Tuesday, February 14, 2012

Haunting Sound

Last week I spent my time on the female ward. It was by far the most difficult week of my nursing practice yet. Monday morning usually begins with frantically trying to orient myself to the ward and trying to determine who the most acute patients are. This can prove to be difficult when many of the patients have no previous charting we can read and many times have no diagnosis written. The nursing shift handover is a far cry from the 30 minutes we take at home to review everything there is to know about our patients from history, to lab diagnostics to how well they slept throughout the night. As I was going from bed to bed, doing a quick assessment of my patients, I noticed a number of Zambian nursing students collecting around a patients bedside. I rushed over to see what the problem was and the patient had no pulse. I asked one of the students to get me an ambubag and another to go find me a doctor STAT. I became a little frustrated as they sauntered across the ward to get supplies with no real sense of urgency. When I finally received an ambubag, the doctor showed up shortly after and we began compressions and bagging the the patient. We were still waiting on suction, which the students had to retrieve from another ward. Since the patients airway was not clear, the air from the ambubag was unable to fill her lungs. Backboards are non-existent at Lewanika so the chest compressions were very ineffective as the body just sinks further into the bed. After about 8 minutes, the doctor called the death. This marked my first code blue. I was immediately overcome with emotion, and headed outside to find one my colleagues to debrief. This was only the very beginning of the long week that was ahead.
The next day again, very early in the morning there was a very unstable woman who was bleeding copious amounts from her mouth and nose. I made it a priority to move her to the acute bay beside the nursing station. As I was doing a head to toe assessment she had no radial pulse in her arm, and using my stethoscope I noted her apical pulse to be slow and very irregular. I called over the doctor who happened to be doing his morning rounds and we transferred the patient to one of the two beds in the critical care unit. Amanda and I spent the morning gaining multiple IV accesses, obtaining blood samples and administering emergency medications to the patient. I took the blood samples to the lab and when I returned her heart rate had dropped to 40 and again, we began CPR. We were fortunate to have a doctor from Kelowna present to help guide us and help with the code. But again, regardless of everything we did to try and save her throughout the morning, the code was unsuccessful. I was sitting, beginning to chart what had happened throughout the morning when I heard the family wailing. I can not begin to describe the haunting sound. The loud cries, the screams, the prayers. It is a sound we have all heard far too often in Zambia. This sound marks the end.. it is something I know that none of us will ever be able to forget. As I sit outside crying, I can feel the stares of passerby's and hear people whispering about the "makuah" in the corner, for it is not normal for nurses to cry, unusual for them to show emotion.
Okay I have made it through Tuesday...
 Wednesday was a really good day- no emergent situations, no death. A well needed, quiet day on the ward
Thursday things went back downhill. In acute bed one was an end stage HIV patient with septicemia. She was not expected to make it through Wednesday night and by 830 Wednesday morning, she had no pulse. It was hard to refrain from doing CPR. Unless we have a Do Not Resuscitate order in Canada, we attempt CPR. Of course there is no such paperwork here. So I sat with the 40 year old patient and her mother, as she watched her child die. I must say, although the death of someone so young was tragic, I knew in my heart that she could finally be at peace. I helped her mother wrap a shetenge around her waist and then sat and comforted her as she grieved the loss of her child.
This Is Africa... the days when we could pull a cord on the wall and have 10 people run to our aid during a code remind us just how lucky we are. Here, we can only do the best we can with the scarce resources we have. After the last week, I can truly say that this experience has changed me. It had opened my eyes, broke my heart and at times made me feel completely and utterly hopeless. It is hard to see the good things in a place filled with so much tragedy. But it is the little things, like the birth of healthy babies, the unmistakable joy in a child's eye when you blow bubbles for them, and the people who have survived surgeries against all odds that I have to remind myself of, and hold on to.

Happy Valentines Day everyone!
Thanks for listening...

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