Liberia #10
Bzzzzzzzzzzzz, generator noise, Bzzzzzzzzzzz, and a muffled voice. I realized I wasn’t dreaming, but that someone was at my window. I pushed button on my phone to see what time it was, 4AM, also noticing that I hadn’t received any calls. Yes, I said in my low morning voice. “Doc, com ……materniti.” The other words I couldn’t make out, but I knew I needed to get up and go to maternity. That is enough for me to know. I have a hard time understanding people to their face, much less on the phone or through a window at 4AM. I crawl out from under my mosquito net, find scrubs, and walk around the corner through a narrow passage just a little wider than my shoulders, and up the 4 flights of stairs and down the hall to the delivery room. I pass one person at the nurses station. All the nurses are sacked out on the floor in an adjacent room. The woman was in the delivery position on the table, with the maternal nurse in her position. The dead fetus (which we had know was dead) lay in a metal bowl still attached by the umbilical cord to mother. “Doc, de …com ot. Placenta? Ya de …..!” So I start to get on my protective clothing, and just as I finish putting it on, she pulls on the umbilical cord, massaging the abdominal wall (and uterus) and out comes the placenta. “Oh tank God”, she says. I disrobe the things I just put on. At the nurses station, I ask the sole “worker” if there are any problems, and he says no. So I head back to bed. 5:30AM- I’ve been tossing and turning but cannot go back to sleep, then I hear the cell phone ring. “Doc……”, What? “……., com!” Ok, then I hang up. I repeat. Arriving at the nurses station, I ask what’s going on. There was a 45-year-old stocky guy who was a diabetic and admitted a couple days ago. I had seen him during the night because of chest pain. No radiation of pain to arm or neck (more common to be heart attack), no abnormalities on auscultation (listening to his chest), so I doubted pneumonia as the cause. Heart attack, pulmonary embolism, malaria, typhoid, pleuritis, and pericarditis .the list is much longer than my memory. So I verified his malaria was treated and added an antibiotic, and aspirin. Treated what I had treatment for, with what I had. So apparently about 15 minutes prior he walked to the bathroom, threw up brown stuff, and then stopped breathing. Heart attack? pulmonary embolism? aspiration blocking the airway? I walked to his room; he was sprawled out in the bathroom, dead. Very frustrating. There are hardly any diagnostic modalities, and even if I did diagnose, I’m not likely to have the treatment.
After breakfast and morning devotions, I made rounds on part of the patients, Dr. Seton on the other part. After a nights rest she appeared somewhat recovered. Most were a little better or wanting to go home. One stood out. I found I had forgotten to write post-op orders on the patient cleaned out the pus and closed her abdomen. This ended up meaning that she got no medications or IV fluid all night long, about 8 hours. And no one asked me about it. The 18-20 year old girl lay on her cot, with tressed hair covered by a small towel. A nasogastric tube stuck a short distance out of her nose. It was attached to a sack with about 8 inches of tubing. She lay motionless, with her hospital gown draping over a large, distended belly, thin legs and feet protruded below. A yellow puddle of fluid lay by the collection sac on her left side. The IV tubing was looped up to the bag hanging on the pole, empty. She lay very still but answered my questions in clear English. She said she had some pain, especially in her back and could she move. Of course! Please do. She shifted a little with a grimace. I guess the nurses had told her not to move all night. So she hadn’t received any pain medicine, IV fluids, antibiotics, or anything for about 15 hours after surgery. I asked the nurse to grab some IV fluid and bolus 1000ml then start another bag, and wrote orders.
There were a few patients to do ultrasounds on, most of them pregnant. They wanted to know the sex of the baby and if it was in a good position. I think that cost them about $12. I got “home” early, and was able to connect via skype to Audrey for about an hour- that was wonderful. Later I ate food with Dr. Seton. Tonight she is taking call, so I plan on sleep. Though my brain is still changing time zones, so not tired enough yet at 11PM. Maybe after my usual nightly shower, my brain will be ready.
Jesus, please give me peace. Help me represent you to the patients and staff. Help me to have love for them as You do.