Bere 5/2025 #6
Long good day with a nurse induced overdose of a child
I check on the guy who had been stabbed by a cow with it’s horn. He is still alive. Still in septic shock with a norepinephrine drip that no one is really monitoring. I just ask the nurse to not touch anything. I go to worship at the Hopital then back home to have my own time of reading and prayer asking God to heal my patients and to give me knowledge of what to do with the ones I will see today.
I have some bread and PB and head in to work. Dr. Andrew is going to do surgery on a 4 day old with a meningomyelocele. (Undeveloped lower back with nerve tissue exposed to the outside on lower back the looks like a healing wound about 1.5 inches across). I go to make rounds. The OR nurse will do a hernia repair in the second room in the OR..
I make rounds with Emma who is the long time day norse of the surgical ward and he is easy to round with as he knows all the patients. The ones that stick in my mind now after a day of operating are: Guy malled by a cow horn, teen girl burned all over body when she had a seizure and fell into a fire, teen boy with hippo bite, Old man with TURP, two old men with hydroceles, two old guys with inguinal hernia repairs, old man with arm with tumor removed and skin grafting, guy nurse with buttocks abscess after antibiotic injection at that site, boy with bladder stone removed. Took me about an hour to see them all. I left some of the dressing changes for Emma to do. I notice a box of carnets (the little booklets that is the medical record that the patient keeps). I asked Emma what that was? He said that those are all the patients he’s following for tuberculosis. And there is a real problem with inconsistency of the supply of medicines. He will get medicines for two months, then none for a month of two, then get them again. I realize right away this is a terrible set up for medication resistance, which I had heard was already becoming an issue in this area. A guy at that moment stopped us to ask Emma for his meds, and Emma was out of his meds and couldn’t get them. I encouraged the man to go to Lai (Emma said they’d be out there too), or to go further away till he found them. I hope he does find them- seems like an impossible task for a local person.
Back to the OR, and Dr. Andrew was just intubating his patient as Phillipe had been unsuccessful. It looked like a hard intubation. I asked if I could help him as I have tried to repair meningomyeloceles before in Cameroon, but hadn’t ever seen one done properly. He agreed. We lay the baby prone to expose the back and put the cautery grounding plate under him. I prepped the kid with betadine and we dawned our cloth gowns after scrubbing our hands with brown colored bar soap. Dr. Andrew cut around the skin beside the open raw looking area- the dura. The anatomy was so hard to figure out. Zach helped use Andrews phone to dial a neurosurgeon in Kenya for a video conference to ask his opinion. The connection was terrible but with some creative hotspot thinking, a better connection was made. The neurosurgeon said this was abnormal anatomy for this disease and gave some pointers on what to do. It’s invaluable to have knowledgeable people, who understand the situation and limitations here, to give their opinions! With a very tedious long dissection we removed the fascia off muscle, bone circumferentially. The power went out so we had to stop about 10 minutes, because we were using cautery and a bloodless field was crucial. The fascia was so thin over the bones the some holes were made which wasn’t good, because it needs to be water tight to hold in CSF (cerebrospinal fluid). Next we undermined the skin all the way out to the sides of the abdomen. We closed the dura in a running layer then the fascia was pulled over that and closed folding the dura in. Then closed the skin in a running layer that was also to be water tight.
I went to the next OR to operate on a child that had a bladder stone. The OR lights don’t work in this room and so I operated by my headlamp. I had a hard time seeing and initially I thought it was my eyes are older and don’t want to focus close, especially after the last surgery that was all very close. About midway through I realized my headlamp was very weak, so Zach turned on his and voila, I could see clearly… So other than the power going out some more the surgery went well.
Dr Staci had come from maternity and said that there was a C-section that needed to be done as the patient had come in labor and had a C-section before and was told to always have a C-section after that. Phillipe had prepared her in the other room so I switched back to that OR. This abdomen was quite scarred as I opened it through the previous incision. Muscles were stuck, bladder was stuck. I opened the uterus to a gush of amniotic fluid. I pulled the babies head out, and found a nuchal cord (cord wrapped around the neck) so I undid the wrap and delivered the rest of the baby. He cried right away and I passed him off to the maternity nurse. The closure of each layer went well and she didn’t have any vaginal bleeding from the uterus at the end of the surgery.
The next young woman had had an early miscarriage and some retained placental products in the uterus that could be suspected on ultrasound. So back in the other OR I did what is called a dilation and curettage. Where we basically use some metal instruments to scrape the inside of the uterus clean of any retained pieces of placenta so that the woman will stop bleeding and also diminish the risk of infection.
I found Dr. Staci on the maternity ward and looked at a patient in the delivery room. Staci was getting ready to do rounds at 7PM as she had been busy all day with administrative stuff and still hadn’t had the time to make rounds. ( I’m convinced that she does a job that really should be three different people. Director of hospital, only doctor on maternity, and director of AHI Chad. So if you are good at any of those jobs and want to live in Chad Africa, contact her or I). Back to the work… I decided to offer to make rounds for her. I’m not as competent as she is but figured that the nurse who was on was a good one and that she would know the patients well. So I made rounds in stead of Staci. Even my help is beneficial when it relieves the load some so that overworked doctors can have a little less. I make rounds and discharge the patient I did a symphisiotomy on a couple days ago. She is walking well, denies any pain. Hasn’t washed the spot of the incision because her mom told her air would enter and she must keep it covered. So I looked at it and it looked fine, and I encouraged her to wash it daily with soap. I’m pleased that her next vaginal delivery should be easier for her.
I walk through the surgical ward on my way back to my room and to go get some supper- 8PM. I check on the cow horn injured man and his family is sitting him up and he’s requesting some water. I tel them they can give him sips. The nurse says the baby we did in the morning has a high fever of 40deg C, or about 104 F. They gave Tylenol and it didn’t come down. She says the Tylenol is nearly finished. What?? The Tylenol bottle is 1000 mg and a baby takes about 30mg… So I have her show me the bottle. It’s about 80% gone. I asked her if the baby got all that in a dose. She said yes. So the meningomyelocele baby who we operated on for hours, was given about 800mg of Tylenol in stead of 35mg. Thats about 20x a normal dose or 2000%. A huge overdose! I told her that this will kill the baby, not immediately, but in a few days or week. She said, well what do we do about his fever? I don’t think she grasped at all the critical error that was made. Later I found out it was her who had started the drip and had overdosed the kid. So if the kid survives his meningitis and fever, he won’t likely survive the liver failure that will result from that error. How terrible…
God, only You can save this baby, only You can save this cow horn injured man. LORD HELP THEM! Save them from their injuries caused by disease, caused by us as we care for them. HELP us!!!!
