Back in the Emergency Room

One month ago I was hanging some laundry up to dry when I (oh so graciously I’m sure) fell off a little step and bent my foot in a weird way.  It hurt.  A lot.  I couldn’t walk on it very well for a day or two but by day three I was managing to hobble around on it.  It still hurt, but if I bent my foot and walked on the inside, I could manage.  It always felt better on days that Peter was home and could help with the kids and I could stay off of it.  But those days aren’t often, and staying off your foot with three kids at home……not really feasible. 

After a couple of weeks it didn't seem to be getting any better so I went to see a doctor friend of mine to get a second opinion (mine being the first).  He basically said the same thing that I was thinking which was that I might have broken the 5^th metatarsal, but if I did it probably wasn’t too bad. I could go get an X-ay, but the X-rays here are generally so poor that a small fracture probably wouldn’t even show up.  He gave me a little flat bottomed boot and suggested that I try and stay off it to allow it to heal.  The boot seemed to help a little as it kept the bones in my foot a little straighter.  Some friends loaned me some crutches and I attempted to hobble around.

My attempt at being an ortho doc!

I could always tell that my foot felt better when I used my crutches.  However, although I’ve given crutches to countless of patients in the ER, I’ve never used them myself.  How does anyone get anything done on those things???  Usually, by noon I was tired of shoving clean laundry down my shirt to bring it inside and carrying things in my teeth so I gave up and hobbled around on my boot.

I’m a month in now, and....it doesn't seem to be getting much better.  My ankle, which wasn’t swollen at the beginning is now swollen, I think from all the bending of my foot to avoid walking on the outside.  So a few days ago, we decided to go ahead and get it X-rayed.  I’ve never broken anything before and in the ER we just patch them up (after getting a good X-ray so we know what's going on of course) and send them off to Ortho.  I know just enough for Google to be scary in a land of little medical care. 

We decided to go to a hospital in Freetown that only caters to emergencies.  I wasn’t sure if they would even see me since technically it wasn’t an emergency, but I knew they had an X-ray machine that might be pretty decent, so we decided to try.  They agreed to see me and actually even got me in pretty quickly.  Then we sat with the other patients and waited for the results.

While we were there an ambulance came in.  Having worked in the ER for awhile, I knew that generally, when an ambulance came in, the patients in the waiting room would wait.  I was right.  After another two hours or so, they called me in for my results.  The ER was basically one large room.  So while I was waiting to see the doctor, I was sitting right next to the patient that was brought in by ambulance.  I saw written on the whiteboard “Trauma transport from Waterloo- 7 year old boy, TBI (traumatic brain injury)". 

I tried not to stare but kept looking over.  I noticed that he was breathing on his own but had a device inserted in his throat that meant he wasn’t maintaining his airway very well.  He was receiving oxygen and had a large bandage wrapped around his head.  As I watched him, I noticed him doing some involuntary movements that are never a good sign in a brain injury. I overheard someone mention a motor vehicle accident.

As I sat there, waiting for my turn to talk with the doctor, I continued to observe.  There were two nursing assistants who were bathing him, preparing him to be transferred to the floor.  Other than that, not a whole lot of activity around him.  Such a stark contrast to a pediatric brain injury patient brought in to a hospital in the States.  And this isn’t to say that the staff was being negligent.  There just wasn’t a whole lot else to do.

I kept thinking about what the scene would look like if it was in one of the hospitals I typically work at.  He would probably be intubated since he was struggling with his airway, which meant a respiratory therapist at his bedside pretty much non-stop.  There was no intubation equipment in this ER.  If he had just come in, we would be rushing to get him to the CT machine so we would know what the damage was.  If it was a small hospital, we would be scrambling around on the phone and doing paperwork to get him the heck out of here, probably on a helicopter.  If he was at a bigger hospital he would be flanked by a pediatrician, a pediatric neurosurgeon, multiple nurses as well as other support personnel.  But here…..there was just nothing else to do. Despite the fact that I knew I would look weak to the staff there, I started to cry.  I couldn't help myself.  It could have been my child. Easily. 

After they took him to the floor, I continued to wait, and watch. Even though this ER was WILDLY different from others that I’ve worked at in the States, there were some things that were the same.  The board showing what was coming in.  Nurses discussing what the cafeteria was serving for lunch. And the apparent universal battle of the ER wanting to send a patient to the floor but the floor not being ready yet.  A tale as old as time. Those small things made it feel familiar enough that I told Peter if the hospital were closer, I’d want to volunteer there.  Too many things to do here! 

The doctor came to discuss my X-ray.  There were no obvious fractures, although he basically said the same thing that the other doctor had said.  There could be a fracture that was just too small to be picked up by the X-ray. However, it wasn’t displaced.  I don’t even know if it was plausible or not, but I had this fear that it was slightly displaced and that every step I took was making it worse.  This was good news for me.  The bad news is that if it’s not broken, I still don’t know what’s wrong and it’s still pretty painful.  So I’ll keep “trying to stay off of it” and pray it gets better.

You get to take your X-ray home as a souvenir! 

Speaking of praying, yesterday I stayed after church to see the kids of the orphanage that were sick. I’d just been there on Friday but that was the day the new uniforms were passed out and kids tend to forget they’re sick when there’s something exciting going on. Sure enough, saw one kiddo on Friday….and 12 on Sunday. 

Precious little boys

They come and see me one room at a time and when I called the kids from the last room to come in my office, there were so many!  I said, Wow! What is going on in your room that everyone is so sick?!?!  One of the boys spoke up and said that they didn’t come because they were sick but because they wanted to pray for me and my foot.  “You take care of us when we’re sick and we want to pray for you because you’re sick.”  Cue the tears again.  So blessed in what I get to do with my life.