Friday, July 5, 2013

I am feeling very American today.

Yesterday was my final day in peds. 
It was a tough one.
When I had first arrived to the hospital I had been informed that a patient died.
It was a four year old girl with what they thought was Guillian-Barre Syndrome.
Since they do not have venilators they could not support her respiratory status.
I did not think that she ever looked that bad.
She was saying the day before, "I am fine, I am better."
So at least she did not suffer.
The worst part was that there was a dead kid in her bed with all of the other children and parents around to witness the whole thing.
I cannot imagine what those children are thinking!
Unfortunately it is not uncommon here so many of them are probably not too phased.

In the morning I went to the high dependency unit to see the new patient.
It was a little boy who they thought had severe anemia.
He was pretty much unresponsive.
We did a blood glucose and it was in the 20s.
The pushed dextrose and he began to cry and turn away from us.
Crying kids are always good!
They were preparing to transfue so I went to assist with the burns.
I gave lots of recommendations.
We used warm soapy water to clean the burns instead of clorahexadine.
And gave some pain meds!
The other nurse and I gave the surgeon lots of recommendations and he said he was happy we were there and he would try to change things.

Then I went back to check on the sick boy.
I was told there was no improvement.
He was not responding again.
Nobody was around or seemed to care.
I then had to play doctor.
I figured nothing was going to put the kid in a worse condition than he already was.
I told the nurse we needed to recheck his sugar.
Once again it was low.
So we pushed the dextrose.
I checked pulses.
Yeah I could not find any.
I told him then to run a fluid bolus.
We did, there were finally some faint pulses.
I tried to get a blood pressure, of course there was not one.
The nurse said he had to leave to go to his meeting.
I asked if they bag or do CPR if kids stop breathing.
He said yeah and pulled a bag out of a drawer for me.
Well thanks, I am sure it will be successful.
The kid's breathing got more shallow and I saw blood start to come out of his gastric tube.
I did not like being in there alone,
I went and got a nurse.
She said do not bag, there is still respirations.
My reply was yes, barely and there will not be for long.
She did not seemed concerned.
I told her to call a doctor.
The doctor did come and agreed that the kid was in septic shock.
We tried about all we could.
I was drained and there was not much improvement.
I decided that nothing I was going to do was going to help.
I think we were only prolonging the poor kid's life.
Which is not fair.
It is also not fair to waste meds and fluids on a child that has no hope.
I want to change this.
There needs to be better assessments and early intervention.
I will be working on this.

Today I was in the HIV/AIDS unit.
It was very well organized and stocked.
But a lot of clerical work.
The nurse was being very pushy and not very patient with me.
I am just tired of living in another culture today.
I am American.
I want to walk fast.
I want my personal space.
And I do not want to be shoved.
I do not want to listen to horrible African Christian music all the time (do they really have no more than ten songs???)
I also do not want to be the center of attention and talked to all the time.
I also do not want to hear honking cars every few minutes.
I am just annoyed today.

Luckily Mike is coming tomorrow and we are celebrating the fourth.
I got Jack Daniels, hot dogs, and lay's chips.
I am ready for a night off!
I think after this week it is very needed.
Happy 4th of July everyone!

Also this post I wrote yesterday.
But in true Malawian fashion the internet was not working so I could not post it! 
Also a side note the child did die yesterday I was told.
There really was nothing that could be done.
It is just so sad that it is the norm here.
Well I think I am going to try to take the weekend off from thinking about things and just relax.

2 comments:

  1. Hey Kendall,

    Thinking and praying for you. I'm sorry about your patients dying that is very difficult. I'll be praying for peace and comfort for you. Hope you had a good 4th..I know I did :) I was working yay! It was a mellow 4th just one admission and lots of outpatients but since then it's been a verrrry busy burn unit time.. I am proud of you for givig lots of burn recommendations :) good job girl. You aren't missing much here, it's blazing hot, work is exactly the same. We miss you. Have a good week girl.

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  2. Hi Mar!
    Thanks for thinking of me. It was a hard week. But it has been better. I'm glad you had a mellow 4th! You deserved it! Yeah I actually told the surgeon that I would give them our burn manual if he was interested. He really was! Do you have a copy of it you can send or email? I miss you guys! I know I am not missing too much, but I still do miss it. Time is flying though. I have already been here a month!

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