Wednesday, September 3, 2008

A really bad day

What you may not have realised is that this blog is as much for me as it is for you. I find that putting my thoughts down in print helps me to consolidate my feelings and provides me with some “cheap therapy”. I know that many of you are following my journey and I almost feel like I have someone to talk to every time I make an entry.

Which probably explains why I am sitting here, in my pyjamas, late at night writing to an unknown, yet familiar audience.

I walked into the hospital, in my pink “Winnie the Pooh” pyjamas without any shame. I already offend everyone here by wearing pants (women here are supposed to wear skirts only) so I thought that being caught in my pyjamas would only give them more fodder to gossip about.
The past two days have been horrendous. I didn’t write in my blog yesterday because I was in the grumpiest mood. I was angry about a great deal of things, too many to put in detail and I was incredibly frustrated. Poor Courtney bore the brunt of it, but I guess that’s what best friends are for.

I had a lady admitted under my care yesterday. She was a 40 year old female who had AIDS but was on retroviral therapy. She was one of the managers on Dr Pons’ farm. Her husband died last year from AIDS leaving her with three children who all live on the Pons’ farm. She presented in acute respiratory distress which my colleague on overnight diagnosed as “hysteria” and gave her some valium. When I saw her, I thought she was going to die. She was too sick to have a chest x-ray and after examining her I thought she may have PCP (a nasty pneumonia commonly found in patients with AIDS). I started her on the appropriate treatment. I have to say, I was pretty nervous. This lady was very special to the Pons Family and I wanted to make sure I did my best. I kept going to check on her and she was making progress. I went to see her this morning and she was markedly improved. She was talking in sentences and had managed to eat some breakfast. I was so incredibly relieved. The rest of the day went smoothly and I actually started to feel that I was really contributing to the wellbeing of my patients. This feeling did not last for long. I was in a meeting this afternoon when my nurses came running in telling me that the patient had suddenly deteriorated. I ran down to the ward knowing full well that this was impending doom. There are no facilities here at Good Shepherd to successfully treat emergencies. When I reached the bed I knew she was dead. As I have mentioned previously, this happens very commonly here- there is very rarely a slow deterioration, people tend to die very suddenly. If any of my medical colleagues have any insight as to why this may be happening- please let me know, because this phenomenon continues to cause me great anguish.
Anyway, I went into the corridor and told her 3 adolescent daughters that their mother had died. All hell broke loose. They all fell to the ground, started screaming and almost convulsing. It was pure mayhem and all I could do was sit on the floor trying to console them. People started coming from out of no where and they all started crying too. It was unlike anything I had paid witness to before. I had to make a discrete exit. I was so upset and I knew that there was absolutely nothing I could do to control the situation. I felt sick to the stomach and automatically started questioning my ability. Had I made the right diagnosis? Had I missed something that could have saved this woman’s life? I know in my heart of hearts that I did my best, but the reality is, there are now 3 young girls who are now orphans.
I was walking out of the ward when I was stopped by one of the nurses. A son of a patient had requested to speak with me. He was from Johanessburg and had just arrived to see his mother. His mother was a 65 year old female who arrived here in a coma. I don’t know why she’s in a coma. An educated guess would be that she had a stroke and I was treating her palliatively. I don’t have a CT scanner to look at her brain- come to think of it, the only tests I was able to perform on her were a full blood count, liver and kidney function tests- all of which were normal. The son did not understand how we were not doing anything for his mother. I tried to explain the situation but he was insistent that I get her to be transferred to Johannessburg. This is simply not possible from here. He wanted to put her in his car and drive her there himself, but I explained to him that transporting a patient, in a coma, who is not artificially ventilated, would be very dangerous. We do not have ventilators here so any chance of me actually intubating her would be hopeless- I would have to hand ventilate her all the way to Jo’Burg. I then thought about Mbabane Government hospital. It is out referral hospital. I already knew that the ICU staff were on strike, but I thought I would give it a go. It was 7pm and I was informed that doctors are only present in the hospital until 4pm- call back tomorrow. I know that this patient will probably die over night and I will have to face the son in the morning. I feel his anguish. If it was my mother, I would be hysterical, but this is Swaziland and this is the reality of our existence.
I then was leaving via the outpatients department when I noticed that there was a baby waiting to be seen. Like a moth to a flame, I was immediately drawn to the child. He was 3 weeks old and looked like he was going to die. He was born to a mother with AIDS and she stood there holding him hopelessly. The doctor on call had a look at him and told the mother that her child would probably die. He was going to admit him into hospital. The nurse asked him about an IV line and he said “I do not put IV lines in children, he will have to wait until the morning”. I was simply horrified. I really like this particular doctor, but I was enraged about this situation. I immediately suggested that I try and get a line. Angels must have been watching over me because I got a line in on my first attempt. The baby was able to receive the antibiotics tonight. What many of you may not appreciate is that this baby looked like it was going to die and it needed immediate fluids and antibiotics. I was just incredibly upset at the way things had turned out because I realised that there is simply no hope in this place. We do not even have the ability to do even the most simplest of things. I am incredibly upset and yet I still cannot cry. This just perplexes me because I am a renowned crier. I have no problems wearing my heart on my sleeve, but suddenly, in the most depressing of all circumstances- I am unable to cry. I feel angry, I feel frustrated, I even feel somewhat tormented and yet I cannot cry. Perhaps if I start I will simply get on a plane and come home, but I know I have so much more here left to do. I can only hope that with the light of another day things will seem a bit easier tomorrow.


mehitabel said...

Hi Mel, just found your journal and wanted to send you some virtual hugs to help you through this difficult time. I wish I could give them to you in person!
Don't worry about not being able to cry. I'll tell you a secret--I still have not been able to cry for either Bob or Andy. I think sometimes when the hurt goes so deep, crying is too trivial to deal with it. You will find the strength to deal with this, and some day when you are home safe in Australia, the tears will come. Until then, please do continue to share your thoughts and feelings with this electronic journal, and we in our turn can send you good thoughts and prayers and wishes to give you the strength you need! At least, know that there are people all over the world who love you!

Trent Y said...

Hey Mel,
It seems pretty pointless offering mere words of support in the face of such misery, but despite that - keep your chin up. I'm sure you're making an enormous difference to all the other people you're not telling us about.. as well as modelling Swazis first ever pair of winnie the pooh PJs.

I would have done as you did for the HIV+ lady (do you have steroids as well as bactrim?) and for what its worth, in all my Pall Care time, you often see people rally just before they die... I don't have an explanation though.

You're doing great work - and don't forget it in the dark times!