“Glucose. We need a glucose.”

“Dr Courtney.  Il y a un urgent a l’admission”

“Dr Courtney.  Il y a un urgent a l’admission”

I looked up.  Moussa de L’Admission, as he’d introduced himself on my first day, did not tend to mess around.  His ‘sick’ pretty much always meant ‘sick’.  I quickly gathered the chart that was spread out on my lap at the head of a bed in Phase II, where the happy, bouncy, almost-home kids stay, and followed him out under the tent flap.

In the open, covered, admission area, I saw the moms and babes sitting on benches, looking for the one Moussa had been talking about even as he moved towards them.  You can usually tell a sick kid from the doorway.  Sure enough, there was a little one held oddly, floppy and arched, in her Mom’s arms, who seemed at first to be suckling her breast, but who had a funny kind of latch.  As I got closer, I could see that the babe’s mouth wasn’t actually sucking at all, but was open, moving in a semi-automatic looking jaw motion.  Her eyes were open, but doing a sort of saccadic movement, not focusing.

I gazed at her for about three seconds. “OK.  On les amène a la salle de réanimation.”

Moussa nodded.

We bustled the child in.  A young nurse, Abdi, took the child.

I met his eyes. “Glucose.  We need a glucose.”

Quickly, he pricked her finger and put it in the little glucose-o-meter.  It was low.

While Abdi tried with the IV, I went and got some D50, a concentrated glucose solution, and dribbled a few drops into the child’s mouth.  She did seem to perk up a bit.  He eventually couldn’t get the IV so he held her while I put down my first Djiboutian naso-gastric tube.  At home I usually stand back during resuscitations and try to be hands-off, but we don’t always have the hands here so I’ve been trying to practice some of the common procedures.  Putting the tube down wasn’t a problem…tricky tape job though.  Abdi took over.  I’d had it the wrong way.  D50 went down the tube.  I felt better.  Abdi got the next IV attempt.

I looked again at the babe.  She was making a funny movement with her mouth and eyes: her mouth miming a suck, her eyes darting side to side.  She seemed to be going in and out of consciousness: when the abnormal movements ended she’d look up at you and fix her eyes on a light, even though she was still very sleepy.

It was hard to tell, but it looked as though she was having intermittent seizures.  Her belly was supple, her breathing fine.  Meningitis?  Sepsis?  Was it the hypoglycemia?  No nasty skin rash.  It seemed to get a bit better after the glucose, so after getting a bolus and antibiotics started, I left her with Abdi and went back to try to take some history from Mom.

We took a closer look at the babe.  She was still making strange movements from time to time, and her vitals were totally out of whack.  She was needing sugar a few times an hour and seemed to be on the verge of passing out.  But she was breathing spontaneously.  And she wasn’t getting any worse – she seemed to be getting a bit better, if anything.  I stood there watching, trying to think of what to do next.  But all the nexts were from a distant land of laryngoscopes and CT scans.  So I propped the bag-valve-mask up at the bedside, drew up some adrenaline, calculated her dose, and left it in the afternoon nurse’s pocket with strict instructions to phone me if she got worse.

I went to a meeting. My brain whirled around thinking about her continuously.