MORTALITY

From James:

The strong young man's body is covered with goose bumps. His eyes are rolled up in his head staring blankly into nowhere. The mourning wails will begin shortly. It's hard to believe that just 15 minutes ago I was standing by his bedside and he was looking at me. Although I shouldn't be surprised considering ever since he came last night and we opened up his abdoment to suck out liter of stool and inflammatory fluid from a perforated small bowel from Typhoid Fever, ever since then he's been hanging on despite being in septic shock. What's sort of weird is to look over at the bed next to him and see a young woman who just 10 days ago was operated on for the same thing and just 8 days ago also stopped breathing but miraculously came back to life.

I can still remember it clearly...

It was while my cousins, John and Jenny, were visiting Bere along with my sister, Chelsey, and a radiology tech named Brian.

It was a Sunday and I was rounding late. About 1:30pm I find myself at the bedside of a 25 year old woman operated on Friday for intestinal perforation secondary to Typhoid Fever. We'd taken out a small section of her small intestine and sutured to bowel back together.

She looks weak and shaky but is looking at us as we ask how she's doing and examine her. There is no bowel function yet and we are keeping her NPO (nothing by mouth) and on IV fluids. She has a quinine perfusion running in slowly. John and Brian are with me as is Abel and two nursing students. It turns out to be the perfectly assembled team for what quickly transpires next.

I am in the midst of talking to the nursing students about Typhoid Fever and its complications when I glance down at the woman and see that she has stopped breathing and her eyes are rolled back in her head. I check her pulse, nothing. My first instinct is to do nothing since I've tried to resuscitate patients here before without success, but something makes me decide to try one more time. I start doing chest compressions and call John over to take over. As he continues CPR, I stop the quinine perfusion and switch to a bottle of 5% Glucose solution that is there at bedside. I think that maybe the Quinine has caused hypoglycemia. I send Abel to the OR to get some Adrenaline. I send Brian to get a pulse oximeter. John keeps pumping valiantly on her chest. I remember something else and send one of the nursing students to chase down Abel and make sure he brings some Atropine as well.

Andre has just shown up, attracted by normally dignified nurses tearing up and down the halls at full speed. I thought about sending for the bag-valve-mask to breath for the dead patient but remember just hearing from my friend, Erling Oksenholt, that chest compressions not only pump blood from the heart but serve to move air in and out of the lungs as well.

I ask Andre if we have any more 10% glucose bottles, He says he thinks we do and runs of to look for them in the pharmacy. Meanwhile, Abel has returned with the Adrenaline and Atropine and Brian has come back with the pulse ox which he attaches to the woman's finger before taking over CPR from John.

Her oxygen saturation is in the low 80's and her pulse is present only with chest compressions. I push Adrenaline and Atropine one right after the other. Still nothing. We continue CPR with John and Brian taking turns. Andre comes back with the 10% glucose which we let run in full bore. Her O2 sats come up to the 90's.

Amazingly, after 20 minutes she has a faint pulse and is taking occasional gasping breaths. We continue to help her with CPR. Finally, after 30 minutes, although her breaths are shallow and labored, she is breathing on her own. Her eyes are closed and her pulse is thready. Without intubation, without oxygen, withous labs, with minimal monitoring and only a couple of medications she came back to life.

All this rushes in upon me as I glance back and forth between the two patients post-op from exploratory surgeries and bowel repair for Typhoid perforations and think about the thin thread that separates life and death. Miraculously for one, all the elements came together so that we were at her side when she stopped breathing (even though I almost never do rounds at that hour) and all the staff necessary were there (Abel is usually in surgery, he only is on the wards occasionally on Sunday but he knew where all the meds were and had the key for the OR where they are kept) and Andre is never on the wards, much less on a Sunday but he is the only one who knew where we had 10% glucose, plus usually we don't have visitors who are familiar with emergencies and CPR like my cousin (worked years in an ER) and enough students to run back and forth to help send messages and find things. So why did it all come together for her and not for the strong young man in the bed next to her?

As I walk away I hear wails and cries of grief pierce the air and my heart as the goosebumps rise on my arms as well.