Mar 24

What a day!  Dr. Jean was stuck in a meeting all day so that left me to take care of the wards.  Thankfully Nikki was there to help or else I may not have made it.  We started rounds in the female ward about 9 am.  Things were going well and I was almost finished with one side of the ward when a patient was rushed by on a gurney.  It was a 19 year old female who is actively seizing.  The nurses place her on a bed and her friends crown around trying to hold her down.  A nurse gives me the chart and it has the diagnosis as shock....this isn't shock.  Apparently the girl was running outside at school when she fell to the ground convulsing.  I push my way through the crowd and call out to the nurse for help.  At this point I have no idea what we have available to treat seizures.  After asking 3 times I find out they have Diazapam.  Then I had to yell repeatedly for a nurse to get the Diazepam our of the emergency kit.  Things were NOT moving fast enough for me.  After giving a 10 ml dose of Diazapam, the girl finally stopped seizing.  She became still so suddenly that Nikki bent down to check if she was still breathing.  I couldn't tell from where I was standing if the girl was still alive for a few seconds.  I thought she may be dead.  I took my stethoscope and, yes, the heart was still beating.  After writing several orders I moved on with rounds only to be interrupted again by another gurney rolling by with a girl who had collapsed.  At least this one wasn't seizing so I started fluids and she revived quickly.  Her lab results indicated that she had malaria.

Once again I continued rounds.  I managed to see one more patient before the 19 year old girl started to seize again.  We gave more Diazepam.  Her labs came back indicating that she also had typhoid.  A friend of the patient's told me that the patient's brother also "struggles".  So I think this patient has epilepsy and the typhoid lowered her seizure threshold making her more likely to seize.

And again I go back to rounds.  At this point Dr. Jean swings by to check on the seizure patient.  I was so glad to see her!  As we are discussing the patient a woman in labor is brought in.  Dr. Young rushes off to perform a C-section and I'm left to continue rounds.  I wasn't able to finish rounding until 5 pm.  The 19 year old continued seizing.  We tried to give 50 ml Dextrose 50 IV push....didn't help.  I tried IM 200 mg Phenobarbitone.  This was the last thing I tried because after this effort there is nothing left to do.  When I go to round tomorrow I will find 1 of 3 things: 1) the patient is better  2) patient is still seizing  3) She is dead.  I guess I'll find out tomorrow.  There is nothing more I can do tonight.