Wednesday, 20 April 2011

42 not the meaning of Life here, but the average life expectancy out here. It's not yet noon but I had to get away for a bit because it all got pretty heavy.

Yesterday I managed to get IV access in an emaciated man in his early 40s, he was very dehydrated, breathing very infrequently but with a deep gasp for air when he does (Cheyne Stoke breathing). Essentially, there wasn't much we could do but to make him comfortable as he was slowly dying. The way his body was wrapped up in that vast dirty blanket he was brought in, it almost looked like he had been mummified.

I spent a large proportion of yesterday looking after Mr S, who was a wanderer. By that, I mean everyone spent a lot of time making sure he wouldn't run off. He wasn't the easiest of patients to get a line in, even harder to convince him not to pull it out. Some of the staff were quite rough-handed with him, and he fought hard when they tried to restrain him. There were five people holding him down for the LP at one point, but it was clear it really wasn't going to happen as he was threshing around. Line was torn out in the tassle and someone said, 'just explain to him what is happening and he'll stop.' Gee, didn't think of that. He's confused, likely to have infection, and a chronic alcoholic. I had to stop one of porters trying one end of his hand bandage to the bedstead.

I had to inject him with Haloperidol to sedate him, didn't really make a difference due to the low dose, the nurse wouldn't give it herself, or let me give the full dose. Mr S cursed me a bit, in between giggling and singing 'I'm free, I'm free' to himself. In the end, he was transferred to the ward.

Then there was that Mr J, who looked like he was expecting triplets. I asked if the doctor wanted a bag to collect the acitic fluid into as it was draining but she asked me to change the small theatre kidney-shaped bowl when it got full. Hmm, interesting.

I was also told by the patient (who at this point was in less pain and therefore getting bossy) to fetch his wife. He said she's got a little one with her, and that she's fat. I found her, and then Mr J ordered me to change his bowl. The nurse got me a bucket, which I was grateful for.

As we were about to leave, there was a girl who got hit by a car. We knew nothing about her and though she was still breathing, and had a pulse, it was clear she was in a bad way. One eye was dilated, the other was drifting upward and outward. She made a constant stream of sound, and looked younger in her school uniform, but it turned out she was 19. I was shaving her hair to look for a source of bleeding on her head, other than the deep wound on her forehead, and the gravel burns. She was transferred to Nelspruit, but as I left, I couldn't help thinking how she was just coming home from school.

This morning, there were lots of pregnant women. There was one with eclampsia, high blood pressure, her baby was 28 weeks old and she had a one day history of headache and vomitting. In UK, you don't normally see eclampsia as it would be picked up earlier. The mum had a seizure this morning and the baby is going to have to come out. The mum was only 18, the dad looked on anxiously by her bedside.

(Just heard from Anna that the baby is alive, but it's early days, mum is in high care at the moment.)

Then I saw a 14 year old girl, pregnant and in a great deal of pain. She gave birth to her 22 week old baby literally as I was trying to get blood from her.
The baby was wrapped up in the blue cloth that the theatre pack came in. So tiny but perfectly formed. He took a breath and gave a cry. The girl didn't speak any English, but I asked if she wanted to hold the little one. Tim later said that we had to make sure she wanted this, as there's a big cultural difference here. Some people will completely reject it, some grandparents won't speak to the child until they are 5 years old because the mortality rate is so high.

She looked at him before he was taken away to the nursery. Baby is still currently alive, but on supportive care. Tim said even with the best care in the UK, mortality for a baby that young is almost 100%. Currently, baby is still alive. He weighed so little when I held him.

I left after a 27 year old lady came in after being assaulted by her drunk boyfriend. Not the first time. He punched her, and then kicked her in the face when she was down.

Sigh. Lunch time. What's wrong with the world, eh?


  1. Hi Lucia,

    I've just sat down and read all of your posts from start to finish. I've been thinking about you and your grand adventures and every time I hear "Africa" I think of you and wonder how you are doing. It's heartbreaking to hear some of what you say, especially today's posting, but I know these experiences will only make you even more caring and thoughtful person and a fantastic doctor.

    From the pictures you posted it's hard to imagine such a beautiful place can bring such sorrow. I'm thinking about you and hope you are still having the time of your life!

    Take care

    PS - It's not all arranged yet but I think I'm crossing the pond next spring and coming to England for a vacation!!

  2. Sound like some pretty harrowing experiences. I'm sure that similar things happen here, all be it more rarely. 'Turning the world upside down' is a phrase that seems pretty apt when I look at your accounts of the medical side of your elective.

    I hope that your trip over the Easter weekend gives you a well-earned break from the more intense/distressing side of hospital work.

  3. Oh, and I thought that you'd like this. Am tempeted to make something similar when you get back.

    Made sushi this evening too :-)

  4. Hey Bella, lovely to hear from you, am excited about your possible travel to England next year. Africa is a place of contrasts, for sure. Beauty and sorrow.

    Peter, I think we'll feel much better if the car hire gets sorted. If not, we will get a lift to Nelspruit later today with one of the doctors, stay with the lovely family again and go to Swarziland from there.

    Yay for sushi!