Day #3 Part 2 - Remember this blog is for me - this post is hearbreaking - read only if emotionally ok

So 8:30 pm until 3:30 a.m. was a whole separate day & experience that is extremely difficult to accurately & completely capture in words – saying you had to be there to understand it is an understatement.

After Aziza called for help I ran in the room along with Glenn. Annameike was already there & the Ethiopian nurse was somewhat anxiously doing chest compressions. The patient had vomited some old blood, coughed out an oral airway & stopped breathing & dropped his heart rate. Glenn & Annameike took control of the situation. We found & started using our equipment to breathe for the child & his heart rate gradually rose. We weren’t really set up for an Emergency – we had our supplies organized for post op care & a list of the things we would get Monday morning. This wasn’t an Op Smile patient, no one really knew what was going on with the child other than that day he had a shunt placed in his brain for hydrocephalus (which is somewhat common in Ethiopia). All we knew was there was a child with a medical emergency & as pediatric medical providers we needed to intervene. A Code situation is often chaotic & this was no different – but we were all Pediatric Critical Care providers & we all went into action seamlessly. We hand bagged him & immediately got ready to put a breathing tube in. We don’t know why but he had a lot of swelling in his airway so it was a challenging intubation but Glenn got a tube in & we realized we didn’t have a stethoscope in the room to check his breath sounds but quickly got one. As a team we secured his tube while simultaneously securing  his IV, placing an NG tube & giving a variety of medications. I felt like I was constantly putting my head out the door asking Molly or someone for another item we needed & didn't have. We were in constant intervention mode until about 10 pm, & while we were doing everything we could - REMEMBER we are in Ethiopia this is not like an episode of ER or Grays Anatomy – we have no respiratory therapy, no pharmacy access, no ability to get lab tests or blood gases, minimal equipment, no ventilator machine to breathe for him so one person had to do that the entire time and no real information from any reliable medical source regarding his condition or surgery that day as the Ethiopian physicians were not there & while we tried to reach them on the phone that was unsuccessful until several hours into this event. We had given many meds so it was hard to know if he was responsive after all our efforts but we had checked is pupils & they were fixed & dilated – often a sign of severe brain injury so there was a lot of somberness in the room. By then it was probably 10:30pm but I am not sure – most everyone other than the 5 of us directly involved in the care & 4-5 of the Op Smile team leadership  had returned to the hotel – there really wasn’t anything they could do & more people in the room typically just means more chaos & poor communication. I just remember it was about this time I was going to get him cleaned up as they had located the parents & we wanted to bring them in the room. Before we did that I asked for a ”team code review” of all we had done & where  we were & if we all agreed we were stable in a critical situation – which was the case. 

The parents & 2 older brothers came in – they had not even seen him since before surgery & had never met or talked to the surgeon which was completely baffling to me but not unusual for this country.  With Aziza translating we explained to them what had happened & that we were trying to reach the Ethiopian doctors & by then an Ethiopian anesthesiologist & resident had come in & Glenn talked to another doctor at the other hospital on the phone. Somewhere in there Molly asked if we were ok – I said to her "yes but this child may very well die I just want you to know that". I am not sure why I felt the need to say that but since she had a lot of responsibility but hadn’t been in the room I thought she needed to be aware of that. Glenn had also communicated with someone that the child needed an ICU bed which this hospital didn’t have?  And they were working on that. We got a bed at a 4 bed pediatric ICU & knew that if the child was to have any chance of survival we needed to get him there so we also asked for an ambulance & prepared all our supplies for a transport. There was an enormous amount of red tape just to get permission to transfer him. The ambulance arrived & I went down to check it out & see what we would need. It was basically a small white station wagon with a stretcher in it – no oxygen, no suction, no place to put an IV, no monitor of course & no equipment & not even a sheet on the gurney which was ground level only did not raise up. I got to go give the team that report….so we needed to take everything we might need. It took us a while to get organized & get him on a gurney, put him on the Op Smiles portable monitor that fortunately had charged a few hours, got portable suction, an emergency box of all the meds we were using, other emergency supplies in case his breathing tube or IV came out, an oxygen tank & a variety of other equipment. By the time he was settled on the gurney it was probably midnite & we were ready to go….we got to the hallway & remember before I said the elevator was unsafe – while we debated whether to use it or not we were told it was not even working….that meant we needed to carry the patient on the gurney with all the equipment down 4 flights of stairs.  We moved slowly toward the stairs & down one flight at a time counting stairs for everyone because of course there are no lights in the stairs & the few flashlights we had gave little visibility. I felt like I could have been in that video of the nighttime rescue of the American girl soldier that was rescued & carried down some stairs in a foreign country. I was at the head with Glenn he was breathing for the child & I had the end of the gurney…it was a challenging process but we got to the ground level then out to the ambulance & loaded the patient & all the equipment & the 4 of us as a medical team – it was a tight fit, plus his parents in the front seat. Molly & 4 others followed us in a car. With all of our equipment not really secured including an oxygen tank we asked them to drive slow & safely with lights & siren.  It was only about a 10 min ride & en route we read the papers the hospital gave us as we left that said the little boy had a large brain tumor…that was new information to us..that no one seemed to know or share with us at the hospital & certainly impacted things. This other hospital did have an old CT Scan machine so Glenn contacted Molly et al to say we needed to go there first to understand what we were dealing with.

