A Bloody Good Weekend

“Doctor on call for Emergency Tent!”  A shrill voice pierced the fog of sleep.  I bolted upright, groped for the VHF radio and switched on my headlamp in one jerking motion.

“Yes? This is Lanice.”

“Doctor on call for Emergency Tent!”  A shrill voice pierced the fog of sleep.  I bolted upright, groped for the VHF radio and switched on my headlamp in one jerking motion.

“Yes? This is Lanice.”

“We have a nine-month old child here, very sick, very pale, low oxygen, and bloody diarrhea….”

I dashed out of my tent, my sandals slapping against the sand.  The bray of a donkey shattered the pre-dawn stillness.  The ER tent was only two hundred meters from our expat compound but a world away in activity.

The nurse consultant and assistant nurse hovered over a small child, “His hemoglobin is only 2.6.” 

This desperately low hemoglobin meant we needed to transfuse blood, and fast.  But the puffy edema secondary to malnutrition, protein wasting and severe anemia meant that finding a vein was going to be near impossible.

“Prime an IV line to normal saline,” I asked the assistant as I tugged a package out of the emergency cupboard.  “I want it ready for the intraosseous.” 

I opened up the sterile package and inserted the special needle onto the drill.  I’d practiced and even taught the technique using chicken bones, but this was my first on a sick child.  The drill whirled, the bone resisted, then a satisfying pop and the needle seated into the bone marrow.

I dashed back to the expat compound, and straight to the tent of Marie Freichet, the French emergency physician who had recently arrived.  “Marie, I need to cross match an infant,” I called through the darkened tent.  “I need your help.” 

While I had spent an hour with the departing head nurse learning the intricacies of cross-matching blood, I was far from expert.  With this little one’s life at stake, I couldn’t make a single mistake.  Marie had recently worked in Pakistan and performed many cross-matches.  Together we’d figure it out.

We had one unit of O negative blood in our lab refrigerator.  Marie decanted the blood into the four attached sterile bags for pediatric use while I took a sample from the tubing to do a bedside cross-match.  Within forty minutes the lifesaving blood was dripping in.

Meanwhile the dawn unfolded into a frantic morning.  The bulk of the staff only work until noon on Saturday and we were racing against the clock.  Marie had admitted a child with severe malaria and a hemoglobin of 3.5 and we needed another cross-match. We lined up three more donors and worked our way systematically through the multiple steps to thoroughly screen.  Fortunately one aunt was a perfect match and we were able to proceed with donation.  By evening both children were stable and out of danger and we sat down to a meal with our team along with two friends visiting us.

Dr. Zeeshan Ahmed, a highly competent ER doc from New York was on call and Marie was backup.  Her radio crackled into life.  “We have a severe blood loss in the ER tent.  We need another cross-match!”

“More blood?  I can’t believe it!”

Both of us raced back to the hospital.  I opened up the lab and removed the last pediatric unit of O negative blood.  It wasn’t going to be nearly enough but it would be a start.  After this, we’d have to find a donor.  I warmed up the bag of blood inside my shirt as I sprinted back to the ER tent.  Zee and Marie were attending to the woman.

Zee hung the first small unit while Marie took the patient’s sister to the lab.  We lined up our array of testing material and began our third cross-match of the day. 

“What blood type is she?”  The radio call came in from our compound.

“O positive,” I answered.

“Our friends want to donate.  They are both O positive.”

“Send them in!”

Now we had three donors lined up and three doctors working to screen and cross match.  The lab hummed with activity as we lined up a full series of screening tests, spun down blood in the centrifuge and double-checked the cross-match.   All three donors were safe and compatible.  The first unit was procured and hung while the second and third units were drawn.  The woman was going to make it.

The next morning Zee and Marie and I visited our three miraculous cures.  All were out of danger, surrounded by loving family.   

Marie and Zee and I group-hugged one another, laughing.  “It was a bloody good weekend!”