Rough Day

Yesterday was a rough day on the wards.  3 deaths.  2 were infants, both with quite similar stories.  They were both 6 weeks old, admitted with respiratory distress.  They had been on the wards for a couple of weeks, both on oxygen by nasal cannula, but showed no improvement.  (We actually have 2 oxygen machines on the pedi wards now, which means that 4 patients can be on oxygen at a time.  This has doubled our capacity in a year.  Not bad!).  On admission, they had the typical “work up” for a child in respiratory distress: a chest Xray, malaria smear, and Hb level.  Both films revealed nothing focal.  Malaria smears were both negative.  Hemoglobin levels were both normal.  They then were managed in the typical way here in Liberia:  Started on Quinine (despite a negative smear b/c you never know what sort of medicines the mother had been giving at home), started on Amp and Gent (the usual antibiotics given to kids for… well… everything), and were admitted to the pediatric ward.  Over the course of their admission, neither could be weaned from oxygen and both became clinically worse.  I think that one of them actually had Tetrology of Fallot (he was having episodes of desating to 40s with crying and an impressive murmur) and the other I think likely had a huge VSD that didn’t make a murmur (or some other non-murmur mixing lesion).  In other words, both were cardiac kids in Liberia…. So, they didn’t really stand a chance here : (  There is no cardiac surgery here.  So, the infants had been on the ward on oxygen, waiting for the impossible. 

One of them passed away during rounds.  I looked over to see one of the Liberian residents pounding on the infant’s chest.  The mother was being escorted out of the room.  A nurse stood on the side of the crib on her phone.  She was calling the ONE respiratory therapist in the hospital.  I ran over and immediately realized that I was in my FIRST REAL infant code.  I checked for pulses: none.  I took over chest compressions.  It was surreal actually.  No one knew how long the baby had been not breathing… so, as I compressed and directed the bagging of this poor little guy, all I could think of was, “how do I know when to stop?”.  We tried for about 5 minutes.  It seemed like an eternity.  Then, I called it.  No one else seemed shaken.  The resident just walked away to go back to rounds.  I walked off the ward to tell the mother… never a fun job. 

Sadly, I have had many patients die here.  Many of them die overnight and I find out in the morning when their bed is empty.  My heart always sinks… but, I silently breathe a sigh of relief because I didn’t have to witness the end.  Others have been “NICU” babies that we really don’t try to resuscitate because they are very premature or need intubation.  We still have no vents, so there is really no hope for them either.  But, this one was different…my hands pumped the last bit of blood through his tiny hypoxic veins.  In the U.S., he likely would have been recovering from surgery by now and his mom would have been planning his return home.  Instead, she is planning a funeral.  What an unfair world.