As I stood over Yohannes in the ICU bed - with other families and patients crowding around in bewildered curiosity - and securing his oxygen mask as tightly as possible to encourage all 6L of O2 to filter into his blood, to ease his pain and gasping discomfort, I began to pray out loud for a miracle. For relief. For healing and life. He was fully alert, responding to my repeated "Ishi, Ishi, Izor" (Ok, it's ok, rest), and his eyes darted from mine to his wife's in desperation. Those eyes still haunt me. Who am I to give orders for pain medications like Pethidine (which happened) and to be the best possible care for such a critical patient?
I've never felt the weight of my duty as an almost-physician like I did in that 45 minute window while I waited for a more senior physician to arrive, watching the saturation tick up and down at dangerous levels. All I did was stand still, talking and praying and fidgeting with the O2, adrenaline rushing and trusting that this man would NOT die right there under "my" care. The ethical dilemma in "Mountains Beyond Mountains" (Tracy Kidder) in which Paul Farmer elects to helicopter a young boy out for further medical care unavailable in his area kept flashing through my mind. How do we get to decide who we save and who we don't - why is that our decision to make as international providers? I don't think I'll ever have the answer, but I'm thankful for Jesus who is the true, great, and glorious physician. Sovereign above my own efforts, abounding in mercy and desiring that none should eternally perish.
...In the last 2 weeks, Soddo Christian Hospital started running a new CT scanner provided for by years of monetary donations and government staff willing to provide a license to the hospital (always the hardest part). It's already making a huge impact in the care for patients, especially considering this is a hospital with a surgical residency and the (unofficial) orthopedic referral center for all of Ethiopia. They were also able to purchase an ambulance recently, and that too is making a difference.
Yohannes (29yo M w wife + 3 kids) was a victim of a high-energy motor vehicle accident (MVA) - too common here - that fractured several of his ribs resulting in a punctured lung. (http://gamapserver.who.int/gho/interactive_charts/road_safety/road_traffic_deaths2/atlas.html)
Even with supplemental oxygen and a chest tube, we were not able to keep him from desaturating to the 50-60% range (should be above 92%). He had improved after the chest tube initially, but the next day he began to decline again with severely labored breathing and an O2 just at 50%. I had been hanging around the ICU all day, the only "doctor" in sight along with the head nurse doing everything in her power to stabalize Yohannes (no official critical care specialists here, and the surgeons were in the OR or gone for the day). We knew he needed immediate medical attention. The chest X-ray was suspicious for a right hemothorax (blood in the lung), and after summoning almost the entire surgical/ER team, he was nearly taken into the OR for a thoracotomy (break open ribs to expose lung damage). But because of the now available CT, we saved him a brutal surgery. The CT in fact showed severe ARDS, and without a ventilator in Soddo, we knew he needed care we couldn't provide here. (Thanks to another bout of generous donations, the hospital has just purchased a ventilator and is awaiting its arrival!)
So the only hope for him was to get to Addis Ababa and a hospital with mechanical ventilation. It was nearing dusk, and the helicopter from nearby Awassa was not able to airlift him there until morning. He wouldn't last until morning. After consulting with the ambulance driver, who had only made one run to Addis before during the day (driving at night is dangerous here), we decided to send him on the 6 hour drive. After much debate, the team intubated him and we began to bag him. Which is much more strenuous than I'd imagined - after only 10 minutes my hands were sore. We rejoiced in the slow upturn of his saturation until it arrived at 90%! Two hours later (9pm), the driver, patient, wife, and a nurse and anesthetist began the journey to Addis. Only the next day did I find out they had been turned away from two hospitals (one of which saw the patient and did not want him because of the work/resources he would take), bagging him until he was placed in an ICU at 5am. The dear nurse said he could barely move his arms for days.
After all that, he is still alive and the medical team here is wiser for it - and expediting the receipt of our new ventilators! Xavier Yamescen (To God be the glory)!
No comments:
Post a Comment