Volume 2, Issue 24
December 18, 2007
…the applause of angels…
I sometimes can not fully understand or comprehend what is happening in my life at the exact moment that it is happening. Something so bizarre, unique, sad, surreal, joyous, or just so unbelievable that you must ask yourself “Is this really happening?” These moments are not that common, but still occur often enough to know that there is a fair amount of unexpected happenings despite how planned we may try to be, but they occur seldom enough that we never forget them. For example, in my own life, looking out over the majestic Blue Mountains in Australia, hearing Fort Recovery announced as the new state cross country champions, traveling on the back of a motorcycle during my last night in Uganda 2006 as the cool air brushed across my face and the stars shone brightly above, hearing Scott Myhre say “It’s Ebola”, hearing Jennifer Myhre on the phone saying “Jonah’s dead”….
I woke up today after a night of labored sleep, as have been many nights recently. But very unlike usual, my disposition was of sadness and sorrow. I am not exactly sure why, but as I walked to the pediatric clinic this morning I had a deep sense of grief and longing. I greeted people as I entered the pediatric ward and began weighing patients, only to hear nurse Mary Irungu call my name shortly thereafter, asking me to place a canula in the external jugular of a very anemic 1 year old child. The nurses had been trying for nearly 30 minutes to obtain IV access on this child, Happy M. I had seen Happy the day before, he was not completely well but he seemed to be improving from presumed malaria. He was active yesterday, breast feeding well, and had a generally favorable disposition. He was not the same child today. Mary also told me that a small girl with sepsis died last night, another patient I had seen yesterday. The young girl’s mother had delayed in coming to the health center, instead seeking local herbs and cutting methods, and when I saw her yesterday I knew she may die very soon, and despite the staff’s best efforts, she died last night.
I walked in the small white room off to the side, adorned with a single brown raised mattress in the center of the room, with a small window off to the side facing the rest of the clinic – our “procedure” room. Upon the mattress were several used canulas, all bent or torn after multiple attempts to obtain IV access in Happy. The small boy was lying motionless on the dirty, worn mattress. His eyes were deviated to the right with some horizontal nystagmus. I picked up his arm only to find a limp child who was unresponsive. My initial reaction was that he was seizing, but the family told me he had been like this since sometime much earlier in the night. The night nurse did not show up last night, nor has he for the past week, so there was no way for the child to seek help until the day staff arrived 30 minutes before me. My next thought was that he may have had a stroke, a possible sickle cell patient that threw a clot. Then I looked in his eyes and could see the pale, piercing whiteness of an extremely anemic child.
I knew that unless this child received blood he was going to die, so two nurses and I spent the next several minutes trying to find access on the child, but again multiple failed attempts. A few days ago I had to put an external jugular IV in a small child with a hemoglobin of 3.0, so I tried again on this child, but his veins were not visible. The only other alternative I had was to put in an intraosseous canula, a large needle that you stick straight through the skin and bone of a child to reach the inner bone marrow. I had never done nor even seen this procedure before, but I have heard of it a few times, including a month or two ago from Jennifer. I knew we had one intraosseous needle, so I called Jennifer and asked her opinion. After my telephone consult I pierced the child’s skin and using brute forced pushed the needle into the center of his leg bone. I was not able to push fluid threw, so I had to take it out and do it again. The second time I felt the “pop” of the bone as I drove the needle deeper into the marrow. I also had to do a femoral vein puncture to obtain blood for the type and cross to perform the transfusion, as I was unable to pull blood through the intraosseous needle. Luckily, I was able to push fluid through the intraosseous catheter this time and was manually able to push 60 cc of blood through the catheter over an extended period of time. Even after the blood the child still looked horrible, and I knew his prognosis was grim, but somehow he appeared a twinge improved.
I left the ward for a few hours to see Jennifer off at the air strip as she headed back to Kampala. I returned to the peds ward two hours later, fully expecting that the child was dead, but he was not. He looked much better, though still a far cry from healthy, but he would occasionally bend his arm and leg, barely noticeable, but definitely occurring. I began to push 10 cc more blood through the canula and said to the family that I thought he looked ever-so-slightly improved. I knew the child still had a poor prognosis, but I thought he had a chance. I then looked at the child, my gloved hand on his small, cool arm, and I swear he finally moved his eyes and he met my gaze. At that moment I said to God, “Whether this child lives or dies, Lord, I believe in you more than ever before.” Then the child breathed his last, and it was over. His lifeless body lay limp on that dirty brown mattress, his half open eyes staring at me, his earthly body now deceased, his mother weeping uncontrollably next to me, but I think I faintly heard the sound of angles rejoicing as they welcomed Happy home.
I love you,
Scott J. Will