In Difficult Times, you find your Inner Strength

                I’m not usually the type of person who publically shows their emotions, but there are times when something difficult happens and through journaling, blogging and talking with my fellow nursing students here in Zambia, am I able to help understand it and get through these difficult times.
                Yesterday was easily the hardest day of my entire nursing career and probably my own life. I have been working on post-partum with new mothers and babies these last few days and I have loved every minute of it. However yesterday was one of those difficult days in Africa, where no amount of lecturing, practice or education can emotionally prepare you for. When I came onto my shift in the morning there was a mom who delivered a new set of twins the night before. I immediately knew something was wrong just by looking at her. She was unresponsive to verbal and physical stimuli, grunting heavily while breathing and her eyes were fixed and dilated. She was actively convulsing and had been several times through the night. She must have bit her tongue during the seizure as she was bleeding from her mouth. The nurses said the Doctor was aware of her condition last night and did not appear to believe this to be urgent. However she was awake and talking last night and her blood pressure was now extremely dangerously high. I knew we had to get the Doctor ASAP so I did a quick assessment on her to give something to report to him. After running outside and grabbing my instructor we both went and found the Doctor. He came in and gave several IV medications and solutions and finally the convulsions stopped and her Blood Pressure decreased. I took on this patient one to one so the other nurse could look after the rest of the ward. They were short staffed so there was only another nurse and I working that morning.
                Several hours had past and the patient seemed to be doing better. She was still unresponsive and bleeding from the mouth, but her vitals were stable and she was breathing okay. My nurse went to go drop something off on another ward when my whole world turned upside down in a matter of minutes. I was sitting at the nursing station when I heard the patient having difficulty breathing. I went to check on her and her breathing was shallow and very slow. Since she had a pulse and was still breathing, I knew I had a little time to spare so I ran and searched the entire ward for an ambu bag so I could give her oxygen. There was nothing. I went back to her and bed and saw her take her last breath, no pulse could be found. I distinctively remember hearing only my own heartbeat at this time, it was pounding in my throat. I have to call a code and I am completely alone, in the middle of Africa. I jump on the bed and start compressions. Thankfully family was at the bedside so I yelled at them to get help. I don’t think they really understood what was happening. 5 minutes past, still no one. I yell for someone else to go get help. Another 5 minutes past. I remember being absolutely exhausted, drenched in sweat from doing compressions, but I couldn’t stop. I kept begging the mom, “come on, breath, you can do this.” But nothing. Finally after 15 agonizing minutes help arrives. I tell the nurses I need oxygen and ambu bag NOW. They come back with a tank of oxygen but there is no tubing, and the only ambu bag they have is for infants. My frustration is evident at this point, how on earth was this going to help me? But the infant bag is all we have so we have to work with it. The doctor runs in and I tell him everything that happened. He starts bagging her as I am doing compressions. He then tells me to stop as he listens for heart sounds. I remember hearing my own heart beat again as we wait. Longest 30 seconds of my life. Nothing. We start again. Then the Doctor tells me to stop, it is too late. My heart sinks into my stomach and I have to lean on the wall for support as I feel my knees begin to buckle underneath me. I am drenched in sweat, and trying not to choke on my own tears. I didn’t have it in me to tell the family she was gone. Now focus has shifted to the twins, how will they survive? Formula is hard to come by here and I wonder what there like will now be like. She was 22 with 3 other children at home. She was only a year older than me and her life is now over.
             After a restless night of replaying the situation in my head over and over again, and talking to my amazing peers and instructors, I am able to get through this difficult time. This was actually my first patient death in my whole nursing career. I had seen patients die before, but never my own patient, and never like this. Even in the most hear breaking experience, I have learned a lot about myself. I called my own code, by myself with no supplies in the middle of Africa. Although the outcome wasn’t successful I have to try to imagine what could have happened if I was not there, at least I fought with every inch of my being for her life, for those twins. Even on the most difficult day of my life, I still am so grateful I am here in Mongu.  I actually surprised myself yesterday; I didn’t know I had it in me. Like I said, in difficult times, you find your inner strength.
-Sam