Bleh

Every morning I do rounds in the peds ward. Malaria season is upon us which means that the peds ward is SUPER busy! Last week we had a record (at least since I've been here) of 31 patients. There were mattresses everywhere and they were labeled things like P2/3 (the matress between bed 2 and 3) and Private Room 1A, 1B, 1C. And there is usually just one nursing assistant for the whole ward. B.U.S.Y.

Since I do rounds in the morning, I generally have a good idea who the semi sick patients are and who are the ones I need to keep an eye on. However, about 10am the admisisons start rolling in. Since they've already been seen by a provider and been given their blood and medicines, unless the nursing assistant or one of the parents comes to get me, I wait to see them on rounds the next morning.

However, since it's been SO crowded recently, I've started doing some more rounds in the afternoon. This set of rounds is abbreviated and just involves me going around the room, physically looking at the kiddo and giving the parents the opportunity to tell me if they've noticed something wrong. I especially like to do this after a child dies because all the other parents get really anxious and need some reassurance.

Today at about 1:30 pm. I was down in the OB ward when I heard the familiar wailing coming from the peds ward. Never a good sign. I went down to check it out. Sure enough, one of the kiddos had passed away. I did what I hate doing, which is listen for the respirations and heartbeat and then tell the mother or father "ee don go." (He's passed away.) When a person dies, they always pull the sheet up over the head but I haven't had the courage to do that yet. I just can't cover their precious little faces.

So after that kiddo died (he'd been a new admission so I hadn't seen him that morning), I started doing the rounds of the ward, reassuring parents and looking to see if there were other super sick kiddos. Ding...found one.

This kiddo had come in a little bit ago with a hemoglobin of 2.6. For those of you who aren't medically inclined.....it's low. Really low. Incompatible with life kind of low. He was getting blood, but he was getting it through his umbilicus. Also not a good sign. Anytime I get a kid who is getting blood through his umbilicus, it means that the OR guys had tried and tried but couldn't get an IV in the scalp. It also means that the blood is going into the abdomen which means it takes a lot longer to raise the hemoglobin level....like days instead of hours. Bad.

The child was not breathing well (not suprising with no oxygen due to no blood....think back to your high school biology lesson). As I stood there for a second, collecting my thoughts, he started seizing on and off. I asked the mother if the child had been breastfeeding well and she said he had been until today. I checked the blood sugar- 46. Really low. Incompatible with life, low.

D50 is a medicine (dextrose- 50%) that we give to patients with low blood sugar. It brings the blood sugar back up really fast. I knew we had had one vial of this but also knew that last time I'd seen it, it was really low. I ran down to the OR to see if it was there. Didn't see it anywhere. I called my boss to see if we had any more. Nope. Then I called another co-worker to see if he knew of any secret D50 storage places. Negative. The only option I have is to give this child D5 (dextrose 5%...clearly not as strong as 50%) which we usually give as IV fluid so the it comes in 500ml. However, I only have on "IV" line...and that's not even going into a vein! He desperately needs blood, and desperately needs sugar.

I knew the OR team had tried multiple multiple times to get an IV in the scalp because it's the only reason they ever put one in the umbilicus, but sometimes they don't try the arms. IV catheters are precious here so they are kept under lock and key. I ran down to the storage to grab a cannula. I wanted to see if I could get an IV in the arm. Maybe they hadn't tried there.

I looked...and looked...and looked. This kid literally had no blood. I think I poked that kid 25 times. I poked him so many times that the needle became so dull it would barely puncture the skin. As I was poking him (he was essentially unconscious at this time so he didn't cry or pull away) his breathing started becoming easier. I also realized, as I was trying again on his other arm, that my elbow was now sitting in a puddle of his urine.....he'd become incontinent. This commonly occurs right before death. I knew as I sat there poking this kiddo that he was not going to make it. But I couldn't seem to stop. I couldn't just sit there and watch this child die. I'm not sure why. I've done it before. For some reason, this time I knew I would keep trying until he took his last breath. I wanted his family to know that we had done everything....tried everything. In a last ditch effort, I grabbed a bottle of D5, the biggest syringe I had (which was 5 ml) and put some sugar water into his peritoneal "IV." As I pushed it in, he took his last breath.

His mother had already left the room to begin grieving outside. The crowd that had gathered began to disperse. The show was over. We'd given it our best shot.....but we'd lost. "ee don go." Malaria wins again. Bleh.