Saturday morning was difficult. We lost another child from the malnutrition ward. She took a turn for the worse on Wednesday and was sent to Intensive Care, but seemed to be doing better over the next few days. I checked on her late Friday evening, she didn’t look well at all but she was on maximal treatment. I told her to hold on, and she did, but unfortunately only until the morning.
I had to fight the heavy feeling in my heart and put on a smile for the Newborn Resuscitation training I was giving that morning for the Midwives. We actually had a great session and we shared lots of laughs as I pretended to be a woman giving birth.
Then I moved on to join our Saturday morning “difficult cases” doctor rounds. By the time I joined the group they were circled around another one of my patients from Malnutrition. This is the 4th time I have admitted her to the hospital, each time for heart failure. The last admission, the nurses and I had a very honest conversation with her family about her prognosis and what the limitations of our treatment were. Unfortunately, the family understood all too well and promptly abandoned the child after discharge. While a kind stranger had ‘adopted’ her, the sadness on her face was clear. She knew too much at 5 years old; about death, desertion, suffering. Despite medication, her breathing was too laboured to eat more than the therapeutic milk we gave her. I felt completely helpless.
Thank goodness for Raghu, the other expat doctor here in Mweso. He immediately made a positive suggestion, one that would help not only the kids, but also us. He proposed we have a movie night in the Children's / Malnutrition ward.
He quickly got to work organizing it along with our Logistican Michi, and by 6:30PM we were ready to watch The Lion King. All the children, mothers and even nurses crowded around the beds to watch. I sat laughing with the mothers as they told me things in Swahili that I only half understood.
Just as the song “Hakuna Matata” came on, one of the nurses from Intensive Care rushed in. A child had arrived in a coma with a very low blood sugar and they couldn’t find a vein to insert an IV line. Could we help them? he asked. ‘Hakuna matata’, I thought, no problem.
I arrived to an inspiring site, at least 5 determined nurses working quickly to find a line. These guys can draw blood from stone, there was no way I would be able to find an IV. The only option was an intraosseus line, a large needle pushed through the bone of the lower leg. I sweat as I struggled to push it in. I was painfully aware of her shallow breathing, her weak pulses, her cold legs. She didn’t flinch as I pushed. Finally, “POP”, I was in. We pushed glucose and antibiotics and got a perfusion running...for about 1 minute. It stopped running; back to the drawing board. Next option: an IV in the large vein of the groin. This one is by feel, by palpating the pulse of the large femoral artery, but her pulses were weak. On the third try, in was in. “Hakuna matata”...ya right!!! I was covered in sweat despite the cold night!
She is doing only a little better today. But I refuse to lose hope. I propose another movie night when she wakes up... Little Mermaid anyone?