Thursday, March 27, 2014

Sure is hot out here......I think I saved his life O_O

I hardly slept last night. For some reason my roommate was up all night and then the noise from the front desk started around 7 again. My roommate has an exam today so I can not understand why she was up literally all night moving things around, cleaning up and just being loud....

Well yesterday was definitely a day to least the evening was.

I was in the OB Clinic in the morning. One student and I looked through the maternal books coming in with the head nurse looking for a good case to clerk. We found a woman with gestational diabetes and one with sickle cell anemia.

The student and I took the gestational diabetes patient. The patient told us she had to go pick up her lab results from the central lab. I guess in a place where there are no computers used for patient care and the patients have to pay certain things in cash, this was necessary. The patient left but the student and I were soon on our way over to see if we could expedite our patients lab results recovery. Once we had the patient and her results, we headed back to the OB clinic.

The student started taking her history while I sat there and listened in. Of course I hardly understood a word because they spoke Twi so I worked on my sketches for the seamstress. On physical examination, the patient requested that not everyone be in the room, more specifically she didn't want the male students but gave in and let two stay and examine as well. This shocked me a bit because she was the first patient to voice such an opinion. She also requested to see a specific doctor because she didn't like another one. I guess this is the equivalent of a difficult patient for their standards.

We presented the other patient to the doctor. That all went well. Our patient was supposed to be presented to a different doctor. The problem seemed to be that the one doctor was busy grading exams and the other had an appointment. The doctor we had first presented to agreed to see the second patient but first after seeing his patients. So there we sat waiting. I hate waiting. Our patient wasn't very amused either.

Then it turns out she didn't have her blood sugar level measured because she didn't have the 4 Cedis cash to pay for it because she needed to the cash she had to get home. The students were annoyed because this would further delay our presentation. They had joked that everyone could pitch in 20 Pesos and it would be covered. I asked if having this procedure done would expedite this whole presentation thing (I had lunch plans with Pablo at 2 and that time was approaching). They said it would and I told them I'd pay for it. It was worth the about 1 Euro to me that this lady gets her blood sugar measured and I get out of there for lunch on time. So I paid, she got tested and we were ready to present. We eventually found another doctor to listen. He said he had 5 minutes and seemed to be in a rush. He started all hectic but then started asking questions and explaining things and my watch was quickly approaching 2 o'clock and then passed it. I was getting antsy because I don't like being late but Pablo said it was all good and he had already ordered the food. At 2:15 I was out of there and headed directly to MedDiner.

After a quick break back at my hostel and charging my phone, I headed back to the hospital for duty in the labor ward. I stopped by Michael's place to pick up my USB (we are trading music, he gets american and I get ghanaian) and chat. Duty officially starts at 5pm but I didn't go unitl 5:30. Thinking this was very african of me, I texted Pablo of my doings....he said I was still way to German and needed to try harder, haha.

The work on the labor ward started off slow. Not much was going on and I just sort of wandered from one ward to the next. Eventually one of the doctors asked me to help him with a bed side clotting test. I'd never heard of it but its basically drawing blood, putting it in a glass bottle, holding that bottle in your hand and seeing when it clots. If its under 10 minutes, you can operate, if not, you give the patient clotting factors with fresh frozen plasma to get them under 10 minutes.

I headed into the OR to watch a C section. The same Anesthetist from last week was there again. We chatted a bit about my weekend and then he said next week, his colleagues and himself would take me out for a beer after work so I can get to know Ghanaian beer.

The first C section was uneventful except for the fact that I thought we might lose the baby. We resuscitated and gave her oxygen and she quickly recovered. After that I told myself I would have to look at neonatal emergencies in my notes the next day to be better prepared for a situation like that.

The next day was too late....I was in the other OR room chatting with the team there while we prepped a patient for her C section. After a while, I headed back into the other OR to see if they had made the cut yet. The surgeon was just beginning. He was through the skin, fat and fascia and was just about to tear the muscle apart to expose the uterus when out of nowhere the uterus must have ruptured because amniotic fluid started gushing out. This usually doesn't happen until the surgeon cuts open the uterus. When he cut the uterus, it started gushing blood. I assumed he must have cut into the placenta. He pulled the baby wasn't wasn't screaming. I thought it was dead.

