If you haven't read my intro to Kalukembe post, check it out here.
A series of stories of the people I took with me, but left behind.
1)
I will admit, although most of my
time in Angola was arguably in the OR (operating room), I’m not even trained to
be there. I have these two licenses that allow me to do things—but there’s a
line between what you’re legally capable of doing and being confident and
competent to do them. Let’s just say this trip has been a huge learning curve
of what I’m capable and willing to do. I’ve also learned A TON about what I
still need to learn.
How about I just tell you a couple of stories?
Saturday at Kalukembe is dedicated
to surgeries. With the exception of a few patient visits in the wards, we’re in
the OR from 8am-ish to when we walk out the door, get in the car, and drive to
Lubango. Our first patient that morning was a beautiful little girl. She is
three years old and has a nice little fluid-filled cyst next to her tongue. The
steps for getting it out should have been routine.
IV goes in.
Ketamine is pushed through IV.
Baby girl falls asleep.
Her mouth is positioned so Dr.
Annelise can remove the cyst.
Cyst is removed.
Baby girl does great and wakes up
near her family.
Another successful case completed.
But that would have been too easy.
First of all, Baby girl does NOT like the scary people wearing weird clothes
and super creepy masks in the operating room. I definitely do not blame her. She
whimpers. She cries. She wants her mom. She’s three. She’s allowed.
Alex and I try to console her as
best as we can. We use our limited Portuguese and iPhones to do anything to
distract her from the impending poking and prodding. After a few screams and
tears, the IV is put in. Shout out to Big C for that. Through all the IVs I’ve
watched him put in, I’ve never seen him try twice. He always gets it the first
try. Big C pushes the ketamine. Right after the IV is set in, Baby girl stops
screaming and watches my phone as I look for pictures of flowers, other babies,
faces; ANYTHING a baby would find remotely interesting. We chill for a while as
she sits on the operating table. All of the sudden, her eyes look up and her
body falls over to my side of the table towards the floor. The next thing I
know, I’ve reached out and I’m holding her head in my arm. That could have been bad. Little did my heart know, it wouldn’t be
the last time my heart would stop today. We reposition her and hook her up to
the O2 Sat and HR monitor. We’re ready to go.
Except her heart rate climbs and her
sats drop.
For reference, a normal adult heart
rate (HR) is around 60-100. Everyone’s normal is different. Kids usually run a
little higher. No big deal. Great O2 Saturations (Measuring how saturated the
blood is with oxygen. More the merrier, but if your cells aren’t getting enough
oxygen, bad) are about 100%. We’ll take anything above 90% for an adult—kiddos
should be a little higher.
Baby girl’s sats drop below 90%.
They keep dropping. Her HR has already been climbing. She can’t breathe. We get
oxygen on her through a nasal cannula. The highest our concentrator will go is
2-3 liters per minute—if it’s working. Dr. Annelise feels her throat and says,
“Laryngospasm” and “she’s getting dusky”. Neither of those things are good
things.
We have no meds for those things. We
have O2 and positive pressure and a lot of praying that it’ll pass soon. We
find an ambu-bag and mouthpiece that are way too big for her. O2 is hooked up
to that. From the amount of dust on it, I’m wondering how many years it’s been
since it’s been used. Alex and Dr. Annelise hold the mask down on her sweet
face and do their best to ventilate her lungs. Wilson and I alternate listening
to her lung sounds, hoping to hear air move through her swollen throat. I hold her limp little hand, wishing
desperately I knew how to help. If she had a trach like both of my clients do,
it would be a completely different story. She doesn’t. So I pray. Help us know what to do, Lord. Keep us calm.
She’s in your hands. She’s your precious child. She is beautifully and
wonderfully made. Give us wisdom. But God, won’t you keep her here a while
longer?
It might be the wrong thing to pray,
but I pray over and over again. What else can I do? We wait. I take a deep
breath every now and then. By this time, we’ve found a correct size tube with
which to intubate her. All it took was around 3 people digging through closets
and drawers of cluttered supplies—oh, and a call to the former hospital
administrator from Dr. Annelise while she’s bagging Baby girl. Former
administrator shows up. His name is Nelson. By golly, by the end of that
Saturday, I’ve become a really big fan of Nelson. He’s one of those top-notch
nurses. I hope to be like him someday. I digress.
We keep working. We keep praying. We
keep watching. Baby girl’s sats start rising. Her HR starts dropping a little,
as does my blood pressure. We can start hearing air go through her lungs.
Slowly, her throat opens up. We stop bagging after a while. She’s been coughing
up pink, frothy stuff. So we give her Lasix to clean up any pulmonary edema
she’s got going on. She’s going to be okay. Apparently, ketamine is a relatively
okay anesthetic. However, we learned of two noticeable drawbacks—it can cause
increased intracranial pressure and laryngospasm. You don’t know which one
you’re going to get—if you even get one. It’s about 10:30am and it’s time to
actually do surgeries now. We check on Baby girl a couple more times as she
sleeps off her morning near-death experience. She’s doing just fine. We’re
fine. It’s going to be fine. Thank you,
Lord.
