Still coming off our buzz of such a great weekend, Monday was one of our toughest days in medicine to date. We basically spent the entire day watching helplessly as a 10-month old little girl struggled not to die.
Mickie came in Monday mornign seizing. Her mother and grandmother reported she had been convulsing since the day before... She was afrebile, but the most likely culprit was cerebral malaria. We've since this before- LP to r/o meningitis, IV Quinine, and you see that patient stop convulsing and start to improve. But Mickie didn't stop convusling. Not after several doses of anti-seizure medication. She was in status epilepticus and we couldn't stop it. |Then she started breathing less and less. There were no other new admissions in the hospital, so we spent the afternoon watching Mickie gasp for each breath (respiratory rate got down to 10), in between episodes of small fasciculations and larger tonic clonic convulsions, all the while contemplating the amoutn of brain damage this girl is going to have, even if she lives. Other than nasal cannula oxygen, there are is no airway support at Ekwendeni Hospital, and Mickie was too unstable to transfer. Back home she would have been intubated long ago. But we literally did EVERYTHING we could for her- Nasal O2, IV fluids, dextrose, anti-malaria drugs, antibiotics, anti-seizure medications (which we had to stop because of her depressed respirations...). Then we just watched her, hopelessly. She remained about the same- episodes of convulsions, respiratory rate of 10 for the rest of the day. There was a sparkle of hope, but both staff and family doubted this little girl would make it through the night. We went home for the usual workout on the footy field with a bunch of the little boys following us, email, dinner of pork & rice, shower, and bed- but Mickie was on our minds entirely.
Call it a miracle, God, or modern medicine, Mickie was alive Tuesday morning. We couldn't say that she had improved, but she was alive. Her respiration rate was up to 16. Her sugar was a little better controlled, as well as her convulsions, but she still remained unconcscious for the most part. She definitely looked strange and hyper-agitated. Its hard to explain, but if an old medicine man confessed to me that there was a child in the hospital filled with evil spirits- I'd pick Mickie out right away. She facial expression and movements were weird and jerky. She's alive, but something doesn't seem exactly right about this child...
But Tuesday brought us more patients- another young boy with seizures that didn't respond right away to anti-seizure medications (but ultimately improved with anti-malarials), an HIV patient in the male ward with possible cryptococcal meningitis. Julie and I joined a medical officer in the operating theater for 2 tubal ligations- done under LOCAL ANESTHESIA. That's right, women who are reading this blog, with just a little lidocaine, the surgeon sliced through the skin and abdomen, dug around until he found the fallopian tubes, tied them off, cut them off, tucked everything nicely back in the small but deep hole he'd created, and sutured the belly back up- all with the same piece of suture. These women must've REALLY wanted the surgery. One woman did end up getting general anesthesia because some adhesions on her uterus complicated the surgery, but the other patient got through the whole shebang with a little lidocaine- while crushing my hand in the process she was squeezing it so hard. But Mickie made it through Tuesday too.
Tuesday evening was very pleasant. I spent quite a while playing games with handful of local girls, about ages 8 through 10. We were playing hand games and they were teaching me some of their clapping songs. This brought me back to my days at Erlton Swim Club, me and Jeannie passing by the miserable minutes of adult swim with "Double Doube This This Double Double That That". If a young African girl comes up to you asking to play Double Double- I'm taking credit for teaching them! We'll see if it catches on... We also joined the Ekwendeni Team Mzungu (bascially all the whites in town plus the Malawian medical students) for Pancake Night at Carol's house- the ever-so-innocent UK holiday similar to Mardi Gras, marking the Tuesday before Lent. They make pancakes in order to use up the flour and sugar and whatnot around the house before Lent. They were tasty pancakes-- much more Ekwendeni-style than earning mardi gras beads in New Orleans (although we've seen our share here, as Julie mentioned about indecent exposure).
This morning, Mickie was still alive- AND NOT CONVULSING! She actually appears to be getting better. Who knows if she will ever be a normal child, but at least she's alive today. Other than that, today was very slow and (dare we say it?) quiet around the hospital. Nice to relax and read on the porch. We'll see tomorrow what Malawi throws our way.
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