In Germany I know there would have been a neonatal team there to help right away. Here, the midwife wasn't there to accept it so the female anesthesiologist took it and brought it over to the baby table. There she and I stared taking care of it. She called for the labor ward (I assume that meant she was calling a midwife. Their response was, yea we heard you....but no one came). The anesthesiologist started ventilating the infant with an AMPU bag while I performed chest compressions. I've never performed actual CPR on a living human so this was a first....and then a baby. She didn't seem concerned about heart beats really but I was. I luckily always carry my stethoscope with me. At first the child had no detectable heart beat. Not hearing one made my own heart beat faster. All I wanted was to hear a heart beat. After a bit of CPR, we had one! He still needed to be ventilated though because he was not breathing on his own. The anesthesiologist intubated him. The slowly accelerating heartbeat was still a comforting sign for me though. The first gasp he took also gave me hope. He was completely floppy though. No movement on his own. I tried stimulating his breathing. During all of this I was happy I liked pediatrics so much and paid attention but was scared I didn't know enough. And there was no actual pediatrician there to help us! We kept up with the CPR while I monitored heart rate. No one seemed to be really concerned. The doctor would even stop with the ventilation at times which almost made me freak out because ventilation is the most important thing for an infant. At some point the midwife came with a cart to take him to NICU (neonatal intensive care unit). She asked if I would go with her. Of course!!!!! I'm not leaving this child until it is breathing on its own. I was still shocked at how little everyone seemed to care! I was checking the heart rate while simultaneously ventilating and pushing the cart to NICU. Once we got there, the nurse calmly said, "See, you hurry up to get down here and then no body has time." What do you mean!!! This baby needs help ASAP!!!! I didn't care what was happening around me (which from the looks of it was not much), my main concern was this baby and monitoring as much as I knew how. A nurse helped move him to a NICU bed, next to another baby. The midwife wanted me to give her the AMPU bag because she was going back upstairs. ARE YOU KIDDING ME?!!?!??! THE BABY ISN'T BREATHING ON HIS OWN! TO HELL YOU ARE GETTING THIS BAG. I obviously didn't shout that at her but I did tell her she wasn't getting it unless she brought me another one. She just told me to bring it along when I come back up. Yea, thanks for all your concern.

So there I stood, all by myself except for a few nurses. One took some blood but otherwise they just looked. I asked for a blanket for the child. They put an oxygen saturation meter on him and he was down to 73%. I told them I wanted oxygen for the baby. These are things I would never be able to just say in Germany and have done but I saw no other option than to make these decisions here. Nurses came and went and finally one asked me who I was. I told her I was a med student and it would be great if the attending could finally come over here and help. She said no one knew who I was so they assumed I was the attending for the baby.WHAT! Don't assume I am the highest qualified position! I told her that the midwife asked me to accompany her and that is what I did and my only focus was getting this child to breathe again and not for me to introduce myself to the team since that hadn't been necessary all week. Besides, if a new patient comes to the ward you are responsible for, you sure as hell better look to see what is up. Unbelievable.

Finally, I had the little guy breathing on his own. The nurse told me they aren't used to getting intubated babies on NICU. Really?! She knew I was a med student since she had asked me a few questions and then she asked me when I thought it would be a good time to extubate. You're asking me?!?! What?!?! Ok, I thought, since I've been making decisions this whole time, this one is mine too. Since he was breathing on his own and we wanted to get a mask on him, I made the decision to extubate him. I stayed a few more minutes just to monitor him before heading back upstairs, returning the AMPU bag and calling my parents to report what had just happened. Before leaving, I went to check on him one more time. He was doing fine.

Pablo picked me up and I had dinner at his place and we watched American Hustel. I fell asleep in the middle for a bit so I kind of lost the plot. At about 1am he brought me home. My roommate was awake and as I've mentioned, stayed that way the whole night. My cellular data stopped working for some reason so I am not available over WhatsApp and will head to the Vodafone store after ward rounds to get it fixed.


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