2)
2:30pm. Our last case of the day.
ETD (estimated time of departure) was supposed to be at 3pm. The goal was to be
in Lubango before dark because it’s Africa. Street lighting in the middle of
nowhere isn’t exactly existent. The likelihood of us hitting a goat, person,
tree, cow, or another vehicle with their headlights out goes up exponentially
after sunset. However, if we’re anything, we’re flexible.
A lady is led to the operating
table. She’s familiar. It’s the same lady in patient consults who was told she
had to have a mastectomy or most likely die. Neither option appealed to her,
but she showed up at the OR.
Same routine that we’ve done so many
times. IV goes in. Anesthesia is either given through a spinal or through
peripheral IV. For whatever reason, this lady’s sats start dropping. Her HR
climbs. She gets intubated and Dr. Annaliese starts bagging her. After a few
minutes of picking her sats up from 15%. I’ll say that again… 15%, the
mastectomy has to get done. So our people prep the patient and they scrub in.
Somehow, I end up bagging her. I’m
still not sure how exactly. If I’m going to bag someone for the first time, it
might as well be for an entire 70-minute mastectomy. Go big or go home. So bag
her I did. Every time I paused to see if she’d hold her own for a while, she’d
drop right back down.
Yet even being in another level of
consciousness, her body would still react to the surgery as she surfaced from
the anesthesia. It was common. Big C would give the first bump of anesthesia
and all would be well. However, he was in charge of keeping patients asleep and
hydrated in two ORs. There was sometimes 2 patients in our OR. That’s up to 3
patients of which to keep track at the same time. It wasn’t uncommon to have IV
fluids run dry, have patients start wiggling off the table mid-operation, or
yelling at the top of their lungs. Finally, I decided I had enough and started
replacing bottles of saline. Then Big C eventually told me to give 2 mLs of the
ketamine in the syringe attached to their IV when they needed it. 1 mL for
kiddos. When I used up the syringe, I would go find him and ask for the
concentration to draw up more anesthetic. My nursing instincts scream “sketchy”
at me, but the alternative is a little more detrimental to the patient lying on
the table. So as I bag our lady undergoing a mastectomy, I’m pushing anesthetic
through her IV and watching fluids drip down.
Dr. Annelise did a stellar job
keeping us all sane through the operation. She’d make a hilarious comment here
or there. Dry humor during a high-stress situation does a world of difference. Panicking
isn’t going to do us or our patient any good. Besides, dry humor is my thing.
At CEML in Lubango, patients are
hooked up to a monitor that can take their blood pressure every 3 minutes
automatically. No such luck here. However, there’s a group of Kalukembe nursing
students and nurses standing around with the wonderful knowledge of blood
pressure-taking.
I ask over the patient curtain (the
barrier between the patient’s head and the exposed point of surgery), “Is it
okay if we ask for a blood pressure?” towards Dr. Annelise’s direction. I have
no clue how to ask for it in Portuguese. So far she’s been pretty good at
multitasking by performing intense, time-sensitive surgeries and translating at
the same time. Is there anything these people can’t do?
She replies, “What? You mean they
didn’t teach you in nursing school to breathe for your patient, keep them
asleep during surgery, AND take their blood pressure?”
“I went to a community college,
okay? You’re going to have to lower your expectations.”
“I bet somewhere like the University
of Minnesota teaches their students how to do them at the same time.”
“You’re probably right.”
We all laugh. We pray. We keep going. I
didn’t get that blood pressure until Nelson finally came in with batteries for
the automatic cuff. He also came in with a unit of blood for the patient. I’m
telling you this guy is on top of things.
For a spare moment, our lady tenses
up and starts making minor movements in the middle of her own mastectomy.
“I’m working on it,” I tell the
doctors, as I push more anesthesia.
From the other side of the curtains,
I hear, “It’s about time” and “So to which college am I writing this letter of
concern to?”
“Itasca. I-T-A-S-C-A. Oh, and send
one to Hibbing too. H-I-B-B-I-N-G.”
We cackle. We’re almost there. With
the BP cuff on her wrist, I can check on it as much as I want. BP 131/87. HR
has dropped to 110. Sats 97% while being bagged with 2-3-ish LPM of O2. We’re
okay.
The surgery is done. 4:40pm. Alex
and Wilson finish suturing her incision. She’s breathing on her own. She’s
being readied to leave the OR. That’s our cue to skidaddle and change as quick
as we can. Thankfully, we had packed before we started the day at the hospital.
We’re almost running out the door. Think of a less regal, rapid trot. We load
up. Dr. Annelise buys us all a can of Coca Cola. Did I mention general surgeons
around here are really nice too? We laugh. Because, what an unreal day we’ve
had. By God’s grace, we’ve made it through. Thank you, Lord, for restarting a
couple of hearts for us--and ours too.
