladies for our outing to the witches’ village. The “witches” live at a shelter for women who have been labeled as “witches” by the community and ostracized. Some years ago, a Peace Corps worker found out about the “witches” and donated beads and taught them how to make jewelry. She took the necklaces and bracelets they made and sold them in the States. Recently, she sent the money from the sales to Mona to return to the “witches” so they could purchase more supplies. There are around 90 “witches” who live together with their children and apart from the rest of society for their own protection. Accusations about being a witch can be based on anything or nothing, and once labeled, it is very difficult for one to prove one’s self not a witch. Besides jewelry, they also make soap to sell and they have an electric mill to grind millet and corn for the community. Mona presented the money to the group and Wendy spoke about the unity of women and our need for love and respect. She encouraged the “witches” saying that God provides the love and security that all women desire even when other people do not offer love. We prayed together and the “witches” seemed appreciative that we had come. There were not many necklaces or bracelets available for sale since a group had come in the day before and bought much of the completed work. Each of us was able to find something to buy to take home.
We arrive back at the BMC and headed back to the hospital for clinic. Most of the children had already been seen my Nelson, one of the medical assistants, so Jill and I saw mostly adults for the rest of the day. A newborn came in with an undescended testicle. I referred him for ultrasound to look for the missing testicle and advised his mother that if it does not descend on its own, it should be repaired surgically when one of the visiting surgeons come. A seven year old came with a laceration in his armpit where he had been kicked by a donkey earlier in the day. A little girl had fallen from a tree and broke her proximal tibia a month ago. She was casted and was scheduled to come today for review. There was no cast on her leg and I asked the mother about it. Her leg had been hot and itchy, so the family soaked it and cut it off themselves three days ago. She had thickening of the bone where the fracture had been, and was walking without pain. I gave her bubbles and prescribed Tylenol and multivitamins.
After that, I saw adults who all had heart burn, generalized body pain, waist pain (aka lower back pain), and agreed to fevers when asked. It was a long afternoon, but everyone was seen.
In the theater, I sutured the seven year old’s armpit laceration. His father was very sweet and thanked me. We said good bye to the theater techs, and walked through the pediatrics ward one last time to give bubbles to the kids, gum and pens to the nurses, and say our good byes before walking home from the hospital one last time. Everyone asked if I wanted to come back, and I told them that I absolutely did, but next time with my husband.
Wendy made dinner and everyone gathered at the M4 house for potato soup, sweet bread from market, mango fruit salad with cinnamon, and cake. We gave our small gifts to the missionary families and chatted for a while. It was hard to say good bye went I felt like I was just starting to get to know them.
We finished packing around midnight. I stuffed all of my market treasures and gifts into my small suitcase and added a few of my clothes to Angela’s trunk. The rest of the things I brought had been eaten or given away. I agreed to take trunks back to the States for both Angela and Mona, along with a cooler containing a sputum sample from a patient with antibiotic resistant TB. The pile sat by the door waiting for morning.
The time in Nalerigu has gone too fast!
