Thursday, September 8, 2016

Tylenol how I love thee....let me count the ways....

Last night a caretaker from the boys’ house called to let me know that one of the boys, we’ll call him “Abdul” was unconscious.  Unconscious? Say, what?  My body immediately went into “fight or flight” mode as the rush of adrenaline swept over me.  In my experience, “unconscious people” don’t do terribly well here. 

Peter was in a meeting so Nicole offered to watch my kiddos while I ran to see what was going on.  I had just seen Abdul yesterday and he’d been fine. He’d complained of a headache and tested positive for malaria, so I started him on the treatment.  But the “positive” line hadn’t even been that dark…at least not as dark as the other boy who had tested positive.  And he came up to me to complain of his headache as I was leaving, almost as an afterthought. What the heck had I missed!??!

I started racking my brain trying to think of what could be going on so I could be prepared with some supplies.  I went to my little IV kit area and had IV fluid but couldn’t find the tubing or IV cannulas.  So…not super helpful.  Nice, Emily.  I ran to the fridge and grabbed a soda with some crackers and peanut butter. When I worked in the hospital, our malaria kiddos would often have really low blood sugars.  Depending on what exactly “unconscious” meant, I could see if a little sugar rush would help.
When I got the house I was led into a dark room, lit only by a single battery operated lamp.  Abdul lay on the bed with several caregivers sitting next to him and other children peering in the doorway.  They made room for me on the bed and I sat down next to him.  As I conducted my initial assessment by just looking at him, I saw a 15 year old boy with about 27 layers of clothes on, the top layer being a wool sweater.  He was laying down on the bed and responded by turning his head when asked questions, but wasn’t talking very coherently.  At least what I could hear. 

I got more of the history from the caregivers.  Apparently he’d been fine most of the day.  He’d eaten all of his rice and had been drinking water.  No vomiting or diarrhea that they knew about.  Ok. This lowers my suspicion for extreme dehydration or hypoglycemia.  Apparently he’d been doing just fine until 5 minutes ago when he said he wanted to lay down and came inside.  Now….5 minutes.  I’ve learned in my years here, that I can’t take things like “minutes” literally.  (Also, FYI also don’t take “I’m coming” or “I’m almost there” literally either).  They’re not meant to be taken that way).  So when they said it was “5 minutes” it really just told me that he hadn’t been laying in the bed for most of the day. 

I checked his temperature and it was 103.6.  Pretty high for an older kiddo.  When I asked about his last dose of Tylenol they told me it had been earlier that morning.  I took some out of my bag and, with the assistance of one of the caregivers, helped Abdul to take the Tylenol. 

Now what to do.  He looked sick.  He wasn’t “unconscious” in that he was completely unresponsive, but he was mumbling and really restless, moving around on the bed.  Although I had diagnoses like cerebral malaria and other scary words in my mind, I decided that because he had only been sick for “5 minutes” I would give the Tylenol an hour to work.  If he didn’t turn the corner by then, I would take him to the emergency hospital.

I had quite a bit of faith in the Tylenol.  Like 80% sure it would work.  The other 20% of me felt nervous just sitting there, but the 80% won out.  I sat there quietly, softly patting Abdul’s arm.  After swallowing my pride and praying for him in Krio (something that I’m STILL uncomfortable doing because I feel like I can never find the right words), I began observing what was going on around me.  

One of the caregivers began massaging Abdul’s legs.  Another one sat near his head and kept alternating the soaked cloths applied to his forehead.  Yet another one stood in the doorway, and with her eyes fixed on Abdul kept clucking her teeth and saying, “Eh, God.”  I wondered how many times she’d sat in a darkened room like this with some unknown ailment tormenting a friend or family member….and it not ending well. 

I debated about making Abdul take off some of the layers of clothes in an effort to help bring down the fever.  But then I remembered when I had malaria.  The first time I was in the village, and put on my own 27 layers of clothes.  Even though I knew it was the wrong thing to do and had chastised I don't know HOW many parents for bundling up their febrile children....I. Did. Not. Care.  I was freezing.  So I had some mercy and just prayed the Tylenol would work really well.

 After 15 min. or so, Abdul began talking.  He quietly explained to the caretaker that when he was small he’d had an accident while going to the market and landed on his head.  Since that time, every August this kind of thing would happen and his head would begin hurting the way it was now.  I didn’t want to just dismiss him but I felt like I had to explain that it PROBABLY wasn’t a chronic head injury that just flared up in August.  Instead, it was more likely due to the fact that August is the height of rainy season, which means it’s also the time that malaria is most prevalent.  Since headache is one of the hallmark signs of malaria, it’s more likely that he just gets malaria every August and that’s what causes his pain.  Everyone nodded their heads…..I'm not convinced they believed me. 

After about 45 minutes Abdul was less restless but still complaining of a headache.  I realized I ran out of ibuprofen in my little medicine bag so I ran home to get some.  When I came back, I noticed that all the caregivers were out on the porch.  That was a good sign!  I asked how he was doing and they said he was sleeping. When I went in to see him he was DRENCHED in sweat and finally agreed to let them pull off the 300 layers of clothes he was wearing. He took some ibuprofen and another dose of malaria treatment and went back to sleep.  Everyone (including myself) was visibly relieved. 

I went to see him today and I wouldn’t have believed it was the same kid.  All smiles, hanging out on the porch.  Jesus, fever reducers and malaria treatments for the win!! 

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