Malaria and dead phones...

It started Thursday... After Physical therapy in the afternoon, I just felt tired. I went back to my room and literally passed out. Woke up 2hrs later, a bit confused and wondering what time it was. Got up, did the night dressing changes and went straight back to bed, didn't even eat. 

I should have known... 

Woke up the next morning and noticed I had slept with my sleeping bag. This is Chad. Lowest temperature is like 30 Celsius (or like 80F). My sleeping bag is for below freezing temperatures (I'm going to Nepal after this). Something was clearly wrong... 

But I still got up and pulled on my scrubs. I made it as far as the living room (50ft away) when it felt like my head exploded and I just collapsed on a chair. 

There was no doubt. I had malaria... 

So whenever I felt able, I pulled myself together to go back to my room and swallow 3 more malarone pills (I had already taken my morning prophylaxis dose). Promptly collapsed again, and didn't move for the rest of the day.

When it rains, it pours, so my phone choose this particular moment to refuse to charge. It still worked perfectly, it would just not charge! So when the battery died, I would have no way of communicating with the outside world. No news of ebola. No way to tell my mother I'm still alive. No blog. Nothing. 

There was nothing I could do, so I just remained in bed and watched the battery drain... 

Today (saturday) I feel slightly better. Even managed to eat a bit... After that, I felt I had a little more strength, so I braved the malaise to go find someone who could tell me if I could get a sim card for my iPad, and get me connected again. 

Clearly, that worked, and I can now still blog and email, just no more phone calls, txt messages or whatsapp... Oh well... It's better than nothing, and my new and overpriced iPhone 5s (which I paid full price for, 3 days before it got reduced due to release of iPhone 6) will arrive in 10 days, along with Dr. Scott. 

I'll survive until then... 

The thing about Malaria...

A couple of days ago, when I went in the evening to do the dressing changes of the two patients who are on twice a day dressings (one who is improving, one who is not), I saw two little babies in our "ICU" brought in with Malaria. 

Again, one had a hemoglobin of 2g/dl and the other 5g/dl (at that age, normal values are 11g/dl - 14g/dl).

The malaria parasites (mostly P. Falciparum in these parts) invade and destroy erythrocytes (red blood cells) causing anemia. 

The hemoglobin in the red blood cells is what carries oxygen in our blood. Without it, you can have all the oxygen in the world available, you're still going to slowly suffocate because there's not enough hemoglobin in your blood to carry oxygen to your cells. 

Hence why we immediately check hb levels and give blood transfusions, along with drugs to kill the parasites in the blood, and the hypnozoites which are maturing in the liver cells waiting to be released into the blood stream. 

Malaria, if diagnosed and treated early enough, is curable and you should feel well again in about 3 days. 

Here, these kids come in when they're already so sick, they're barely alive. The percentage of parasites in their blood is so high, it takes a while for the drugs to help. The transfusions improve oxygen transport, but don't fix the underlining cause. 

The drugs and the parasites damage the liver, and once they get jaundiced (sign of liver failure), there's little we can do. We have to stop the drugs, and then the parasites in the blood can once again roam free, worsening the anemia until the child is dead. 

That's what happened to one of the babies who came in Wednesday night. He was still alive last night, and I actually thought he was going to make it (when they come in that sick, they usually die in the first 24hrs)... but he was no longer there this morning. 

I broke my rule and asked what happened, and the night nurse said he got jaundiced, they stopped the quinine and the family took him home to die. 

In comparison, this is Chrystelle: 

She's the little girl I mentioned in this blog post: http://livinglifewithoutfear.blogspot.com/2014/08/the-day-i-did-everything-i-shouldn.html?m=1

For a few days after that, she would hide from me, because she knew I was the cause of her getting pocked full of holes so we could finally get her meds, fluids and blood. But it doesn't matter. She's back to her smiling, adorable self, went home with her mama, and even accepted a kiss on the cheek from me. Her parents always have a big smile on their faces when they see me. 

I might not be able to control the infection that is rampant in some of my fracture patients. 

I might not be able to save all the little babies that come in already half dead and unconscious from advanced malaria. 

But I will take heart in the story of Chrystelle. She might have been one of those who came in too late to be saved, if I hadn't stepped in. 

She'll probably not remember me after I leave. I, on the other hand, will never forget her... 

The day I did everything I shouldn't...

I actually had a different blog post planned for today, but it turns out I did everything a medical professional the world over ***should not do.***

Before I get into the specifics though, let me just say that I had good reasons on both counts... but you can judge for yourselves. 

Case 1: 

Remember Taira, the little boy I mentioned earlier with the femur fracture? Well, he was doing great, we had him up and walking, he got crutches and was basically ready to come home. That's him, with me and Will, the first day we got him up. 

Except today during dressing changes, pus started pouring out of his leg. Not much, but enough to show it was infected. Surprise, surprise. So Dr. Scott took him back to the OR to open it up and clean it out... 

I walk in the OR when they're prepping him, and there are two nurses, one on each arm, trying to start an IV. Admittedly, I don't know much, but I do know how to start an IV. And I know that on an 11-year-old boy, you don't take a large IV needle. We have pediatric needles for that. They were poking the boy full of holes, starting in the ante-cubital fossa and moving toward the hand, not missing the veins, but exploding them because the needles were too big. 

At one point, one of them sets a needle on the counter, repositions the stopper, and picks it up again. That was my limit. I jumped in and yelled out "No! Stop! You just can't do that! You can't keep using the same needle over and over again! And why are you using such large gauge needles and exploding this kid's veins??" 

He turns to me and says "if we get new needles, they have to pay for them again..." so I said "Fine! I'll pay for it then!" 

Stormed out of the OR, bought pediatric needles, came back and gave it to them. Sure enough, they got it in the first try without exploding the kid's veins... And I yelled at them again for not using smaller needles to begin with!

Case 2:

There's a little girl (about 3 years old) whose dad is a patient. I have already won her over and she smiles and shakes my hand. A couple of days ago, her dad told me she wasn't feeling well. This morning I asked about her, and he tells me mom had taken her to the city hospital. This afternoon I go over to the ward and she's sitting there on mom's lap, struggling to breathe... 

Now, there are a lot of little kids who come in with one foot in the grave, mostly malaria, and I have made the decision that I would stay away from them. They come in so advanced, that try as we may, most of them die...so I didn't want to have my heart torn out time and again, kid after kid. Call me a coward if you will, but I know my limits. 

However, this little girl, I know her. I saw her healthy and playing. I know her name, I talk to her parents every day, and I would see her just deteriorate and die. No way. 

So again, I jumped in and told her dad to get her in to the consult that I would be responsible (financially) for anything she needed. 

She is now on IV quinine and blood (she was severely anemic) and hospitalized right next to her dad. She should be ok, because she wasn't on death's doorstep yet. One more day, and she probably would have been. 

So there you have it. I broke all the rules. I pissed off the nurses and got too involved with my patients. 

I dare you to come over here and do anything different.