Well, it’s been over week since we’ve been back…….home? I don’t even know anymore. We’re back to where most of our junk is. J We jumped right in. The day after we got here, we took a break from cleaning up the rat poop that seemed to invade every corner of our house and went to see the girl kiddos we’ve been working with. We chatted with them for awhile and they ooooh’d and ahhh’d over Ben. As we were getting ready to leave, one of the Auntie’s brought a 9 year old girl…..we’ll call her “Aminata” over to me. They said she that her “belly hurt.”
The complaint of a “belly hurting” is probably one of the most common complaints I get when working with 50 little kids. It is usually vague, non-specific and sounds suspiciously like what my sister would say when trying to get out of going to Kindergarten. (Sorry Lis, called out on the World Wide Web).
But this was different. This girl had tears coming down her cheeks as she walked towards me. I asked how long this had been going on, asked about other symptoms, and did an exam. All the little tests I did in school for appendicitis seemed to be positive. They told me that she’d been sick for a couple of days so I didn’t want to sit on it and decided to take her to the hospital right away. We’re very fortunate that to have a new emergency outpost near our house so I took her there. They did an exam, gave her some pain medicine and called their supervisor. After some discussion, they decided to let her sleep overnight (treat her for the malaria that of course she had as well) and the next morning she would go with Nicole to Freetown to the bigger hospital where they would do a more thorough exam, blood work, etc.
The next day she and Nicole went to the capital and spent the day at the hospital. They couldn’t find anything definitive and thought it might be because she had received some pain medicine. She was vomiting and dry heaving most of the way to Freetown but by the time the doctor saw her, she was looking better. They sent her home and said we should bring her right back if she started having the pain again.
Then next day, Friday, I went to check on her and she looked much better. She wasn’t doubled over in pain and wasn’t in bed. Great! Maybe it was just a virus or something. However, the next night I got a call that she was vomiting again and was crying in pain. I went back to see her and she looked like she had the first night I saw her. My initial thought was that maybe her appendix had ruptured which was why she felt better the day before but was now developing some peritonitis. It was Saturday night. I knew that if I took her back to the hospital in Freetown, unless she was in danger of dying THAT NIGHT, they would sit on her and wait for someone to see her in the morning.
I decided that I’d take her back to my house so I could watch her closely overnight. Marie was thrilled to have a “buddy” to sleep with her that night. (One of her biggest nighttime complaints is that it’s not fair that both Daddy and I have a “buddy” to sleep with and she’s all alone in her room.) Aminata spent the night and the next morning…..looked better!! She wasn’t in obvious pain anymore, although her belly was still tender in that right lower quadrant. I hemmed and hawed, trying to decide what to do. I kept thinking about a girl I’d taken care of in the village several years ago. She had had belly pain that I just couldn’t figure out. I treated her for everything I could think of. I asked the surgeons to look at her, but they didn’t think it was a surgical case so I told her parents to just hold on for a couple of days. The American doctor was coming and he could help me figure out what was going on. She died the night before the doctor got there. That was rough. I couldn’t go through that again.
I decided that instead of taking her to the hospital in Freetown, I’d take her to a hospital closer to our house. They have two doctors there, one being a recently arrived American surgeon. He did an exam and decided that he didn’t think it was appendicitis. She wasn’t in enough pain, and it had been going on for so long that if it WAS, she would be much sicker by this time. He gave her several different antibiotics as well as some worm medicine.
I took her back to our house where she was able to eat a little and then played with Marie for awhile before I took her back home. The next day, she was doing well but then that night I got another call that she was crying in pain. They gave her some Tylenol and the next morning when I went to check on her she was still crying in pain and wouldn’t eat anything. Grrrrr. What is going on? That night when I went to check on her again, she was still crying. I decided to take her back to the hospital the next morning. This was so weird! She’d been on the antibiotics for 3 days and I thought she should have started feeling better by now.
The next morning when I went to get her…..she looked better again. No longer in obvious pain. Now I didn’t know what to do. Do I take her in when she looks better than she had looked when I originally took her in?? What I needed was a dang CT machine to give me a definitive diagnosis! Nary a one to be found in the country. With my previous patient in mind, I decided to go ahead and take her back in, just because she’d been complaining of so much pain the day before.
They wanted to do some more tests, one of which was a stool test. They gave me a container that was about the diameter of my pinky finger (MY PINKY FINGER!!!!) and told me to put some of her stool in there. I just looked at them. Excuse me? Can you please explain to me how I’m supposed to get THAT from THERE to THERE!?!?!? Well, I can now explain it if you ever need to know! Let’s just say that it was done using a pit latrine, an empty water bag and a stick. No gloves of course.
We waited for the doctor for a couple of hours…..and I started to get a little suspicious. There was ZERO sign of pain. She was happy as a clam, snuggling up to me, laying her head in my lap, watching the pictures and videos on my phone. I started to feel like I MIGHT be getting played. I knew that it would most likely be several more hours before we were able to see a doctor so……I decided to peace out. I could always bring her back if I needed to (and find out the results from the hard earned stool test) but honestly I felt like kind of an idiot bringing her back because she looked so much better than the first time I brought her in.
As we left, Aminata asked if I was taking her back to my house but I told her no, I was taking her home. A few minutes later she told me she wanted to go play with Marie. Hmmmmm…….I told her that she was sick, so she needed to go home and rest. I stayed at her home for awhile to make sure she was ok and there were a couple other things (such as requests for cookies after just complaining of nausea and deciding that she WAS in pain…..but only when I was paying attention.) that made me think this sickness might have been extended just a little bit. I think I’ve been well played by a 9 year old.
I was annoyed at first, of course. I was annoyed with the kiddo, but I was also annoyed by myself. ER nurse rule #7: Your patients lie to you. (For example: Excuse me sir, I noticed that you cannot stand up straight, are covered in vomit and reek of alcohol. How much have you had to drink tonight? Patient: ONE BEER I SWEAR!!!!!!!!!!) But this was different. This precious little one didn’t feel good and because of that got some extra attention, extra one on one time. And she wanted more. Can I really blame her for that? She just wants what Every. Child. Wants. To be loved and important to someone. Not because she’s one of the crowd, but just because she’s HER.
Thank you Lord, so much for the privilege it is to care for these little ones.