Shanksteps Bere April 2023 #3 with picture
Death- We all die. Most of you reading this have hope of a life after death, one where we will live with God after all the pain of this world is gone and it is made new again like God designed it in the first place. Since we are on this world we experience death, and in third world countries death is a daily experience. Adults and children and especially young children. If you ask a woman here how many children they have- the response is usually I’ve had (example) 6 children and 3 are living. Since there is so much death it is an expected though mourned part of life. I can accept it better when I know why someone dies than here where it’s sometimes diagnosed and sometimes i just suspect why someone I was caring for in the hospital dies.
Im called in last night to see a lady that I had performed a procedure on earlier that afternoon. She had been admitted a few days ago and had malaria and seemed short of breath yesterday. So Olen did an ultrasound and found what seemed to be a prominent amount of fluid on one side. He sent her over to the OR to have me drain it. The lady was tachypnec (breathing at a rate about 30) after being moved around. No one spoke her language so we made signs as to what we were doing and she also seemed not all there. i did an ultrasound with my Butterfly and saw fluid on the right. So I didn’t know wether to draw it off with a small needle or a chest tube. so I put a needle into her chest and drew off fluid that looked like pus. So I decided the chest tube is what she needed. I put lidocaine in her chest wall about the level of the mid breast and made an incision and spread slowly down between the ribs. as soon as i entered the chest cavity pus came spewing out with each breath. I put a chest tube in and attached it to the one pleuravac (canister) that has been washed out and reused for many years. (They aren’t available here.) after finishing the procedure I hook the pleuravac to suction and more fluid pours out. I get a total of 1700 of pus, after whatever drained all over the OR bed and the floor. she is coughing and that gradually calms down. I call her family, three guys, into the OR so they can see the amount drained off before I dump it as it nearly fills it and I want more space in it for the weekend. It’s made to be used one time so it is difficult to dump out as it doesn’t have a drain place. eventually i get it emptied and reattach it. Her saturation is good and she’s a little low on blood pressure and as we give her IV fluids it improves. She is taken to the surgical ward. I check on her shortly there after and verify that the tubing isn’t kinked and that the family knows how to push on the foot pump every so often to create suction for the system.
So Im called in at night to see her because she isn’t doing well. I go in right away to see her and she is dead. Not just dead but cool and dead. The nurses have a list of hourly blood pressures which I asked them to do- and amazingly enough they did. Usually it’s a fight to get daily blood pressures. Anyway the blood pressures have been good. They said a bit earlier she drank water and didn’t choke and that from the nurses (don’t know wether they were students or nurses) point of view she was doing well. When they came to get her blood pressure it was zero so they called me. No CPR. I don’t do it either, as i find in this rural place when we are treating suspicion rather than diagnoses it’s futile. No ekg machine, and Im not sure it would help anyway here. I tell the men she is dead. This usually causes an uproar by women of the family who start mourning. However there are no women of that family around so they are silent and sad.
Another patient that has cheated death so far, but may die in the near future is about 18. He came in a couple days ago with a severe neck infection after having a tooth abscess that continued down into his neck and necroses the skin on the front of his neck. The dead tissue was debriefed in the OR and when I came the first day he was in the recovery room he was being suctioned frequently because he was bleeding from somewhere in his mouth. No spot could be identified but clots kept coming out. he wasn’t conscious enough to protect his own airway. I didn’t expect him to survive the night. A visiting ER doc got up every hour or two and suctioned out his airway in his room with a foot operated little pump. It worked and when I rounded the next day he was still alive and more conscious. Yesterday when I rounded I take off the neck dressing and I see all the muscles and thyroid of the anterior neck. From side to side and up onto the left jaw muscles too. It’s a gruesome site that reminds me of the “bodies” display I saw at the museum once on the human body. Or anatomy class in medical school. I flushed out the pus in his neck and realize that he seems to be choking. So I sit him up and have him drink some water. a fair amount comes out his neck wound. So there is communication with his throat and this open neck wound. Im not sure what to do about that. I will tell the family that he needs a feeding tube. I think he has survived the infection and will die of starvation if I don’t feed him someway. We also still need to pull the rotten teeth that were the source of the infection.
So death is ever present. It is always hard to deal with and each patient I get attached to and think they are doing well and that what we did made a difference- if they die it is hard to deal with. Other patients I expect to die it seems less painful. Then there are the ones like this last one I expect to die and didn’t (yet).
God, help me to know what to do with each patient I see and guide us to help as many as possible and know when it’s not possible.
