This was a brutal week. we lost two young girls. The first was the young girl who died of tetanus. The second was a lovely ten year old darling who died of respiratory arrest from pulmonary edema. The morning she died was one of the moments I was pushed by the demands of this place. I was trying to coordinate her care when she arrested. I ran to her bedside and she was breathless and pulseless. I started CPR, having the intern bag her while I did chest compressions. Ten seconds in we got a call that there was a critical infant born in the maternity ward. Then I was informed that our baby with neonatal tetanus was having obstructive apnea from secretions and that her bedside suction wasn't functioning. Trying to triage 3 acutely ill patients while running the code and doing chest compresstions was an extraordinarily trying moment. I definitely prayed for grace. The intern had to step out and I gave a medical student a crash course in the proper seal and bagging technique. I gave another instructions on where to look for some suction supplies for the infant with tetanus. I did everything I could think of to save these children's lives. Two hours later, the babies were both doing well, and the girl had passed away. I was covered in sweat and saddened by the loss of a life ended too soon.
There is always such inspiration here, though too. Last week I was called to the NICU to see a baby with birth asphyxia. She was seizing by the time I arrived. We gave her IV glucose and I ran around procuring her some phenobarbital to quiet her seizing brain. It took less than 10 minutes as I ran between hospital floors investigating emergency cabinets, but that is a long ten minutes. Every second of a seziure can seem like it is lasting for days. The baby began to breastfeed, slowly at first, but then increasingly well. She became more active and vigorous with each passing day. She was discharged home today with a happy mother. The NICU nurses asked if I was considering moving here, and told me I take good care of Liberia's babies. Hard to have dry eyes when you hear something like that.
I have had the challenge of working as an attending here for the first time. Emmanuel has had other commitments for the past 2 weeks, so after the first half hour, I am leading rounds by myself. I had to switch gears fast from the medicine I am used to practicing to the resource limited setting. I have enjoyed the teaching immenselyand I have 8 medical students and 2 interns on my team. I also gave hospital wide Grand Rounds on Monday. I almost died when I opened the talk on my flashdrive and 1/4 of my slides hadn't been saved, but somehow I mustered through. I presented a tetanus case, and discussed the pathophysiology, current treatment recommendations, and public health issues of the disease. It led to a fascinating discussion between the Peds, OB, Internal Medicine, Surgery, and Anesthesia departments on the disease and management. It made me wish we sometimes had a forum like this back in the States!
It is also my responsibility to give the students Friday afternoon lectures. I had prepared a talk on fluids and electrolytes, and one of the students was assigned to help me set up the projector and connect the power cords, etc. Since the projector was locked in Emmanuel's office, he had given me the key. I arrived ten minutes early to have ample time to set up. I was quite surprised to see the projector up and running. I asked the medical students if they had a spare key. Turns out they couldn't find the key (it being in my pocket) so they called the carpenter and had the doorknob and lock removed so they could set it up for me. Talk about overly enthusiastic medical students. I mean, you all know I love the nephron, fluids, and electrolytes, but busting down doors for my talk was a bit over the edge. Luckily they have repaired the lock so I don't have to feel too guilty.
I can't explain the passion I have for working here. It is brutal, it is hard. I have to work harder with sicker patients and less diagnostics and medications to treat them with. Yet I am always inspired by the strength of the patients, the beauty of the children, the community of families that rally around the family member in need. The people of Liberia know adversity, and that in the face of adversity, you cannot quit, but must keep trying, if only "small-small."
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