The Doctor’s View: How The Nightmares Begin
By Denise Kavuma, Uganda:
There are people milling about on the earth every second of every day, going about their normal business with their neighbors none the wiser on what manner of skeletons lay in their closets. We've all experienced some shocking moment, some manner of horror; the stuff nightmares are made of. We know what they are and we keep them hidden in an attempt to protect ourselves and those around us. I however, hold no such convictions and believe that nightmares need to be let free to go back where they came from and that is what this article is all about.
It was a cold and damp Friday night; the kind that even the habitual partier would choose to stay in and instead have a hot cup of tea or a stiff drink to warm him up, depending on the kind of partier you're imagining. There I was however, roaming the nearly deserted wards of the hospital with nothing but my flimsy white coat to protect me from the biting cold of the howling winds. I never was a sensible dresser but I've never regretted it more than I did in that moment. I needed something to do, some sort of activity to keep my mind fresh for I feared that with every passing gust of freezing air, my mind was becoming more and more numb until I thought I'd even forget where I was and what I was supposed to do there.
Unfortunate wishes are fulfilled at the most inopportune of times and so it was in such an instance that a panicked, young mother of three ran into the hospital with her severely ill one day old child. She'd just given birth in a clinic quite a ways from our hospital and had been referred over because the child was severely anemic. I was called immediately to attend to the child and at first glance, it was clear there was more than just measly anemia going on.
The child had lost so much blood, he was practically as white as a sheet and was so severely dehydrated, his skin had become quite wrinkled giving him the appearance of a shrunken very old man. He had no energy left to even cry in discomfort and would just give off a pathetic wheezing sound with every breath he took. It was one of those pictures that stays with you, gets ingrained in your mind and for days, every time I'd close my eyes, there that child was and I'd feel sickened. No mother can stand to see her child in such a state and this one was no different, she begged us to do our best and practically ran out of the room, leaving the grandmother to see to it all.
And so the battle began; there were no signs of bleeding and I asked the family questions, trying to find out any possible cause of the anemia. There was none. This was puzzling enough but we needed to work fast and so we tried to stabilize the child, giving warmth (which was almost impossible in that place at that specific time) we got all the monitors up and supplied oxygen; moving as fast as our exhausted bodies would allow. When it came to trying to access an IV line, we failed. And then we failed again. This went on more times than I could count and each time, our hopes would rise, thinking it'd be the last time we'd prick the poor baby, only to find we'd failed. It was an agonizing, heart-rending moment when we came to the realization that the shit had just hit the fan and the child just might die.
I would not give up however, and still had one last ace up my sleeve. Most people do not know this but at times, in emergency situations, if a blood vessel cannot be accessed, then we go for the bone-marrow. It's an intraosseous emergency line in which you can give fluids, blood and any medicine you require as you search for IV access. I'd never tried this before and had only read about it in books but there I was, clearly needing to perform the procedure and quickly. I felt like a clueless intern all over again but like in all other situations before, on slipped that mask and that authoritative manner we'd been groomed into for half a decade.
That wasn't the case with the nurses however and it seemed like they had been severely discouraged by the whole encounter. I did not have time to try and strengthen them, but neither could I afford to yell at them; it was only human for them to react the way they were after all. I ordered for what I needed and tried to not wring their necks for being slow and unsure despite the emergency of the situation. With trembling hands, they finally gave me the instruments and I set to work drilling into the child's bone, trying to access the bone marrow, only to fail. And then I failed again.
My mind went blank for a minute or so at that time as I tried to figure out what was wrong. What was wrong? Yes, I was inexperienced but I'd done exactly what was required, so it couldn't be me. The needles needed for the procedure were special but we didn't have those and used what we could, only to find out that those were too weak and kept breaking before I could even begin to go through the periosteum.
Would this child die? If he did, would it be my fault; would it be because of my incompetence? Had I killed this child? All this went through my head in milliseconds and I felt my mind slowly start to slip into madness even as my face remained blank. But a few seconds later, I snapped out of it and decided to call someone. It was a Friday night however, and everybody was elsewhere. They knew I had done what I could and suggested I call the anaesthetist whose job description practically includes the line: 'finding IV access when the doctor cannot.' But the anaesthetist picked up his phone once to inform us that he was nowhere close by (and probably didn't intend to be that whole night) then hang up and refused to pick our phone calls again.
The ball was back in my court and I finally took the decision to refer the child elsewhere…perhaps…perhaps if he reached alive, they might do a better job than we did. It was certainly better than leaving the baby in our care when we'd failed and could do little more. So, I sent one of the nurses for referral forms but as her achingly slow legs carried her away my brain went into hyper drive again. It reasoned that if the problem with the intraosseous line was the needles (and not my inexperience) then I owed the child another trial with a stronger needle.
Desperate to save a life and praying furiously I was not wrong, I grabbed a non-standard but stronger syringe needle and started drilling into that baby's bone with all the hope I could muster at that moment. And it worked! On my first try! Sweet Jesus, it worked! My heart soared and even my blank face broke into a small smile and I called the nurse back. When she finally arrived, I explained the situation and I could literally see the life and energy returning to her previously dead eyes. Hope quickened her feet and we soon had blood for transfusion, and drugs, and fluids, and hope for life again.
The child started to improve and we all breathed a collective sigh of relief. Soon after, I was called for another emergency, one not so difficult to manage and when I took a break, I just fell into an exhausted, dreamless sleep. The next day had me up and about and when I finally had some free time, I called the paediatrics ward to ask about the baby, only to be informed that the child had passed on that very morning. There was little more emotion I had left in me at that point and instead of being devastated, all I remember feeling was plain, old, simple disappointment. And then I moved on.
Later, I had a meeting with the paediatrician to discuss the child's case and he commended me on a job well done at that time. What stuck with me from that discussion however was that no matter what anybody could have done, the child would have died anyway. He had a bleeding disorder that few ever survive and it was just unfortunate.
It's been weeks since that happened and I find myself more able to face the facts of the case. For somebody who tries to see the humor in all the stress I've experienced, this child hit me really hard and took quite a bit of my soul as he passed on. What more is left to say after narrating a story like that? Perhaps this little quote from another writer-doctor much like myself: Insanity is often the logic of an accurate mind overtaxed.