Tuesday, March 27, 2012

Night Shift

Weekends are always thrilling around the village. (Insert thinly veiled sarcasm here). However! On Saturday night I got a dinner invite for pizza over at the doctor couple's house. It was a big party with med students, doctors, nurses, teachers and maintenance people. We had a blast and I learned how much fun you can have with pizza, chocolate, a blow up globe and some people who have had to learn how to entertain themselves with no TV.

I tucked myself into bed at about 10:30 (pretty late for me....I was partying hard!) but was jolted awake about an hour later by my phone. It was one of the doctors who had just been called down to the hospital because one of the staff had collapsed outside his house. Apparently he was having chest pain and collapsed. Now, of course if he was in the States we'd have him back in the ER in minutes, running a hoard of tests. Here, we gave him some nitroglycerin (which did help his pain) and something to bring his blood pressure down a bit.

I got the call because while the doc was down there, he noticed that there was one, count them one person working for the whole hospital. And he was a nursing assistant. Granted, he's a stud (you can read more about him here) but still. (We were supposed to have 3 people on but the nurse that was supposed to be on was the one having the chest pain and the other guy had worked during the day because we were short staffed then.) The doc called to see if I could go down and work for a little bit to help him out.

I went down with one of the other nurses. Um, it was kind of crazy. There was our staff member who had collapsed from the chest pain as well as a lady who had a gastro-intestinal bleed and was receiving blood. Almost as soon as I got there I saw some people carrying a guy down the hall. That's almost never a good sign. I peeked in on the GI bleeder, sent the nursing assistant "Abdul" to go make sure our chest painer's blood pressure was ok and went to find our new unconscious guy a bed. There literally were no empty beds in either of the mens wards. What's happening to the men around here??? I went to the little storage area and fortunately there was a bed in there, so in he went.

I started getting a history from his friends. Apparently the day before he had been in the bush and was accused of throwing a lighter at a group of guys (which the friends vehemently denied). The group of guys did not appreciate having a lighter thrown at them and proceeded to beat the snot out of him. Apparently he had been unconscious since that time.

Ok, unconscious. Breathing? Check. The other nurse started getting his vitals and blood sugar. All was normal, except his heart rate, which was low. His blood pressure was fine though, so it was fast enough to keep his pressure up. I proceeded with his neuro exam.

The first thing I noticed was that for being jumped by a bunch of people, he didn't look too bad. In fact, I couldn't find any bruises, scrapes, nothing. I opened his eyes and he fought me a little bit and his eyes moved all around in his head. Pupils equal, with a brisk reaction. I did some stimulation to see if he responded, and he responded to my painful stimulation. Next I did my "faker test." I learned this one in the ER and I love it. When a patient is lying down I lift their arm over their head and drop it. I know it's not perfect, but the logic is that if someone is really unconscious they won't move their arm at all and it will hit them in the head. I did it on this guy and hit himself in the face a little. I did some other things and then went back to the "faker" test. I lifted his arm over his head and dropped it....probably about 10 times. Never once did it hit his face.

The rest of his exam was also essentially normal. His abdomen was soft, good bowel tones. No obvious broken ribs and his breath sounds were normal.

Hmmm. His vitals and exam were essentially normal. He failed the "faker test" but he did seem a little "off." It was possible that he had a concussion. It was possible that he had a big bleed in his head. Either way, there wasn't a whole lot I could do because we don't have any neuro surgeons around. Since his vitals were OK, when they came to get me to tell me there was a new patient who just came and was vomiting blood, I went to see him.

After getting the new guy settled I went back to "unconscious guy." He was snoring. I was kind of naughty and snuck into his room and startled him awake. He woke up and looked right at me, something he hadn't done before. I told him I needed to give him an injection for which I got a "are you serious?" look and then he rolled over so I could inject his bum. This reassured me that at least he was following commands now...... (The injection I gave him was something for pain).

While I was in the mens ward helping with the paperwork, I heard a guy working to breathe who had been admitted earlier in the evening. He sounded like he was drowning. I went and listened to his lungs and they definitely had some stuff in them! However, I wasn't sure if it was fluid overload, or pneumonia. He had a low grade fever and a non-productive cough. The person who had seen him originally had ordered fluids for him. I sat and hemmed and hawed. If it was pneumonia, he was probably dehydrated and could use the fluids. However, if he already had too much fluid on board, the fluids that were hanging would not be helpful.

After watching him be restless for a few minutes, really working to breathe, I pulled the trigger. I stopped the fluids he was getting, went and got him a medication to get rid of the extra fluid as well as a strong, injectible antibiotic. He really needed some oxygen but our oxygen concentrator was being used by the lady getting blood, and it was almost to the end of it's 2 hour battery. Darnit!

By this time it was about 2:00am. I was planning on sleeping down at the hospital so "Abdul" wouldn't be alone. However, since things had quieted down and I had to make a 6 hour drive the next day, I decided to go back up to my house and told him to call me if he had any problems.

At about 3am I got a call saying that my respiratory distress patient had passed away. Darnit. I laid there going over and over the things I'd done. After thinking about it for awhile, I'm not sure that I could have done anything differently. In America he would have had a tube stuck down his throat to breath for him and been shipped off to the ICU. Here, we couldn't even give him oxygen.

It can be tempting to be discouraged. There is too little staff, too few resources, and too much that I don't know. However, the last few weeks I've really been convicted (once again....I always need to relearn things) that my job is not to save everyone. My job is to show people here that they are loved. By me, but more importantly, by Christ. :) Thank God!!

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