My phone calls




12:59

The phone ringing beside my bed startled me out of a deep sleep. The nurse on medicine was calling for bed 8, a teenage boy who had been admitted several days prior with a hemoglobin of 3.9 in the setting of an unknown bleeding disorder. Apparently the boy would periodically have nosebleeds at home throughout his life that somehow his family had previously managed to stop. Hemophilia A? B? Von Willebrand disease? Hereditary Hemorrhagic Telangectasia? We will never know in this country.


I found him laying on the ground with the nasal tampon in his R nare that I had placed 2 days prior and blood steadily dripping from his L nare now. He was snarfing and crying. I shoved a new nasal tampon in the other nare and blew it up as much as he could tolerate. Then I turned to the father and asked how many bags of blood his son had received since admission. He sheepishly looked around, and I turned to the nurse who reported he had still only gotten the one bag of blood we gave him from our blood bank upon admission. Great. I lectured the father on the fact that his son was going to die if he didn’t find donors, but the father appeared to have given up on his son. I went to our blood bank, took one of our precious stock, and handed it to his nurse. Whew, hopefully he would survive this bleed. I stumbled back home to bed listening to the scratching of a rat getting out of my way as I entered the house


05:54 

A female voice called this time. The phone connection was so garbled I could not understand what she wanted, but a female nurse often means maternity is calling, and maternity means messy. I put on my scrubs just in case. The new nurse on peds intercepted me on my way to maternity and let me know that it was her calling, wanting me to see a sick toddler. The toddler had been admitted overnight for what appeared to be cerebral malaria. She was febrile, had been convulsing, and now appeared post ictal. I confirmed the nurse had been thoughtful enough to check her hemoglobin and glucose level, which were normal. I also checked her dossier and confirmed she was on all the medications that I would have prescribed for her. Whew. I encouraged the nurse and family to keep staying the course and then walked home. 


The kids and Gabriel soon woke up and we ate breakfast together. We sang a song and read a nature lesson. Then I put Juliana down for a nap and we watched kindergarten Sabbath School online for Elijah - startingwithJesus.com


09:31 

The daytime peds nurse called requesting a unit of blood be exchanged for a patient with a negative blood type. Whew, nothing that would take too long. Elijah requested to join me so we walked together to the hospital. The patient’s families always get excited to see white kids, like we are some zoo attraction. 


After our mission was accomplished, I pushed Elijah “way high” on the tire swing. Gabriel came a few minutes later to get the motorcycle truck warmed up.


We went to church and brought one of the student missionaries with us. Our little church, Topadjere, has usually about six adults who attend, two of which are blind old men. The number of kids is about twenty. 


Gabriel thought the kids would enjoy songs and stories underneath the mango tree next to the church building. We sang a few songs in French and their local language, and I told a Bible story. Gabriel taught about the Sanctuary inside the church.


11:53

I saw I had missed two calls from the maternity nurse. She had two cases to present. One was a lady who delivered the first twin at home and came in because the arm of the second twin was the presenting part. The other was another lady with twins, but a first time mom and the first baby was footling breech


We bounced back to the hospital in the motorcycle truck on the dusty pot-holed dirt road. Which patient should I help first? I chose the arm presentation. 


She was calm, and thankfully not bleeding. The fetal arm was floppy and macerated. I brought her to the OR and called in our nurse who does anesthesia. His phone was charging at a charging station and not with him, so I had to keep trying repeatedly over the course of perhaps half an hour. 


Once she was prepped and the nurse finally arrived, I performed an internal version of the dead baby by reaching deep into her uterus, finding a foot and gently pulling it downward. Thankfully since her uterus had previously held two babies, I had enough room to bring the baby out without rupturing her uterus. Whew! We saved her from an always potentially dangerous operation.


After we rolled her out, I walked in the breech primigravida. I discovered her blood pressure to be 170/110 after hooking her up to the monitor. I checked her cervix again, which had not changed past the 5cm I had first found. The feet of twin A, however,  were trying already to push through. 


The two babies were crying and wiggling within minutes of exiting their mother’s womb, thank the Lord. The mother’s blood pressure dropped to normal with the spinal anesthesia and never returned to its previously very elevated state. Whew. I finished the c section and joined our missionary colleagues for potluck. Elijah was busily playing in the dirt with the little gal also his age. Juliana happily clutching her blankie (that is never supposed to leave the house) and sitting on the cement floor of the potluck pavilion close to Gabriel.


15:57 

The next call was from the nurse in the ER. An elderly gentleman had arrived with urinary retention and the nurse was unable to pass a Foley catheter. Whew, this one I could pawn off on my surgery colleagues.


16:24 

The nurse on maternity called to report the c section patient’s hemoglobin was 4.5. I knew she had a hematoma on the L side of her hysterotomie that I had watched for several minutes to make sure it wouldn’t bleed. I jumped out of my chair and rushed to the lab. I grabbed the lab tech and his hemoglobin machine and fast walked to her bedside. The tech poked her finger, added the blood to the machine, and I waited with baited breath. With a hemoglobin post operatively of 4.5 down from 11.7 prior to surgery, I imaged that her hematoma must have mushroomed and I would need to beg the surgeon to help me reopen her to stop her bleeding. Worst case scenario she would need a hysterectomy. After a few seconds, the result popped up on the screen. 10.5. Whew! Mercy, I sighed with relief. I chose to believe the second result and not the first.


16:31

I returned to potluck to finish the plate that Gabriel had saved for me until I received another call from pediatrics. The nurse requested I exchange a unit of blood for another patient needing a transfusion. Whew, at least this one wouldn’t take too long.


We finished potluck and headed inside the house as darkness was falling and mosquitos were starting to prowl around.


17:55 

The pediatric nurse called again. This time he had a boy with a tongue laceration. I left Gabriel, my hero, to get the kids fed and washed, while I went to inspect the tongue. The story was that the kid has ?epilepsy and has some kind of seizure activity chronically. This afternoon he had “fallen” and made a through and through laceration 2/3rds of the way across the end of his tongue.


Given the unlikelihood that this boy of 4-5 years old would let me repeatedly poke his tongue with a needle without biting me, I requested one of my missionary colleagues to help me with anesthesia in the OR. Somehow I had previously missed out on the opportunity to suture a tongue, but thankfully this tongue came together fairly well with the help of some ketamine to keep him calm. Whew.


I hustled home after sending the boy to back to pediatrics to recover. The kids were indeed fed and washed and zipped up in their jammies. We sang a song, read a Bible story and zipped them up in their tents for the night. Whew!


"O my God, incline thine ear, and hear... for we do not present our supplications before thee for our righteousnesses, but for thy great mercies." Daniel 9:18


Comments

  1. Wow, I don’t know how you do it! Hod bless and strengthen you, sister! Hugs and prayers! Linda Suhari

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