We arrived at the other hospital dark exterior & no one to meet us & slowly got out onto a very rocky road, were met by a doctor who said he didn’t know about the patient & when we said we wanted to go to CT scan just pointed out into the darkness – someone insisted that he show us where to go (basically they kidnapped him & he led us to the other bldg) &this was another 600-800 yard journey thru a parking lot over rocks & speed bumps, over curbs to another building that fortunately had a ramp up to it because otherwise all that was outside it was gravel.  The resident physician in the CT scan areas said he volunteered to help us but we needed an order & payment promise from the other hospital – it was beginning to feel like a weird movie. Finally that was settled & we got him on the scanner – he did have a very large posterior fossa tumor that blocked his 3^rd & 4^th ventricle & it didn’t seem the shunt device they put in toady was working in fact the bottom end in his abdomen may have punctured part of his stomach. What that meant was no matter what he had a very slim chance or survival. As Glenn & Annameike went to review the CT scan results I stayed in there & hand ventilated him. At that point I just wanted to give him the loving care any child deserved. I took my glove off my right hand as I used my left hand to breathe for him & just caressed his head & told him he wasn’t alone….all the time crying behind the CT machine.

We now needed to get him to the PICU on the 4^th floor of another bldg.. but the doctor (the intensivist I thought but it turns out it was a resident on call for the entire hospital?) told us we couldn’t take him up cause their ventilator didn’t work.  He also told us they didn’t do neurosurgery there – that only happened at the hospital we came from…but that hospital didn’t have an ICU….we were for a few moments in no mans land. Glenn told them I know you don’t think you can take this patient & he may very well code & die but none of us what that to happen here plus we were running out of oxygen in our tank so we basically said we were going to the PICU. The doctor left us at that point & we proceeded out on our own not 100% sure how to get there. We came out of this building & then went down a tiny alleyway full of old medical equipment on a rocky road – about this time Glenn said he felt like we were in a scene from American Sniper….it truly was surreal. We got to the elevator & 3 of us went in – we were told the buttons didn’t work well, sometimes it stopped on the floor & other times in between floors –but we really had no choice at that point. Everyone else walked up the stairs & fortunately when the door opened we were on the 4^th floor.

We rolled to the PICU, got a new oxygen tank but they would not let us in or assume care of the patient as they didn’t have a functional ventilator and weren't sure they were going to let him stay. It was again very surreal – they didn’t even come talk to us or ask about the patient. Out Op Smile Bio med tech Abreham who is truly gifted tried to fix the ventilator & at least figure out what was wrong & went back to the other hospital to get his tools to fix it…while we took care of the patient in the hallway. He had a high fever & was probably septic so we gave Tylenol & tried to cool him. I told the parents to hold his hand & asked Glenn if we could update them. Thru Aziza I told them we were  doing all  we could for him & brought him here for the scan & the breathing machine.  The mom was tearful & I just put my arm around her as she cried like I have done hundreds of times before with parents at CHOC – I might not be able to change their sons condition or outcome but I could care for them with compassion. Glenn also asked them some questions re. their understanding of their sons condition & tumor & how long he had been sick – it had been 5 months since he was diagnosed with the tumor & today was their turn for surgery & they thought the tumor was being removed & he would be "all better". There was nothing further from the truth. That again is something truly most people in the US & other countries don’t understand – in the states you have a brain tumor & within a few days have surgery…it made everything that had happened that night a little more understandable but no less heartbreaking.

Miraculously Abreham fixed the ventilator & we were able to move him into their unit & onto a bed got him settled, gave them our “report” and were ready to go…that was about 2:30 am – I was exhausted physically & emotionally – I had only eaten some fruit for breakfast and a protein bar at lunch –  I hadn’t had many fluids & had a huge headache & heartache – I stopped to hug the mom once more & then we left to load ourselves & our equipment back in the ambulance for a silent ride back – no one felt like talking. They took us back to the hotel & we offloaded all the Op Smile equipment there. I walked up to the hotel wondering if all of this just really happened….again I found myself wondering was it better that I was here? That we were all here? If we weren’t the child probably would have just died in the recovery room alone with an Ethiopian nurse…he was given the best care by some very skilled people in a very limited environment. Were we able to change the ultimate outcome – maybe not but he got a better chance than any other Ethiopian child, We couldn’t not intervene….we did get his parents there to be with him …these seemed like very small ‘wins” but they were all we had.

I dropped my bag of equipment & took the elevator to my room & my head was spinning as it always does after a situation like that again I thought - was it good that I was here?, that Glenn & Annameike & Aziza were here? Did we make a difference – is this part of a bigger plan or is this just life in a 3^rd world country & we witnessed it up close & personal?  I laid on my bed at 3:30 & fell asleep at some point & woke up at 9….the patient announcements were at 8 am this morning – I had no remembrance of that, today was the team day – that seemed insignificant, the mission hadn’t even started????  There were probably 35 team members who had minimal to no idea what went on last night or what we went thru – it seemed like a bad dream. I made my way to breakfast, told Molly there was no way I could go to team day at 10 but I did need to go & get a fresh start & didn’t want to sit around the hotel all day. I needed to shower, regroup & start this new day. Jeanne & Laney came to check on me – I told them my plan & that I would take a taxi to the team day…they asked if I knew the little boy had died at 4 am…I didn’t….

I mean I was the one to say he might die, I was there thru it all & saw all the signs but I just didn’t think that an hour after all or our heroic efforts & after we left he would be in heaven. I had a hard time wrapping my head around it all. Glenn said we would have a “debrief” but I don’t know when…

Often these missions teach me lessons that I know I can’t learn anywhere else & give me opportunities to meet & instantly love & use my training & talents to treat children & families I will never see again – today & this experience was no different. I am so grateful to now life is eternal that there is meaning & purpose in everything we just can’t always see it at the time it happens & we have to have faith & often learn the meaning much later. Perhaps I will understand this situation when I am further away from it..right now I need to start a new day….keep the prayers coming…they are felt